Maternal Mortality

"Giving birth is supposed to be a time that is exciting, beautiful, and supportive. Unfortunately, for some families, it can be a different experience. Black people who give birth are five times more likely than White people who give birth to die of pregnancy-related causes. Our goal is to eliminate disparities so that all people who give birth have birthing experiences that are safe and empowering. No person should die while giving birth or after bringing a life into this world. The Department remains committed to ensuring that all people who give birth have healthy pregnancies and babies and receive support and resources after giving birth.

With the unwavering support of Governor Kathy Hochul, the State Department of Health has been working to combat maternal mortality and continues to engage in a multifaceted effort to eliminate inequities and improve health outcomes."

State Health Commissioner Dr. James McDonald

Overview

Maternal deaths are devastating events with profound and prolonged effects on families and other survivors, as well as a public health issue of critical importance. The United States is one of the only countries in the world that has seen a rise in maternal mortality rate since 2000. For many years, New York State's maternal mortality rate mirrored that increase. In recent years, following NYSDOH's efforts, this trend has begun to reverse.

Still, there is work to do. Black birthing people in the U.S. die at more than double the rate of Caucasian birthing people. The number of maternal deaths in New York State and the persistent disparities in maternal mortality rate between Black and Caucasian New Yorkers are both of urgent concern.

NYSDOH remains committed to addressing systemic inequities and creating safer birth experiences for New Yorkers. To support this work, NYSDOH has established the New York State Maternal Mortality Review Board (MMRB) and the New York State Maternal Mortality & Morbidity Advisory Council (MMMAC). Both groups help to identify common factors contributing to death and develop the recommendations needed to improve the health and safety of pregnant New Yorkers statewide.

This page offers information and resources for soon to be, pregnant, or post-partum New Yorkers, as well as the multitude of providers who care for them.

What We’ve Done:

  • Extended Medicaid coverage through the postpartum period to 12 months following the end of pregnancy to ensure continued access to care.
  • Provided incentive payments to hospitals and community-based providers to improve maternal care and outcomes.
  • Increased Medicaid reimbursement rates for midwifery services.
  • Expanded Medicaid coverage for the maternal population to includes nutrition counseling services, community health workers services, and enhanced remote monitoring services.
  • Supported access to doula services by maintaining a directory of doulas enrolled to provide covered services to Medicaid members. As of March 1, 2024, New York State Medicaid covers doula services for pregnant, birthing, and postpartum people.
  • Issued a statewide standing order that all New Yorkers who are pregnant, birthing, or postpartum would benefit from receiving doula services. This order is another step in expanding access to doula care and fulfills a requirement for Medicaid to provide reimbursements for these services. The standing order will allow doulas to provide physical, emotional, educational, and non-medical support for pregnant and postpartum individuals before, during, and after childbirth or at the end of pregnancy through 12 months postpartum.

In collaboration with partners, the State Health Department is involved in a statewide effort to reduce the instances of maternal mortality and eliminate health disparities, while implementing several initiatives to reduce pregnancy-related deaths and improve health outcomes.

  • The Maternal Mortality Review Board (MMRB) was established in 2019 to examine information related to pregnancy-associated deaths and to issue findings and recommendations to advance the prevention of maternal mortality.
  • Maternal Mortality and Morbidity Advisory Council (MMMAC) was established in 2019 to review the findings and recommendations of the MMRB to identify social determinants and other issues known to impact maternal health outcomes. The MMMAC develops its recommendations on policies, best practices, and strategies to prevent maternal mortality and morbidity.
  • The New York State Perinatal Quality Collaborative (NYSPQC) was initiated in 2010 and led by the Division of Family Health. The NYSPQC engages a statewide network of birthing hospitals and centers that seek to provide the best, safest, and most equitable care for birthing people and infants in New York State.
    The NYSPQC has focused on:
    • New York State Birth Equity Improvement Project is a learning collaborative that has engaged New York State birthing hospitals and centers to support the development of anti-racist policies and practices at the facility level and improve the experience of care and obstetric outcomes for Black women/birthing people in New York State.
    • The New York State Opioid Use Disorder in Pregnancy & Neonatal Abstinence Syndrome Project aimed to improve the identification and care of people with Opioid Use Disorder during pregnancy, as well as improve the identification, standardization of therapy, and coordination of aftercare of infants with Neonatal Abstinence Syndrome.
    • New York State Obstetric Hemorrhage Project worked to reduce maternal morbidity and mortality statewide by translating evidence-based guidelines into clinical practice to improve the assessment, identification, and management of obstetric hemorrhage.
  • The Perinatal Infant and Community Health Collaborative (PICHC) is a community health worker/paraprofessional-based home visiting program. PICHC programs implement strategies to improve the health and well-being of individuals of reproductive age and their families, focused on individuals in the prenatal, postpartum, and interconception periods.
  • Nurse-Family Partnership and Healthy Families New York programs provide education, screening, and referrals to those who are pregnant or parents of young children.
  • The New York State Family Planning Program supports more than 160 clinic sites across the state to provide accessible, confidential family planning services to all, including low-income and uninsured individuals. Family Planning Programs provide low-cost, high-quality services such as pregnancy testing and options counseling, contraceptive methods (birth control), reproductive life planning and counseling, preconception health services, testing for HIV and other sexually transmitted infections, routine screening for breast and cervical cancer, health education, and referrals. Family planning clinics provide services in a way that does not discriminate against any client based on religion, race, color, national origin, disability, age, sex, sexual orientation, gender identity, sex characteristics, number of pregnancies, or marital status.

New York State Maternal Mortality Review Initiative

In response to this public health issue, NYSDOH created the Maternal Mortality Review Initiative in 2010 to perform a comprehensive review of maternal deaths.

Public Health Law Section 2509, enacted in 2019, requires the establishment of the state maternal mortality review board and a biennial report to the Commissioner of Health. The law provides the committee with the authority to collect data for a maternal death case review. It also ensures the confidentiality of the case reviews.

In 2019, the NYSDOH established the Maternal Mortality Review Board (MMRB) to examine information related to pregnancy-associated deaths and to issue findings and recommendations to advance the prevention of maternal mortality. The Board's multidisciplinary members volunteer their time to review maternal deaths and develop recommendations to improve maternal outcomes to prevent future deaths. The mission, vision, and goals of the MMRB are as follows:

MISSION

To increase awareness and knowledge of the issues surrounding pregnancy-associated deaths and to promote change among individuals, communities, and health care systems to reduce the number of deaths.

VISION

No New York State family or community suffers a loss of a mother due to a preventable pregnancy-associated death.

GOALS

To conduct a timely, comprehensive, multidisciplinary review of all pregnancy-related and select pregnancy-associated cases within 2 years of the date of death to identify actionable recommendations to prevent future deaths.

Public Health Law Section 2509 also allows New York City (NYC) to establish its own board. In NYS, two boards review pregnancy-associated deaths. The NYS Maternal Mortality Review Board, led by NYSDOH, reviews all pregnancy-associated deaths in NYS that occur outside of NYC. The NYC Maternal Mortality and Morbidity Review Committee (M3RC) led by the New York City Department of Health and Mental Hygiene, reviews pregnancy-associated deaths that occur within NYC. These committees' collective efforts form a comprehensive review of pregnancy-associated deaths in NYS. The NYSDOH combines the review of both committees into a statewide report with recommendations.

Process

  1. Maternal Mortality Review Initiative staff identifies potential pregnancy-associated deaths.
  2. MMRI staff gathers records for each pregnancy-associated death.
  3. Abstractors enter information and prepare case summaries using a standardized review tool: CDC's Maternal Mortality Review Information Application (MMRIA).
  4. MMRB member reviewers examine the case abstraction and prepares to present the case to the MMRB.
  5. During the MMRB meetings, Board members review and discuss each case summary and determine pregnancy-relatedness, preventability, and contributing factors leading to death, as well as proposing focused recommendations for action.

Definitions

Pregnancy-associated death:
A death during pregnancy or within one year of the end of pregnancy.
Pregnancy-related death:
A death during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
Pregnancy-associated, not related death:
A death during pregnancy or within one year of the end of pregnancy from a cause that is not related to pregnancy
Pregnancy-associated, unable to determine relatedness death:
A death during pregnancy or within one year of the end of pregnancy where it cannot be determined from the available information whether the cause of death was related to pregnancy.

Contact Information

  • New York State Maternal Mortality Review Team
    Phone: (518) 473-9883
    Fax: (518) 474-1420
    mmr.bml@health.ny.gov
  • Marilyn Kacica, MD, MPH
    Medical Director,
    Division of Family Health
    New York State Department of Health
  • Joanne Guo, M.S.
    Director, Maternal Mortality Review Initiative
    Division of Family Health
    New York State Department of Health

Resources