A new Maternal Health audit from New York State Comptroller Thomas P. DiNapoli calls on the New York State Department of Health (DOH) to do more to ensure maternal deaths and morbidity rates decline.
While the 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, according to a news release.
“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 2020, the 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 report said.
The audit found that the 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.
Two recommendations from the board and the taskforce include the need for developing a systemic approach to reduce structural racism; and designing and implementing a comprehensive training and education program for hospitals on implicit racial bias.
From 2018 to 2021, during the COVID-19 pandemic, maternal deaths were estimated to have increased up to 33% in New York, according to Center for Disease Control and Prevention estimates. According to the 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.
In addition, the 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. 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.
The DOH has numerous projects to educate providers, hospitals and community partners about reducing maternal deaths and morbidities, but oversight and coordination must improve, the report said.
The 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 that the the DOH did not follow up to find out why providers were not participating in various maternal mortality prevention programs and training.
DiNapoli recommended that the 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.
