The rate of pregnancy-related deaths in Idaho remains high, according to the latest annual report published by a committee studying maternal deaths in the state.
The release of the report comes just as the maternal mortality review committee, or MMRC, has officially terminated its work, after the Idaho Legislature declined to remove its June 30, 2023 sunset date.
The latest report, analyzing deaths that occurred in 2021, will be the committee’s last, unless new legislation is passed allowing its work to continue. This leaves Idaho as the only state without a maternal mortality review committee.
For four years, the committee made up of doctors, social workers, coroners, emergency personnel and more, studied each death that occurred during pregnancy or within a year after, in an effort to eliminate preventable maternal deaths, as well as health problems that result from being pregnant or giving birth.
Of the 42 pregnancy-associated deaths the committee analyzed between 2018 and 2021, all but one – or 98% – were found to be preventable.
Pregnancy-related death rate remained high in 2021
The committee analyzed 16 deaths associated with pregnancy that occurred in 2021; in four of the cases, the person was pregnant when they died. Of those 16, nine of the deaths were “pregnancy-related,” meaning they were caused by “a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.”
The MMRC determined there were 40.1 pregnancy-related deaths per 100,000 live births in 2021, slightly lower than the previous year’s rate of 41.8, but much higher than the 2018 rate of 18.7.
Across the U.S., pregnancy-related deaths have more than doubled in the past two decades, according to a study published this week in the Journal of the American Medical Association.
Following the sunsetting of Idaho’s MMRC, there could be an “underestimation,” of the state’s pregnancy-related death rate, the report said, as the federal data accessible generally doesn’t include deaths caused by injuries or accidents, including overdoses and suicide.
New in this report is a picture of how COVID-19 impacted maternal deaths in Idaho. COVID-19 was found to be an underlying cause in two of the nine pregnancy-related deaths in 2021. COVID-19 may also have contributed to two additional deaths during pregnancy or within a year after; one of those deaths was not directly related to pregnancy and the other the committee could not determine. In three out of four of these cases, a positive COVID-19 result was reported, but there was no record the person was vaccinated.
Mental health was an underlying cause for six of the pregnancy-related deaths and an amniotic fluid embolism was the cause of the final one.
A health care provider or patient lacking knowledge or understanding of a health event or treatment was a common contributing factor in a number of the deaths, the report found.
The MMRC will have access to more limited data going forward
The legislation that established the MMRC gave members legal protection to review specific case information for maternal deaths and the authority to request records from health and law enforcement agencies.
A bill to extend the MMRC beyond its June sunset date was tabled in the state House Health and Welfare Committee this past legislative session.
“Absent the statute, or the enabling legislation, the committee can’t function in the same way,” Elke Shaw-Tulloch, with the Idaho Department of Health and Welfare, told Boise State Public Radio in May.
Some lawmakers questioned why Idaho needed state-specific maternal mortality information and the far-right lobbying group Idaho Freedom Foundation argued the committee would inevitably lead to the expansion of government.
One of the MMRC’s key recommendations for preventing maternal deaths has been to expand postpartum Medicaid coverage from 60 days to 12 months. A bill introduced this past legislative session to do so did not receive a hearing.
The final MMRC report provided a window into the more limited data the committee might have going forward, without the ability to review specific case information.
Looking ahead at numbers for 2022, the committee found there were 10 maternal deaths that year, eight of which occurred when the person was still pregnant. The information included on death records suggests six were directly related to pregnancy. But without analyzing the cases in detail, and checking whether the information on the death certificates was correct, the committee couldn’t determine this with certainty.
The death certificate information also indicated that none of the 10 deaths were related to mental health or substance abuse disorders, a marked shift from previous years when mental health was found to be a leading underlying cause of maternal deaths in Idaho. This discrepancy, the committee noted, “reinforces the need for the Idaho MMRC to continue to monitor the causes of maternal death in Idaho.”
Without specifically mentioning Idaho’s near-total abortion ban, the final MMRC report said the “maternal health landscape continues to shift in Idaho,” in part due to health care provider shortages, hospitals discontinuing labor and delivery services and changes in state and federal laws.
“With these changes, it stands to reason that the causes and rates of maternal mortality and morbidity will change as well,” the report said. The end of the MMRC could prevent uncovering the root causes of these deaths, it continued, “which may lead to adverse maternal and infant health outcomes.”
Going forward, the Idaho Department of Health and Welfare plans on publishing the data on maternal deaths it still has access to.
Find reporter Rachel Cohen on Twitter @racheld_cohen
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