Mental health was the leading cause of death for pregnant and postpartum Missourians in the state’s latest maternal mortality review, followed by cardiovascular disease and infection.
Based on the new Pregnancy Associated Mortality Review [PAMR] report, an average of 70 pregnant or postpartum Missourians died each year between 2018 and 2022, and 80% of those deaths could have been prevented with better care, more check-ups and stronger social support.
This is a 3% increase from the last report released in 2024.
Black women were 2.5 times more likely to die during pregnancy and postpartum than white women. This ratio is a continued decline from previous years, but maternal mortality has increased since 2017 among all age groups.
Ashlie Otto is the PAMR coordinator with the Missouri Department of Health & Senior Services, and said each preventable death has a trickle down impact on the community.
“From my perspective, one death is too many,” Otto said. “There’s at least a baby typically left behind, and you’re leaving a significant other, a spouse, a brother, sister…It makes me emotional to think about that.”
The PAMR review board found that factors, such as mental health stigma, inadequate mental health treatment, lack of clinical skill and failures of care coordination contributed to preventable pregnancy-associated deaths.
It also attributes 11 deaths to financial barriers to care, such as inactive Medicaid or lack of insurance, and another seven to community-level factors, such as poor social stability.
Several of the report’s key recommendations include expansions to insurance coverage, such as full coverage for substance use treatment for postpartum patients and reimbursement for psychiatric services.
The “One Big Beautiful Bill Act” passed into law on July 4, 2025, and includes sweeping cuts to Medicaid across the country. The Congressional Budget Office estimates the number of people without health insurance in the United States will increase by 16 million by 2034.
Alison Williams is the vice president of Missouri’s Perinatal Quality Collaborative, which works with patients, providers and policy-makers across the state to reduce maternal mortality through educational initiatives and community programming.
She said she anticipates logistical challenges for patients and providers due to federal Medicaid cuts.
“Many of these individuals face extreme hardships,” Williams said. “They face extreme traumatic situations in their lives, and so there is a definite need for and a critical importance that we keep lifelines going for them amongst these services.”
Williams said her team is currently developing clinical community integration networks to improve social determinants of health.
“We know that when people don't have their basic needs met, they tend to have worse clinical outcomes,” Williams said. “We're all trying to work together to increase the screening and assessment of those issues so that we can better connect the patients and the individuals to services within their own communities. Identifying when resources just don't exist is a big element of the work, too.”
Williams said their partnerships with state and local organizations may help to mitigate these threats to insurance coverage and social services.
