Health Department review finds most pregnancy-related deaths in 2018 deemed preventable; committee outlines policy targets

Dr. William Greenfield, medical director for family health at the Arkansas Department of Health, told the Senate Public Health, Welfare and Labor Committee that the state’s two post-2019 maternal-review panels have identified specific actions to reduce maternal and infant deaths.

“Thirty pregnancy-associated deaths, 12 pregnancy-related deaths, 13 pregnancy-associated but not related, and 5 pregnancy-associated but unable to determine relatedness,” Greenfield said in summarizing the committee’s review of 2018 data. He reported a 2018 crude rate of about 33 maternal deaths per 100,000 live births and noted the committee’s work began with the 2018 birth cohort.

The committees have increased meeting frequency and formed subcommittees focused on quality-improvement projects and education, Greenfield said. Major recommendations include wider implementation of maternal safety bundles in hospitals, expanding postpartum Medicaid coverage from 60 days toward a full year, improving diagnosis and treatment of mental-health and substance-use disorders, and increasing access to contraception so pregnancies are more likely to be intended.

Greenfield also described outreach efforts carried out during COVID-19, including rapid messaging through the Health Alert Network to urge vaccination among pregnant women and targeted educational presentations to hospitals and community stakeholders to boost testing and treatment for syphilis in pregnancy. He cited Centering on Pregnancy, a group prenatal-care program at UAMS, as one evidence-based model his committees plan to promote statewide to lower preterm birth rates.

The review highlighted racial disparities: Black non-Hispanic women accounted for 19% of births in 2018 but 37% of pregnancy-associated deaths in the committee’s review. On preventability, Greenfield said the review applied a broad standard and concluded “there were things that could have been done that would have prevented the deaths of 92 percent of those pregnancy related deaths,” emphasizing a spectrum of system-, provider-, and community-level interventions.

Committee members pressed for specifics and metrics. Representative Lademan and others asked for geographically disaggregated data to target resources; Greenfield responded that small absolute numbers complicate highly local breakdowns now but that geography will be tracked as the review accumulates more years of data. He offered to supply participation figures for safety-bundle implementation and other requested breakdowns to the committee.

The committee did not take formal legislative action on the presentation; members indicated interest in reviewing the committees’ reports and in pursuing policy changes that follow the review’s recommendations.