Health Department Releases Report on Severe Maternal Morbidity

Report tracks data related to adverse health outcomes or illness during the time of delivery

The Health Department will use data to inform future maternal health efforts and promote health equity

May 12, 2016 – The Health Department today released the “Severe Maternal Morbidity, New York City, 2008-2012” report, which documents rates of life-threatening complications during childbirth. The data shows a 28 percent increase in the incidence of severe maternal morbidity during the 2008-2012 period, from 197 per 10,000 deliveries in 2008 to 253 per 10,000 deliveries in 2012. The report is the culmination of a two-year collaboration between the Health Department and the Fund for Public Health – with support from Merck for Mothers – to design the first citywide severe maternal morbidity surveillance system in the nation. The report can be found on the agency’s website, nyc.gov/health.

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Since 2008, severe maternal morbidity rates have increased across the United States. The drivers of the increase vary and include improved documentation and surveillance, delayed childbearing, increased cesarean delivery, emerging infections and increasing proportions of pregnant women who are obese and have underlying chronic conditions.

The report also shows persistent disparities across race, ethnicity and income. These disparities are likely a product of a history of structural racism. Severe maternal morbidity affects approximately 2,500 New York City women a year. Black non-Latina women had the highest rate (387 per 10,000 deliveries), three times that of White non-Latina women (127 per 10,000 deliveries). This disparity persisted even when comparing Black non-Latina and White non-Latina women with similar risk factors, such as low educational attainment, neighborhood poverty and pre-pregnancy obesity. The severe maternal morbidity rate was also high among women who were Puerto Rican (272 per 10,000 deliveries) or of other Latina origin (249 per 10,000 deliveries). Several maternal morbidity rates were highest among women living in the poorest neighborhoods, with Brownsville having the highest rate in the city, with 497 per 10,000 deliveries.

“This report underscores the need to do all that we can to ensure a woman has the opportunity to live a healthy life before, during and after pregnancy,” said Health Commissioner Dr. Mary T. Bassett. “We will continue to focus our efforts in neighborhoods most affected by severe maternal morbidity, which far too often are communities of color. I encourage health care providers and community-based organizations to join us in this effort.”

“As the major provider of health care to minority communities we continue to eliminate disparities in health care and fight for health equity. Data such as these help us focus our efforts and resources to improve outcomes, so women throughout New York City despite income, insurance or immigration status, remain healthy during pregnancy and through their postpartum period,” said Dr. Ram Raju, President and CEO of NYC Health + Hospitals.  “We are committed to ensuring the highest level of care to our obstetric patients and I commend DOHMH for their work compiling this data.”

“We are pleased to see New York City personalize CDC’s national maternal morbidity surveillance model to develop a clearer, local picture of the impact of these life-threatening conditions,” said Dr. William Callaghan, MD, MPH, chief of CDC’s Maternal and Infant Health Branch. “These new data will give all of those involved in caring for pregnant women in New York City the perspective they need to improve maternity care and ensure the health of the next generation of mothers and their babies.”

“Although maternal mortality is the most devastating problem in obstetric care, severe morbidity affects more than 50,000 women nationally,” said Dr. Mary E. D’Alton, MD, FACOG Co-Chair of the ACOG District II Safe Motherhood Initiative. “The New York City Department of Health & Mental Hygiene has continued their commitment to shine a light on this issue, particularly with respect to health care disparities. Translating the results of their work into better care for women must now become a priority.”

“New York City’s pioneering severe maternal morbidity research is a vital step toward making pregnancy and childbirth safer for women across the city, regardless of which zip code they live in,” said Dr. Priya Agrawal, executive director, Merck for Mothers. “Knowing the depths of the problem is a critical first step in working to improve maternal health for the four million women who give birth in the U.S. every year.”

“Maternal morbidity can have devastating long-lasting consequences for women’s health and the wellbeing of their families; we commend the Health Department for bringing attention to this important issue,”  said Ngozi Moses from the Brooklyn Perinatal Network on behalf of the Regional Perinatal Coordinating Bodies (RPCBs) funded by the New York City Council. “The RCPBs have led a collaboration of local and citywide perinatal programs for 15 years to facilitate access to services in communities that historically have faced barriers to perinatal care. We hope this report will bring about renewed support for our efforts to ensure that all pregnant women get timely and quality care.”

This citywide data surveillance system is the first of its kind in the nation to track and monitor severe maternal morbidity cases at a municipal level. Severe maternal morbidity events were identified using an algorithm developed by the Centers for Disease Control and Prevention. The algorithm identifies 25 indicators, – including respiratory failure, eclampsia, blood transfusion and hysterectomy – that represent serious complications of pregnancy or procedures used to manage those conditions. The Health Department is working to disseminate these findings widely through print and online channels as well as ongoing meetings with community members, health care providers and policymakers to ensure that data are shared to inform policies and programs aimed at improving maternal health.  

The Health Department will continue this surveillance and is committed to addressing the increasing rates of severe maternal morbidity, with a particular focus on reducing inequities in maternal morbidity using a multifaceted approach. In partnership with stakeholders, the Health Department is working to improve the overall health of women before, during and after pregnancy. Key initiatives include addressing chronic disease in women of reproductive age, increasing access to a wide range of contraceptive methods in postpartum, post-abortion, family planning and primary care settings, designating women’s health suites in the new Neighborhood Health Action Centers to increase clinical and non-clinical community-based programs to address poor maternal health outcomes, and partnering with the state and medical and hospital associations to implement both community prevention and clinical strategies to support maternal health, including the mental health of new mothers.  

Some of the Health Department’s programs that support healthy pregnancy outcomes and women’s health include:

The Nurse-Family Partnership: The Nurse-Family Partnership is an evidenced-based, nurse home-visiting program, in high-need communities across New York City. Under the Nurse-Family Partnership, nurses visit women in their homes every one to two weeks during pregnancy and throughout the child’s first two years of life, offering guidance on breastfeeding, child development, parenting skills, pregnancy planning, preventive health practices and strategies to attain economic self-sufficiency – including going back to school and finding a sustainable job.

Healthy Start Brooklyn: A multifaceted place-based initiative, Healthy Start Brooklyn provides education and support to improve the health and wellbeing of women, their babies and families. The program focuses on central and eastern Brooklyn, serving the neighborhoods of Brownsville, East New York, Bedford Stuyvesant and Bushwick. Healthy Start Brooklyn provides home visiting as well as resources on breastfeeding, perinatal depression, developmental delays and home safety. The program works with the entire family by engaging fathers through the program Fathers Also Matter (FAM), which supports men as parents and through referrals to job training and other services.  Healthy Start Brooklyn also operates the By My Side Support Program, pairing doulas (trained childbirth assistants) with pregnant women.

Women’s Health Suites: Housed within the Neighborhood Health Action Centers opening soon, the women’s health suites will be dedicated spaces to promote maternal wellbeing and family health. The Women’s Health Suite will expand the scope of reproductive and women’s health services by providing a physical space for women to breastfeed, rest, exercise, and strengthen their social support networks structural supports that are often missing in communities with poor birth outcomes and high infant mortality rates. Programs offered at the suites will include activities to support breastfeeding, risk-reducing behaviors during and after pregnancy and, healthier eating, as well as resources for referral to medical and social service providers and birthing centers.

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MEDIA CONTACT: (347) 396-4177
Christopher Miller/Carolina Rodríguez: pressoffice@health.nyc.gov