DiNapoli: New York Must Do More To Reduce Maternal Deaths

August 6, 2024

The New York State Department of Health (DOH) needs to do more to ensure maternal deaths and morbidity rates decline, according to an audit released today by New York State Comptroller Thomas P. DiNapoli. While DOH has made progress to improve maternal health, federal and state health data shows pregnancy-related health conditions and death rates have increased since a taskforce was established in 2018 to address maternal health and racial disparities.

"Despite New York's efforts to reduce maternal deaths and pregnancy related health conditions, progress has stalled," DiNapoli said. "The Department of Health needs to strengthen its oversight of policy initiatives and take steps to help ensure all mothers, regardless of race or ethnicity, have access to the highest level of care."

In 2010, New York launched the Maternal Mortality Review Initiative to reduce maternal deaths and morbidities. In 2018, the state created the Taskforce on Maternal Mortality and Disparate Racial Outcomes, which produced several recommendations, including creating a Maternal Mortality Review Board and a statewide expert work group to improve postpartum care.

Better Oversight Needed

DOH has not evaluated all of its maternal health programs, and therefore can't measure whether its efforts have had a positive impact on maternal health or why the maternal death and morbidity rates are not improving. During the audit, DOH officials suggested more time and resources were needed to evaluate and implement the recommendations, as some required substantial system changes and multiple stakeholders. DOH also said the COVID-19 pandemic limited resources and funding to address the recommendations, and if not for its ongoing efforts, maternal deaths and morbidities would have been even higher.

From 2018 to 2021, during the COVID-19 pandemic, maternal deaths were estimated to have increased up to 33% in New York, according to CDC estimates. According to DOH data, 78% of deaths during or after childbirth were preventable in 2018.

Auditors reviewed 27 task force, board, and work group recommendations and found that DOH implemented 63% (17) and partially implemented or did not implement 37% (10). Recommendations not implemented included important actions such as:

• Promoting universal birth preparedness and postpartum continuity of care.
• Creating competency-based curricula for providers as well as medical and nursing schools.
• Implementing a maternity medical home model of care and convening a multi-stakeholder group to develop standard guidance about additional psychosocial services and coordination of care.

Maternal Death and Persistent Disparities

DOH has progressed in addressing the recommendations to combat maternal mortality issues in New York. In some instances, the actions taken predated the recommendations:

• The board recommended improved access to telehealth. On a pilot basis, DOH worked to temporarily obtain payment parity for telehealth services.
• The board recommended greater community resources to help support high-risk mothers. DOH is investing approximately $14 million between 2022 through 2027 to fund 26 Perinatal and Infant Community Health Collaboratives.

The taskforce and board also recommended the state create a comprehensive data warehouse to monitor and track perinatal outcomes by race, ethnicity and insurance status to improve maternal health outcomes and address disparities; however, this has not been completed. In 2020, DOH found for every 100,000 babies born, 54.7 Black mothers die during or after childbirth in New York. This is a rate over four times higher than white mothers who experience about 11.2 deaths for every 100,000 babies born. While DOH collects this data, it does little to utilize it. The audit found DOH needs to thoroughly analyze this data and share it with partners to help determine whether its efforts are working and guide how it moves forward.

Additionally, two recommendations from the board and the taskforce highlighted the need for New York to address disparity issues in regard to maternal health:

• Develop a systemic approach to reduce structural racism; and
• Design and implement a comprehensive training and education program for hospitals on implicit racial bias.

Maternal Morbidity

DOH has not done enough to ensure it will meet the goals of lowering severe morbidities happening across the state. These health conditions can have serious short- or long-term health consequences or result in death. In New York state in 2018, the overall severe morbidity rate for Black women was 2.3 times higher than for white women. DOH does not track severe maternal morbidity cases, despite officials saying an analytic strategy to monitor them is needed. Officials said they are working to develop a statewide surveillance program.

Improved Outreach Needed

DOH has numerous projects to educate providers, hospitals and community partners about reducing maternal deaths and morbidities, but oversight and coordination must improve. DOH does not track whether facilities and providers are utilizing their information or engaging in the projects and programs to improve maternal health, and as a result cannot assess why mortality rates are not declining, or what improvements may be needed. Auditors also found DOH did not follow up to find out why providers were not participating in various maternal mortality prevention programs and trainings.

DiNapoli recommended DOH:

• Evaluate progress and impact on maternal health to assess the effectiveness of the programs aimed at improving maternal health outcomes. This should include:
  • 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.

DOH officials generally agreed with the audit's recommendations and indicated comprehensive actions they will take to implement them.

Audit
Department of Health: Maternal Health