State Strategies for Preventing Pregnancy-Related Deaths: Four Step Process
Step 1: Use data to understand the scope of the problem [PDF – 6 MB]
There are population-based data sources that can enhance the MMRC data and provide complementary information for identifying and adapting potential strategies.
While there are many types of data available about the populations that MMRC recommendations will impact, and the providers and systems that serve them, commonly used population-based data sources highlighted in this guide include:
- Pregnancy Risk Assessment Monitoring System (PRAMS).
- CDC’s Levels of Care Assessment ToolSM (CDC LOCATeSM).
- Hospital discharge data.
- Medicaid data.
Other ways for gathering complementary data to inform and adapt potential strategies, particularly related to health equity, include collecting and analyzing qualitative data such as key informant interviews and community-led focus groups.
Step 2: Understand the context of the solution [PDF – 6 MB]
Another important step is placing MMRC priority recommendations in the context of the organization, state, community, and implementing partners. Context can influence the success of implementation. In Step 2, we describe key community and organizational factors to consider when selecting and implementing strategies that address priority recommendations:
- Identify community strengths and potential barriers.
- Collaborate with decisionmakers.
- Consider organizational readiness and capacity.
- Map human and fiscal resources.
- Engage public health, clinical, and community partners.
Step 3: Identify potential goals and strategies [PDF – 6 MB]
This section provides a summary of five potential goals to address priority recommendations from a MMRC. These five goals were identified from experiences supporting state and local MMRCs, including analyzing contributing factors and recommendations from MMRC data.
Effective actions will likely require implementing a number of strategies that address multiple goals, including acting on more than one strategy within a goal. In addition, it is essential to identify potential goals and related strategies that aim to improve equity and eliminate disparities in maternal mortality. Applying an equity lens is important in selecting goals and associated strategies and may lead to improvements in outcomes and decreased disparities among populations disproportionately impacted by maternal mortality. The goals and associated strategies provided here are illustrative and are not exhaustive. The five goals used in Step 3 are:
- 1.1: Recruit and retain a diverse workforce.
- 1.2: Implement tools and trainings to address discrimination and interpersonal racism in health care settings.
- 1.3: Implement policy changes to address inequitable distribution of the social determinants of health.
- 1.4: Actively engage organizations that are community–based and that serve disproportionately impacted populations.
- 1.5: Implement initiatives that improve standardization of care, quality, and coordination in health care facilities that serve disproportionately impacted communities.
- 2.1: Increase funding and support for community-based organizations in communities disproportionately impacted by maternal mortality.
- 2.2: Connect pregnant and postpartum persons with community health workers who can provide support and help meet their needs.
- 2.3: Build and support community-centered approaches to care.
- 2.4: Integrate maternal care services with other sectors of the community.
- 3.1: Improve prenatal and postpartum healthcare coverage.
- 3.2: Increase availability and accessibility of care.
- 3.3: Establish and maintain strong systems for care coordination.
- 3.4: Establish and strengthen systems of maternal risk-appropriate care.
- 4.1: Ensure respectful, client-centered care for all pregnant and postpartum persons.
- 4.2: Promote standardized management of clinical situations.
- 4.3: Partner with Perinatal Quality Collaboratives to improve and standardize clinical care and community linkages.
- 4.4: Educate patients, their support networks, and clinicians about warning signs.
- 5.1: Strengthen identification of pregnancy-associated deaths through quality assurance and improvement of death record data.
- 5.2: Improve MMRIA data through expansion of available data sources for abstraction.
- 5.3: Improve MMRC data through comprehensive review of pregnancy-associated deaths and complete documentation of committee decisions.
Step 4: Act on your selected strategies [PDF – 6 MB]
In Step 4, selecting strategies for implementation is based on an assessment of the fit of these strategies with the identified goals and with the context in which they will be implemented, development of an implementation plan and timeline, and creation of a plan for evaluation of these strategies.