OLYMPIA – Maternal deaths in Washington rose between 2021-2022, and most pregnancy-related deaths were preventable, according to the Washington State Department of Health’s (DOH) new Maternal Mortality Review Panel (MMRP) Report. Behavioral health-related deaths – including suicide, homicide, and accidental overdose – accounted for nearly half of all pregnancy-related deaths. COVID-19 was the second leading cause. The report includes recommendations to address the root causes and systemic gaps behind these deaths.
The report is based on reviews conducted by DOH’s MMRP and includes data and findings from maternal deaths in 2021-2022, as well as demographic and trend data from 2014-2022. The MMRP reviews pregnancy-associated deaths, which are deaths from any cause during or within one year of pregnancy. The Panel determines which deaths were pregnancy-related – meaning they occurred due to a pregnancy complication, a chain of events initiated by pregnancy, or an unrelated condition aggravated by the effects of pregnancy. The MMRP also determines which pregnancy-related deaths were preventable and makes recommendations based on these deaths.
Key findings:
In addition to increased maternal mortality rates, the report found that maternal mortality impacts some Washington communities disproportionately and inequitably.
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American Indian and Alaska Native communities had the highest maternal mortality rates, which has been the case in all of Washington’s MMRP reports to date. Their risk of dying from pregnancy-related causes was 7.3 times higher than that of non-Hispanic white people. The new report contains an addendum by the American Indian Health Commission, with recommendations from Tribal and Urban Indian leaders .
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People living in rural areas with less access to maternity and emergency care experienced higher rates than people in urban areas. People enrolled in Medicaid also faced higher rates than those with private insurance.
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82% of pregnancy-related deaths were preventable, meaning there was at least some chance of the death being prevented if a clinical or social factor contributing to the death had been different. These factors included care quality, financial barriers, limited health care access, and lack of continuity of care.
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The lead underlying cause of pregnancy-related death was accidental overdose; most of these deaths involved fentanyl. COVID-19 was the second-highest cause, followed by cardiovascular conditions, suicide, and thrombotic embolisms (blood clots).
“The Maternal Mortality Review Panel Report helps us understand how to make pregnancy, birth, and postpartum care better for people in Washington,” said Lacy Fehrenbach, Chief of Prevention, Safety and Health, DOH. “To improve outcomes, we need to tackle the systemic issues that drive inequities—things like making sure people have stable housing, enough food, and access to health care that fits their culture and needs, including vaccines and mental and behavioral health services. We hope these recommendations provide a roadmap to ensuring all people in Washington receive the support they need before, during, and beyond pregnancy.”
Recommendations to improve maternal health outcomes:
The report includes 12 recommendations for the Washington State Legislature and 75 recommendations for other audiences, which focus on:
- Improving health care quality and access, such as maternity care in rural areas
- Strengthening community support services, including doula care and home visiting
- Providing equitable and culturally relevant care, such as providers that meet patients’ cultural and communications needs
To help prevent maternal deaths from COVID-19, DOH and the West Coast Health Alliance recommend the COVID-19 vaccine for all pregnant people, as well as for those who are planning pregnancy, are postpartum, or are lactating. Every COVID-19 death in the new report occurred in someone who was unvaccinated or only partially vaccinated at the time of diagnosis.
Earlier this year, DOH issued a COVID-19 vaccine Standing Order, allowing most residents to go directly to a Washington pharmacy or clinic and receive the vaccine without an individual prescription. The COVID-19 vaccine is generally covered by insurance or available at little to no cost through Washington’s Childhood Vaccine Program for people younger than 19, and through the Adult Vaccine Program for those 19 and older who are uninsured.
DOH publishes maternal mortality reports every three years, as required by the Washington State Legislature.
