Maternal Mortality Review Committee reports decline in pregnancy-related deaths for 2023, highlights mental health and hemorrhage

The Maternal Mortality Review Committee (MMRC) reported its 2023 findings to the Senate Health and Welfare Committee, documenting a decline in Idaho’s pregnancy-related mortality ratio and recommending continued work on access to treatment for pregnant and postpartum women.

Oren Duffin, program director for the Health Professions Bureau and executive officer for the MMRC, told the committee that 13 cases from calendar year 2023 were provided to the MMRC for investigation and 11 met the committee’s inclusion criteria — defined as the death of a woman from any cause while pregnant or within one year of pregnancy. Of those 11 pregnancy-associated deaths, the committee determined five were pregnancy related and six were pregnancy associated but not pregnancy related.

The report found that Idaho’s pregnancy-related mortality ratio declined from 40.1 deaths per 100,000 live births in 2021 to 22.6 in 2023. Using a more constrained federal methodology (MEC4), the state’s pregnancy-related mortality ratio was reported as 13.6 deaths per 100,000 live births; the report cited a U.S. target rate of 15.7 per 100,000 live births. The MMRC identified mental-health conditions and hemorrhage as the most common causes among pregnancy-related deaths in 2023, each accounting for 40 percent in the committee’s classification for that year.

Other report details presented to the committee: 64 percent of the 2023 maternal deaths involved women residing in urban areas and 36 percent involved women in rural or frontier counties; nine of the 11 women were insured at the time of death; two (18 percent) had illicit substances identified at autopsy; and one pregnancy-related death occurred after the woman did not seek medical care during, before or after the pregnancy.

The committee made multiple recommendations targeted to different audiences. The single recommendation directed at the Idaho Legislature asked lawmakers to consider investigating current access to care for pregnant and postpartum women, including those who are incarcerated, and to review availability of evidence-based treatments including pharmacologic agents for substance-use disorder. The MMRC also recommended expanded use of telehealth for rural populations, increased awareness of substance-use disorder treatment options for pregnant and postpartum women, and increased attention to complications such as sepsis, preeclampsia and hemorrhage by hospitals and providers.

Senators asked about committee composition and methodology. Senator Wintrow questioned whether physicians were present during committee deliberations; Duffin said committee membership includes OB-GYNs, a maternal–fetal medicine specialist, a rural physician and other clinicians and that the roster is publicly available in the report. Senator Shippey asked whether any deaths involved denial of care; Duffin said the committee found no evidence in the records it reviewed that medical error or denial/withholding of care contributed to the 2023 maternal deaths.

Duffin told senators that MMRC meetings in 2024 reviewed cases in November and December; the MMRC is slated in 2025 to review calendar year 2022 (15 incidents) and 2024 (five incidents), with those figures subject to final validation by Vital Statistics and the MMRC. The committee’s recommendations are included in the published report and are directed at health systems, providers and policymakers.