Following the 2022 U.S. Supreme Court decision that dismantled the federal right to abortion and opened the door for state bans, leaders in some states are limiting or halting the work of committees that investigate deaths that occur during and after pregnancy. (John Moore/Getty Images)
This story originally appeared on Stateline.
Every state has a committee of medical and public health experts tasked with investigating deaths that occur during and after pregnancy.
But as data paints a clearer picture of the impact that state policies such as abortion bans and Medicaid expansion can have on maternal health, leaders in some states are rushing to limit their review committee’s work — or halt it altogether.
In November, Georgia officials dismissed all 32 members of the state’s maternal mortality review committee after investigative reporters used internal committee documents to link the deaths of two women to the state’s six-week abortion ban. In September, Texas announced its committee would not review 2022 and 2023 maternal deaths — the two years immediately following its near-total abortion ban. And two years ago, Idaho effectively disbanded its committee when conservative groups went after members for calling on the state to extend Medicaid coverage for postpartum women.
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In March, Arkansas Republican Gov. Sarah Huckabee Sanders created her own maternal health advisory group after Arkansas’ maternal mortality review committee, like Idaho’s, recommended extending the amount of time that low-income postpartum women can qualify for Medicaid coverage — something Sanders has staunchly opposed.
The maternal mortality rate for U.S. women is far higher than in any other high-income country, and Black women are more than twice as likely to die during pregnancy or after birth than the national average. Research has shown most of these maternal deaths are preventable.
State officials have given varying reasons for their decisions.
Sanders has called an extension of postpartum Medicaid “duplicative” because Arkansas has other insurance options. The maternal mortality review committee chair in Texas said the panel would skip a full review of the 2022 and 2023 deaths in order to offer analysis and recommendations based on the most recently available data. And Georgia’s state health officer said she dismissed committee members because they violated state law by sharing confidential information. Georgia plans to replace them with new appointees.
Charles Johnson, an Atlanta father of two whose wife, Kira, died in 2016 after a routine cesarean section and who has advocated for maternal health committees, is dubious. He said the dismissal of the Georgia panel appears to be “an attempt to retaliate for exposing some of the unfortunate outcomes of Georgia’s laws.”
“The only role politicians and politics should have in this work is to support the committees and make sure they have the resources needed to do their job,” said Johnson, who founded a nonprofit in his wife’s memory, 4Kira4Moms, and in 2018 testified before Congress to push for a measure supporting the creation of more state committees. It was signed into federal law that year.
Recommendations lead to change
While every state has a maternal mortality review committee, often abbreviated to MMRC, many of them were established just in the past decade, as state and federal officials focused attention on the nation’s high maternal death rates.
These committees perform comprehensive, deep-dive reviews of any deaths in the state that occur during pregnancy or within the year following a pregnancy. The committees typically comprise a mix of professionals including obstetricians, nurses, public health officials, forensics experts, behavioral health providers and community advocates. They issue public reports that highlight their findings and make recommendations for how the state can prevent future deaths.
“Being able to answer questions with hard data is really important for informed policymaking,” said Jennifer Callaghan-Koru, an associate professor at the University of Arkansas for Medical Sciences and the research director at the Arkansas Perinatal Quality Collaborative.
“We want to be able to answer questions for policymakers to help with crafting legislation or regulations that are going to provide the best outcomes for mothers and babies, but also balance all the different needs of a health care system that has cost considerations.”
Many states have adopted their committee’s recommendations. Illinois, for example, was the first state to extend Medicaid coverage to all women for one year postpartum after legislators followed the advice of its MMRC. In Washington, when the state’s MMRC found that pregnancy-related deaths weren’t always referred to the local medical examiner for autopsy, the state legislature passed a law requiring birthing hospitals to refer those deaths to the local coroner or medical examiner, and it provided funding for the autopsies.
In California, which in the mid-2000s became one of the first states to start formally investigating maternal deaths, expert recommendations adopted by the state and health care providers helped cut the maternal mortality rate in half by 2013.
Reports often lag a few years behind, due to the time-consuming nature of the investigations. But now that more than two years have passed since the U.S. Supreme Court dismantled the federal right to abortion and opened the door for state abortion bans, MMRCs are starting to review data that could paint a clearer picture of the ruling’s impact on maternal health.
‘An abuse of power’
Last year, the investigative news outlet ProPublica obtained internal documents from Georgia’s MMRC that found two Georgia women died preventable deaths in 2022 after they couldn’t access legal abortions and timely care. Georgia law prohibits abortion after six weeks of pregnancy.
Dr. Kathleen Toomey, commissioner of the Georgia Department of Public Health, said in November that she dismissed the committee members because confidential information provided to them was “inappropriately shared” with the ProPublica reporters, violating state law and the confidentiality agreement that committee members must sign.
The state’s investigation never determined whether a committee member, or someone else, leaked the documents.
“I am concerned that this will continue to happen in other places,” said Johnson, the Atlanta father. “I think that Georgia demonstrated an overreach and abuse of power that other states and other state medical directors may not have been aware they have.”
Last September, Texas’ MMRC made headlines by announcing it wouldn’t review maternal deaths from 2022 and 2023. The committee chair, Houston OB-GYN Dr. Carla Ortique, said skipping those years would help avoid a backlog of older cases so they could work on more recent deaths. The committee’s latest report, released that same month, covers 2020 cases. Ortique also noted that a few years ago, before the abortion ban, the committee “leapfrogged” records from 2014 to 2018.
But the decision also means the committee won’t investigate any potential deaths that could be connected to the state’s abortion ban for the first two years it was in effect. ProPublica’s reporting has tied the deaths of three Texas women to ban-related delays in care.
They don’t want the public to know that the policies they’re passing to hinder women’s reproductive rights are having a negative impact.
– Tennessee Democratic state Sen. London Lamar
Tennessee state Sen. London Lamar, a Democrat, sponsored a bill signed into law last spring that requires the state’s MMRC to reserve four of its seats for community-based birth workers. She hopes the move will increase the diversity of perspectives on the committee and position it to make recommendations that address the severe racial and economic maternal health disparities in the state.
In Tennessee, as in many states, Black women die at two to three times the rate of white and Hispanic women from pregnancy-related causes, while low-income women who qualify for Medicaid are nearly three times as likely to die as their counterparts with private insurance.
Lamar, who lost her baby at full term in 2019 due to a pregnancy-related condition, is frustrated by conservative politicians’ efforts to intervene in what she said should be a bipartisan issue.
“When majority governments take steps to remove people because they are not pleased with recommendations that are based on their own ineffective legislating, to me that’s an abuse of power,” said Lamar. “They don’t want the public to know that the policies they’re passing to hinder women’s reproductive rights are having a negative impact.”
An Arkansas workaround
Arkansas is the only state in the nation that hasn’t taken steps to extended its Medicaid coverage to one year postpartum for low-income women. Nationally, researchers and advocates have stressed the importance of continuing insurance coverage after birth because more than half of pregnancy-related deaths in the U.S. occur in the year following a pregnancy, and Medicaid covers about 40% of births.
In recent years, Arkansas’ maternal mortality review committee has recommended postpartum Medicaid extension as a way to reduce maternal deaths.
But the governor remains staunchly opposed.
“[W]e want to make sure that we are transitioning women to coverage that already exists in the state,” Sanders said during a March 2024 news conference. “I don’t believe creating a duplicative program just for the sake of creating a program is actually going to fix the issue. We already have so many women who aren’t taking advantage of the coverage that exists.”
About 40% of low-income pregnant women in Arkansas lose their Medicaid eligibility two months after they give birth.
Last March, the governor created her own maternal health working group to review and recommend solutions for improving maternal and infant health.
The working group of more than 100 people included health care professionals, advocates and public health officials. They held meetings throughout the year, facilitated by state health department officials.
The group released its report in September. It does not include extending pregnancy Medicaid among its recommendations. Three months later, Arkansas’ MMRC released its latest report; for the first time since 2020, postpartum Medicaid extension wasn’t among its recommendations.
Camille Richoux, health policy director for Arkansas Advocates for Children and Families, was part of the governor’s working group. She said postpartum Medicaid extension was not included in the report even though it was brought up several times during group meetings.
“We had a feeling it was not going to make it through because the governor had made that stance, but there were still people who believe it should happen,” she said. “But ultimately this was a really positive group with lots of great people with expertise, and some great recommendations that came out of it.” Arkansas Advocates is one of many groups that continue to push for the extension.
Arkansas Surgeon General Dr. Kay Chandler, who is also an OB-GYN in Little Rock, said one reason postpartum Medicaid extension was not recommended by the working group is that most Arkansans who lose their Medicaid coverage 60 days postpartum could be eligible for subsidized coverage under the state’s public-private insurance program called ARHOME.
“A lot of people weren’t aware of what we already have,” she told Stateline. “What we are hoping is if we streamline this process and make it easier for women to get into the appropriate plan they qualify for, that’s going to be a better long-term solution” than just extending Medicaid for one year postpartum, she said.
As the state’s 2025 legislative session begins this week, Richoux said she expects several bills related to maternal health, including one for postpartum Medicaid extension. Earlier this month, Arkansas was awarded a $17 million federal grant to fund maternal health improvements. Sanders said the money will be used to increase the maternal care workforce and improve access to care.
Conservative pushback
Last March, Idaho lawmakers, led by Republican former House Majority Leader Megan Blanksma, reinstated its maternal mortality review committee.
Prior to that, Idaho was the only state without a maternal mortality review committee after lawmakers in 2023 effectively disbanded it by not renewing legislation. At the time, the Idaho Freedom Foundation and other conservative groups blasted the state’s MMRC for recommending postpartum Medicaid extension. State lawmakers tabled the bill in part over concerns over the cost of extending pregnancy Medicaid.
Two months after legislators passed a law reinstating the MMRC, Blanksma lost her Republican primary to a candidate backed by the Idaho Freedom Foundation.
Idaho’s newly reconstituted committee is scheduled to release a report on 2023 maternal deaths at the end of this month.
In Georgia, the state health department is currently interviewing candidates for a newly constituted MMRC, according to a department spokesperson. Toomey, the state health officer, also said the state will consider new procedures to ensure confidentiality, including committee oversight and a modified organizational structure.
Johnson said he’s spoken with former members of the Georgia MMRC who doubt the new committee will be truly independent. Nevertheless, he remains hopeful.
“Even though this has been politicized, I think [state officials] may have shot themselves in the foot,” he said. “Because now people are calling for more accountability, more transparency and they’re holding people’s feet to the fire.”
Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.
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