An overwhelming majority of all Tennessee's maternity deaths in 2017 could have been prevented, according to a new report released Tuesday that was commissioned to address the state's high maternal deaths.
"We dedicate this report with deepest sympathy and respect to the memory of these women who died while pregnant or within a year of their pregnancies," said Health Commissioner Lisa Piercey in a statement.
The report comes nearly three years after the Tennessee General Assembly passed the Maternal Mortality Review and Prevention Act of 2016, which created a review panel to not only look over maternal deaths but also offer prevention recommendations.
According to the 59-page report, the panel verified 78 pregnancy-associated deaths in 2017 and determined 85% of them could have been prevented. Initially, there had been 98 deaths that had been flagged as pregnancy-associated, but the number dropped due to the review panel — which established the state's official procedure to confirm maternal mortality cases.
The pattern is similar to what recently happened in Texas, where health officials originally reported a dramatic number of maternal deaths in 2012 only to later find the number was drastically lower than previously reported.
Nationally, an estimated 700 women in the U.S. dies as a result of pregnancy or pregnancy-related complications each year. The statistics have startled public health officials, who have pointed out that the US is one of the few countries in the world to show a spike in maternal mortality rates despite health improvements.
The numbers become starker when breaking down racial disparities, where black women are three to four times more likely to die from a pregnancy-related complication than white women. The report didn't explicitly go into why the racial disparities existed, but pointed out that large portions of the women who died didn't have a college education and qualified for Medicaid.
Tuesday's report cited nearly 30% of the deaths were directly related to the pregnancy—where causes ranged from hemorrhage to embolism. Meanwhile, more than 60% of the deaths were determined to be associated due to the pregnancy. Those causes ranged from overdose, motor vehicle accidents and violence—primarily homicide but two cases were reported suicides.
"Of all deaths reviewed, 14% of Tennessee's maternal deaths in 2017 were the result of homicide, highlighting the need to address critical issues of maternal mortality including intimate partner violence," said Morgan McDonald, co-chair of the maternal mortality panel, in a statement. "Health systems and the public should be aware of the increased risk of violence and the availability of resources for women during the pregnancy and post-partum time periods."
The report also found that the majority of the deaths reviewed occurred 43 days to one year after pregnancy. The remaining deaths occurred during pregnancy or shortly after.
According to the report, key recommendations focused on an expansion of resources and patient access to treatment options for substance and mental health disorders for during and the following year after pregnancy.
The report also encouraged improving protocols and screening in clinics and hospitals on maternal health topics. Other recommendations included more multi-disciplinary teams and coordination of care; establishment of protocols and standards of care; and public awareness and understanding of risk factors for patients and providers.
Officials with Tennessee's Department of Health say they're developing a maternity collaborative to help with implementing these recommendations.