Maternal Mortality Review Committee reports decline in pregnancy-related deaths in 2023, flags mental-health and hemorrhage as leading causes

Oren Duffin, program director for the Health Professions Bureau and executive officer for the Maternal Mortality Review Committee (MMRC), presented the MMRC’s 2023 summary to the Senate Health and Welfare Committee.

Duffin said 13 cases were provided to the MMRC for investigation in 2023; 11 met the committee’s review criteria (death of a woman from any cause while pregnant or within one year of pregnancy). Of the 11 pregnancy-associated deaths, five were determined to be pregnancy-related and six were pregnancy associated but not pregnancy related. The MMRC found no evidence in reviewed records that medical error or denial of care contributed to the 2023 deaths, and it found no direct evidence that the deaths were attributable to discrimination.

Idaho’s pregnancy-related mortality ratio decreased from 40.1 deaths per 100,000 live births in 2021 to 22.6 in 2023, Duffin said. Using a federal methodology (MEC4), Idaho recorded a pregnancy-related mortality ratio of 13.6 deaths per 100,000 live births; the Department of Health and Human Services target cited by the committee is 15.7 deaths per 100,000 live births by 2030. Mental-health conditions and hemorrhage were the most common causes of pregnancy-related deaths in 2023, each accounting for 40 percent of pregnancy-related deaths. Duffin also said that one of the five pregnancy-related deaths occurred because the woman did not seek medical care during the relevant period.

Key statistics cited in the report included: 64 percent of 2023 maternal deaths were among women residing in urban areas and 36 percent in rural or frontier counties; nine of the 11 women were insured at time of death; two (18 percent) had illicit substances detected on autopsy; and 64 percent of the women had education levels of high-school graduate, GED or some college without a degree.

The MMRC made several recommendations tailored to specific audiences. The only recommendation directed to the Idaho Legislature asked lawmakers to consider investigating the current access landscape for pregnant and postpartum women — including those who are incarcerated — for evidence-based treatments such as pharmacologic agents for substance-use disorder. Other committee recommendations urged greater use of telehealth in rural and frontier communities, increased awareness of substance-use-disorder treatment options for pregnant and postpartum women, and provider- and hospital-level efforts to improve recognition and treatment of complications such as sepsis, preeclampsia and hemorrhage.

Senators asked about committee composition and process. Duffin described recruitment and vetting of members, noting communications with professional associations and public posting; he said names of committee members and practice settings appear in the report. Senator Wintrow requested follow-up from a physician on a case involving hemorrhage after a dilation-and-curettage procedure; Duffin said he would arrange for a clinician on the committee to provide more detailed explanation outside the hearing. Senator Shippey asked whether any deaths were attributable to legal restrictions on care; Duffin said there was no evidence in reviewed records of denial or refusal of care.

Duffin said the MMRC will continue reviewing data for 2022 and 2024, noting those counts may change pending final vital-statistics review. He closed by thanking committee members for their work and urged continued efforts to improve maternal outcomes.