Efforts to tackle the country’s continually high maternal mortality rates involve state expert panels that scrutinize and learn from the circumstances surrounding each maternal death.

These panels, known as maternal mortality review committees, typically operate discreetly and away from public scrutiny. However, in recent months, attention has focused sharply on three states with stringent abortion regulations.

In Georgia, all members of its review committee were dismissed in November following a leak of confidential details regarding the deaths under investigation. Shortly thereafter, it was reported that Texas’ committee would not be reviewing any cases from 2022 and 2023, which are significant years since the state imposed a virtual ban on abortions. Meanwhile, Idaho experienced a similar situation, allowing its panel to dissolve in 2023 before reinstating it later this year.

Michael Kramer, an epidemiologist and director of the Center for Rural Health and Health Disparities at Mercer University in Georgia, remarked on the increasing visibility of these committees: “They’ve become more of a lightning rod than they were before.”

### What are maternal mortality review committees?

“Maternal mortality review committees serve as crucial sources of detailed information about maternal mortality,” explained David Goodman, who heads the maternal mortality prevention team at the U.S. Centers for Disease Control and Prevention (CDC).

These panels investigate deaths that occur during pregnancy or within a year postpartum, regardless of whether they were directly related to the pregnancy. Causes of death can include complications like excessive bleeding during childbirth as well as unrelated issues such as drug overdoses or car accidents.

Kramer stated that the committees’ primary objective is to analyze maternal fatalities and determine “what we can do about them.” All U.S. states, a few major cities, and Puerto Rico have these committees in place. Their membership can vary, often including OB-GYNs, maternal-fetal medicine specialists, nurses, midwives, mental health experts, public health officials, and advocates from patient organizations. The CDC advises that most panels comprise diverse representatives from various fields.

Selection processes for committee members also differ, with individuals either applying, expressing interest, or being invited to participate. According to Kramer, political motivations should not influence this selection; otherwise, it hampers an authentic understanding of the issues at play.

### How do they investigate deaths?

The committees collaborate with state vital statistics agencies and epidemiologists to identify pregnancy-related deaths by reviewing death certificates for relevant indicators. They might also connect this data with birth and fetal death records, as well as hospital discharge papers, news articles, and obituaries.

Upon identifying cases, they gather extensive information, including prenatal care files, hospital and social service records, autopsy findings, and interviews with families. Professional “abstractors” synthesize this data into case narratives, which committee members analyze during their meetings. Most committees utilize a standard review process outlined by the CDC, which offers support and guidance as needed.

Key questions they ponder include: Was the death related to the pregnancy? What was the root cause? Could it have been prevented? What contributing factors were at play? Generally, states entrench privacy regulations that protect both committee members and sources of information.

These groups ultimately publish reports that maintain confidentiality for individuals but provide insight into overall findings, trends, and recommendations. Some reports take a couple of years or more to be made public.

In 2023, Goodman noted, 151 recommendations from these reports were acted upon by various communities, healthcare providers, and policymakers nationwide.

### What’s happening in Georgia, Texas, and Idaho?

Georgia’s public health commissioner announced plans to revamp the state’s committee through a new application process.

In Texas, the committee is currently analyzing deaths from 2021 and is set to begin reviewing cases from 2024 during its next meeting, according to Lara Anton, a spokesperson for the Texas Department of State Health Services. Anton noted that reviewing cases is a complex task, and the aim of starting with 2024 cases is to provide more timely data for forthcoming reports, while maternal and child health epidemiologists continue to analyze information from 2022 and 2023.

In Idaho, the newly revived review committee will now operate under the state board of medicine instead of the health department. According to Bob McLaughlin, a spokesperson for the medical board, the committee will function as it has previously. Its members convened for their initial meeting in November and plan to release a report by January 31. The legislature’s interest in having the latest information will mean that this first report will solely cover cases from 2023, with evaluations of 2022 deaths to follow.

Goodman expressed optimism that now every state has a review committee in place, a significant increase from the 20 states that had such committees in 2015.