By Dominique Johnson, Policy Associate
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While much attention is rightly given to Ohio's high infant mortality rates, an equally critical issue often overlooked is the alarming disparities in maternal mortality. The recently released 2020 data from Ohio’s Pregnancy-Associated Mortality Review (PAMR) committee reveals both heartbreaking and eye-opening statistics about the state’s maternal health crisis.
Of the 127 pregnancy-associated deaths reviewed, 28% were determined to be pregnancy-related, with a staggering 66% of these deaths deemed preventable. The leading causes of pregnancy-related deaths included infections, cardiovascular conditions, injuries, autoimmune diseases, and hypertensive disorders during pregnancy, with mental health issues and thrombotic embolism being significant contributors. These causes reflect a broad range of health challenges, emphasizing the need for comprehensive healthcare strategies that address both physical and mental well-being.
The disparities in maternal mortality closely mirror those in infant mortality. Black mothers in Ohio were found to be more than 1.5 times as likely to die from pregnancy-related causes than non-Hispanic white women. This inequity is not merely a statistic but a profound call to action. The review identified 88 contributing factors across 23 preventable deaths, with each case involving an average of 4 contributing factors. Preventable factors included inadequate risk assessment, poor care coordination, lack of knowledge, limited access to financial resources, and concerns about clinical skill and quality of care.
These findings underscore the harsh reality that systemic barriers significantly impact Black women's access to and quality of healthcare. Black women are more likely to experience implicit bias, face historical mistrust of the healthcare system, and navigate socioeconomic barriers that delay critical prenatal and postpartum care. Such systemic inequities not only affect immediate health outcomes but can also lead to long-term health disparities for both mothers and their children. The fact that most deaths occurred within 42 days after the end of pregnancy highlights an urgent need to connect mothers with consistent and accessible postpartum care.
The PAMR report not only sheds light on these critical issues but also offers actionable solutions for healthcare systems and providers. The report calls for policy changes and healthcare reforms to improve both patient and provider education, aiming to prevent future deaths. It highlights the importance of standardized protocols for risk assessment and continuity of care, as well as the need for robust training programs to address implicit bias and improve cultural competency within healthcare settings.
Despite the Centers for Disease Control and Prevention (CDC) reporting a decrease in national maternal mortality rates from 2022 to 2023, maternal mortality among non-Hispanic Black women continues to rise, emphasizing the need for targeted, community-driven interventions. Programs such as Cradle Cincinnati, First Year Cleveland, and Celebrate One are critical examples of initiatives that are making a difference on the ground. These organizations not only provide direct support to mothers but also advocate for broader systemic changes to reduce health disparities.
At Groundwork Ohio, we recognize that while systemic change is necessary, it is also a long-term endeavor. That’s why we advocate for scaling evidence-based home visiting programs and community-driven solutions to reduce maternal and infant mortality. Programs through Help Me Grow and Nurse-Family Partnership, provide invaluable postpartum support and offer in-home visits where healthcare professionals can educate mothers on urgent maternal warning signs and address potential issues like infections and mental health challenges before they become life-threatening. These home visiting programs create a safety net, offering personalized care and helping bridge the gap in healthcare access for vulnerable populations.
Furthermore, it is crucial to continue policies that extend postpartum care beyond the immediate postpartum period. In 2022 the Department of Medicaid expanded postpartum converge from the previous 60 days to a complete year. Expanding this Medicaid coverage to a full year postpartum provided mothers with the continuous care they need to manage chronic conditions and address postpartum health concerns. Along with that support, ODM implemented the Maternal and Infant Support Program (MISP) adding additional supports including doulas services and housing visiting supports, which play a significant role in improving outcomes, as these professionals can advocate for mothers and provide culturally sensitive support. For years, doulas have played a vital role in supporting mothers through the challenges of pregnancy and the postpartum period while also advocating against biases within the healthcare system. Policies that allow doula services to be reimbursed through Medicaid create greater access to essential support for mothers who need it most, providing education, guidance, and advocacy throughout their pregnancy and postpartum journey. This along with expanding Medicaid coverage to a full year postpartum will ensure doulas are included as part of comprehensive maternity care and help mothers receive the continuous support necessary for a healthy and successful pregnancy and recovery.
By investing in community-based initiatives, evidence-based support systems, and meaningful policy changes, Ohio can create lasting improvements in maternal health. Ensuring that all mothers—regardless of race or economic status—receive the care they deserve before, during, and after pregnancy is critical to eliminating preventable maternal deaths, reducing health disparities, and achieving equitable health outcomes for all Ohio families.
As we move forward, Groundwork Ohio is advocating for legislators to expand access to evidence-based home visiting programs, including the statewide implementation of the Family Connects model. Community-based programs have already demonstrated success in lowering infant mortality rates, and applying similar approaches—along with expanded doula support and high-quality home visiting programs—can also have a significant impact on maternal health outcomes.
Through outreach efforts rooted in the voices of impacted communities and strong advocacy for policy change, we can drive real progress in Ohio’s maternal and infant health landscape. It is essential that our efforts remain focused, data-driven, and responsive to the needs of those most affected by these challenges.
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