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Maternal deaths continue to increase in Missouri, most are preventable

This is a screenshot of a pregnancy-associated mortality review dashboard. Different counties in Missouri are shaded based on the frequency of pregnancy-associated deaths in that county.
Missouri Department of Health & Senior Services
Nearly half of the pregnancy-associated deaths happened between 43 days and one year after giving birth

Maternal mortality has continued to get worse in the state of Missouri according to a new report released Thursday.

The annual Pregnancy Associated Mortality Review, which looks at deaths from 2018 to 2020, found the pregnancy-related mortality ratio increased from 25.2 deaths per 100,000 live births to 32 deaths.

More than 80 percent of these deaths were determined to be preventable, which is nine percent higher than the last multi-year review.

Ashlie Otto, a Registered Nurse Specialist with the Missouri Department of Health & Senior Services, said a lot of that prevention comes down to continuity of care.

“It's so important to make sure that when you're connecting that patient with another source of referral, or follow up care, that those appointments are made ahead of time,” Otto said.

“And when you send a patient out the door with a follow up in six months, or follow up in two weeks, and they have to then call back, make an appointment – likely, those are not going to happen.”

This is a screenshot of the of the pregnancy-related mortality ratio per 100,000 live births, separated by how those ratios manifest in different racial and ethnic groups. Black people consistently experience more pregnancy-related deaths.
2018-2020 Pregnancy-Associated Mortality Review
Missouri Department of Health & Senior Services
In the past five years, Black people have experienced significantly more pregnancy-related deaths than their white counterparts.

Black Missourians are three times more likely to die a pregnancy-related death than their white counterparts, and Hispanic and other underrepresented group data was determined to be too small for stable interpretation.

Otto said that while the rate is still much higher for Black pregnant people, it did decrease slightly from the last review — to 3 times more likely.

“So, a little bit less than last year, and we certainly hope that that continues to decrease,” Otto said. “Closing that disparity gap is really the ultimate goal.”

Mental health conditions — including substance use disorders — were again the largest cause of pregnancy-related deaths in Missouri, followed by cardiovascular issues and homicide.

Otto added that nearly half of the deaths happened between 43 days and one year after giving birth, so she is hopeful that the recent extension of pregnancy Medicaid benefits from 60 days postpartum to one-year will help reduce the mortality rate in the state.

“I mean, when you look at the general timeframe of having to wait to get into some specialties, I mean, you're on a six-month waitlist," Otto said. "So, to have to get that appointment in before your healthcare coverage ceases can be very stressful."

Gov. Mike Parson signed this legislation into law in July.

2018-2020 Pregnancy-Associated Mortality Review
Missouri Department of Health & Senior Services

The Pregnancy-Associated Mortality Review Board gave many recommendations on how pregnancy-related deaths, as well as the deaths of pregnant women not related to their pregnancy could be reduced.

These included establishing a statewide perinatal psychiatry access program and funding and expanding Medicaid coverage.

“It's really a goal that we look at that women's health care overall,” Otto said. “So, during their entire lifespan — so if they can be healthy prior to pregnancy, it's going to, in turn, have a healthy pregnancy, healthy delivery, healthy baby, and on down the line.”

The Board also recommended an increase in the seat belt violation fine from $10 to $60 by 2024, as motor vehicle crashes were the second most common cause of death for pregnant Missourians and 73% of these women were not buckled up.

2018-2020 Pregnancy-Associated Mortality Review
Missouri Department of Health & Senior Services

When it came to providers, the Board recommended additional training in implicit bias and trauma-informed care, implementing universal mental health screenings for depression and substance use disorders, and the use of social workers to increase continuity of care.

The Board also called for additional investment in urban infrastructure in Missouri and further community-based education and resources to decrease stigma around mental health and substance use disorders.

The report also noted that Gov. Mike Parson allocated $4.3 million to DHSS for the development of a maternal mortality reduction plan.

Rebecca Smith is an award-winning reporter and producer for the KBIA Health & Wealth Desk. Born and raised outside of Rolla, Missouri, she has a passion for diving into often overlooked issues that affect the rural populations of her state – especially stories that broaden people’s perception of “rural” life.
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