Objectives

To determine whether the Department of Health (DOH) has implemented recommendations with the goal of reducing maternal mortality and morbidity in New York State; and whether DOH is effectively monitoring related actions and outcomes to ensure rates of maternal mortality and morbidity are improving. The audit covered the period from January 2018 through December 2023.

About the Program

One key indicator of the overall health of a population is its occurrence of maternal mortality and morbidity. Maternal mortality refers to deaths of pregnant persons during pregnancy or within a year from the end of pregnancy. Morbidity refers to having a disease or a symptom of disease, or to the amount of disease within a population; whereas severe maternal morbidity (severe morbidity) is defined as unexpected outcomes of pregnancy, labor, or delivery that result in short- or long-term consequences to a person’s health, including postpartum depression and any life-threatening medical complications or the need for life-saving interventions during delivery.

According to Centers for Disease Control and Prevention (CDC) 2020 data, the United States has a maternal death rate greater than almost every other high-income country, at 23.8 per 100,000 births—more than 2.5 times the rates of France and Canada and 3.5 times higher than the United Kingdom. There are also persistent racial and ethnic disparities in these deaths, with Black women dying nationally at a rate three times higher than White and Hispanic women; these disparities were exacerbated during the COVID-19 pandemic.¹

New York has made progress in comparison to other states: once ranked 46th among other U.S. states in 2010, it climbed to 15th with a maternal mortality rate of 19.3 deaths per 100,000 live births for 2018 to 2020. However, despite this progress, Black women were still dying at a rate over four times higher than White women. Also, cesarean section rate is a significant factor in maternal deaths. According to CDC data, New York’s cesarean section rate improved slightly from 34.1% in 2021 to 33.9% in 2022, but it is still higher than the national rate of 32.1% for both these years. According to a June 2023 U.S. Department of Health and Human Services (HHS) press release, nationally, severe morbidity cases are on the rise, increasing from 146.8 per 10,000 discharges in 2008 to 179.8 per 10,000 discharges in 2021—a 22% increase.

To address these alarming rates, New York established the Taskforce on Maternal Mortality and Disparate Racial Outcomes (Taskforce) in April 2018, which produced 10 recommendations to reduce maternal mortality rates and racial disparities. Two of these recommendations called for DOH to convene a statewide expert work group (Work Group) to optimize postpartum care and for New York State to establish a maternal mortality review board (Board). In 2019, Public Health Law Section 2509 officially established the Board and an advisory council on maternal mortality and morbidity. Generally, the Board is required to review all maternal deaths in New York State to determine cause and preventability; report findings, recommendations, and best practices to DOH’s Commissioner; and issue a public report at least every 2 years. The report, released in April 2022, reviewed 2018 maternal deaths and produced an additional 14 recommendations. The recommendations required a collaboration between both public and private entities, with DOH being a main player in the majority of the recommendations. Lastly, the Work Group ultimately issued four recommendations in January 2021.

New York State’s 2019–2024 Prevention Agenda (Prevention Agenda) developed by the NYS Public Health and Health Planning Council and DOH is New York State’s health improvement plan, the blueprint for State and local action to improve the health and well-being of all New Yorkers and to reduce health disparities for populations who experience them. One focus area in DOH’s Prevention Agenda is maternal and women’s health, including a goal to reduce maternal mortality and morbidity in New York and an objective to decrease the rate of severe morbidity.

Key Findings

While DOH has made progress in addressing the recommendations to improve maternal health in New York State, data from the CDC and DOH shows that maternal mortality and morbidity rates in New York State have not decreased since the Taskforce was established in 2018, and the maternal mortality rate has actually increased, along with increasing racial disparities statistics. We found DOH needs to do more to ensure that maternal mortality and morbidity rates decline. For example:

• DOH has not evaluated all of its maternal health programs and therefore can’t measure whether its efforts have made an impact on improving maternal health.
• DOH does not collect severe morbidity data and has no analytic strategy to evaluate it, thus limiting its ability to effectuate change. HHS data shows that national severe morbidity cases have increased steadily since 2018.
• DOH conducted limited outreach with other agencies and private sector partners to understand their lack of participation in DOH maternal health programs. More robust outreach will likely increase participation of these programs and positively affect mortality and morbidity rates.

Key Recommendation

• Evaluate progress and impact on maternal health to assess the effectiveness of the programs aimed at improving maternal health outcomes. This should include but not be limited to the following:
  • Develop objectives, as appropriate, and implement monitoring and evaluation processes to assess the effectiveness of programs and projects aimed at maternal health outcomes.
  • Identify and analyze severe morbidity data and develop a strategy to address risks.
  • Increase outreach and collaboration efforts with birthing hospitals and other involved entities (such as providers and applicable agencies) to maximize participation in efforts to decrease maternal mortalities and morbidities.

1 U.S. Government Accountability Office. Maternal Health: Outcomes Worsened and Disparities Persisted During the Pandemic. October 19, 2022