Maternal Mortality and Severe Maternal Morbidity Surveillance

The NYC Health Department monitors maternal health outcomes throughout the city. Structural racism and inequities in care access and quality contribute to inequity in maternal health outcomes. The Health Department’s maternal mortality and severe maternal morbidity surveillance reports document the crisis of inequities in maternal health.

Maternal Mortality

Since 2001, the pregnancy-associated mortality ratio in NYC has remained steady, but inequities remain. From 2016 to 2020, Black non-Hispanic women and birthing people were four times more likely to die of a pregnancy-associated cause and six times more likely to die of a pregnancy-related cause compared with white non-Hispanic women and birthing people. Racism drives these disparities. This includes historical and current intentional underinvestment in neighborhoods where Black non-Hispanic women and birthing people live, interpersonal racism that wears on the health of Black people, and anti-Blackness in health care.

The maternal mortality surveillance is based on a comprehensive search and linkage of data sources including vital records, inpatient hospital discharge data and medical examiner reports to identify all women in NYC who died during pregnancy or within one year of the end of the pregnancy from any cause. From 2001 to 2015, these deaths were reviewed and analyzed to determine pregnancy relatedness and cause of death.

Since 2018, the NYC Maternal Morality Review Committee has conducted multidisciplinary reviews of all pregnancy-associated deaths in New York City, starting with deaths occurring in 2016. Case abstractors develop case narratives of the deaths using vital records, autopsy reports, medical records, social service records and family interviews to determine if the death was causally related to the pregnancy, to determine key contributing factors to the deaths and to make recommendations to prevent future deaths. The committee uses standards and protocols developed by the CDC Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) program.

Pregnancy-associated death is the death of a woman or birthing person from any cause during pregnancy or within one year from the end of pregnancy, regardless of the outcome of the pregnancy. Pregnancy-associated deaths are further categorized into three subsets based on whether they are causally related to the pregnancy.

• Pregnancy-related death: death of a woman or birthing person during pregnancy or within one year from the end of pregnancy that is caused by a pregnancy complication, a chain of events initiated by pregnancy or the aggravation of an unrelated condition by the physiological effects of pregnancy.
• Pregnancy-associated but not-related death: death of a woman or birthing person during pregnancy or within one year from the end of pregnancy due to a cause not related to the pregnancy.
• Pregnancy-associated but unable to determine pregnancy-relatedness: death of a woman or birthing person while pregnant or within one year of pregnancy, due to a cause that could not be determined to be pregnancy-related or not pregnancy-related.

The Health Department publishes five-year pregnancy-associated mortality reports. In between the publication of five-year reports, the Health Department posts an annual report including pregnancy-associated mortality data and recommendations to eliminate preventable maternal mortality and racial and ethnic disparities. Annual data are also posted on NYC Open Data.

Severe Maternal Morbidity

Severe maternal morbidity is defined as life-threatening complications of labor and delivery that result in significant short- or long-term consequences to a woman or pregnant person’s health. In 2017, the Health Department recorded 284 cases of severe maternal morbidity for every 10,000 live births. Black women experienced the highest rate of severe maternal morbidity, at 457 cases per 10,000 births.

The leading indicators of severe maternal morbidity include blood transfusion, disseminated intravascular coagulation, hysterectomy, ventilation and adult respiratory distress syndrome. These indicators reflect many of the leading causes of pregnancy-related mortality, including hemorrhage, pregnancy-induced hypertension and embolism. The severe maternal morbidity surveillance is based on matching birth certificate data to hospital discharge records from the New York Statewide Planning and Research Cooperative System (SPARCS) for all NYC hospital deliveries.