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A Review of Maternal Mortality in Colorado

A Review of Maternal Mortality in Colorado

By: Bentley Porterfield-Finn

In my previous post, I mentioned that improving maternal health is a complex, multilayered undertaking. And now that I have spoken broadly about the state of maternal mortality in the United States, I want to talk about the landscape of this issue in Colorado, where Goldbug is located. It is important to understand what is going on in our state so we can intentionally work in community with people directly interacting with birthing persons to improve birth equity.

Within the United States, maternal mortality rates vary state-to-state. Compared to other states, Colorado’s maternal mortality numbers are relatively low. According to recent evaluations, Colorado has the fifth lowest maternal mortality rate in the United States [1]. However, just because we are doing better than other states, does not mean we are doing well. It is also important to acknowledge that these numbers do not include data on maternal morbidity, or near misses or serious health consequences that result from labor.

It is also challenging to compare statistics state-to-state because there is no standard procedure for collecting data on maternal deaths so maternal mortality rates are calculated differently in each state. Therefore, a crucial element of improving maternal health is doing a better job of accurately collecting data which contributes to our understanding of the circumstances which led to each death. Only then can we work to truly identify how these deaths could have been prevented.

Additionally, similar to the national trend, Colorado’s maternal mortality numbers have been rising. Pregnancy-associated mortality has nearly doubled in Colorado since 2008—climbing from 24.0 deaths per 100,000 live births in 2008 to 47.4 deaths per 100,000 live births in 2016 [2]. According to the Maternal Mortality Review Committee (MMRC) report, most maternal deaths in the state are a result of suicide or drug overdose (17% of maternal deaths 2014-2016 were by suicide and 13.8% were by drug overdose), highlighting the importance of strengthening maternal mental and behavioral health resources in Colorado.

Racial disparities also exist in Colorado’s maternal health outcomes. Native and Indigenous populations are most impacted by maternal mortality in Colorado— a look at birth outcomes between 2014-2016 found that people of Native descent were 4.8 times more likely to die than non-Native people who gave birth in the same period [3]. Moreover, while these statistics are informative, they do not tell the full story of the challenges and barriers pregnant persons face in the maternal health care system.

Now for some good news. Colorado lawmakers have acknowledged the need to improve care for pregnant persons throughout the state. Colorado is trying to improve data collection to gain a deeper understanding of the maternal health landscape in the state. In 2019, HB19-1122 was passed to strengthen Colorado’s Maternal Mortality Review Committee (MMRC), which seeks to offer a more comprehensive analysis of maternal deaths, looking not just at numbers but at circumstances surrounding each death.

Further, the Colorado legislature recently signed into law three bills that seek to improve maternal health care throughout all stages of the birthing process. The collection of bills is known as the Birth Equity Bill Package and legislative efforts were spearheaded by a birth justice nonprofit called Elephant Circle. One bill, SB21-194, focuses on maternal health providers and has a section about improving data collection to achieve better insights into various health disparities, as well as making the data public for increased transparency and accountability. Another bill in the package, SB21-193 includes many provisions to protect pregnant people in the perinatal period, including incarcerated people. Among other things, the bill package also increases support for midwives, doulas, and other community birth workers.

Through legislation, Colorado is taking important steps toward supporting moms and birthing persons throughout the state, but there is still a lot of room for improvement. Raise Colorado’s Diverse Colorado Voices Report on community-based solutions for the perinatal period explores opportunities to improve maternity care in Colorado, articulating a need to consider systemic racism, lack of postpartum support, and systems-level inadequacies [4]. Structural inequities, specifically structural racism, impact health outcomes and any attempt to address this issue must be attentive to the impacts of historical oppression and of our current social and cultural landscape. Lastly, social and public health solutions aimed at addressing maternal mortality must support the various community-based and community-centered movements already happening.

Here at Goldbug, we have spent the past few months engaged in conversations with community leaders in this arena and doing our best to listen and learn before we act. Being committed to supporting birthing persons means being committed to understanding the deep complexities of circumstances that influence care in the perinatal period.  But with understanding comes action and there is an opportunity in Colorado and around the country to better respond to the needs of our moms. Here at Goldbug, we are taking the first step in getting involved in this space by partnering with Denver Health’s Doula Program. We are initiating support of this program by contributing to data analysis to further understand how we can impact sustainable change.

References:

[1] Maternal Mortality by State, 2021.  https://worldpopulationreview.com/state-rankings/maternal-mortality-rate-by-state

[2] Colorado Maternal Mortality Review Committee Report. Maternal Mortality in Colorado, 2014-2016 (July 2020). https://nursing.cuanschutz.edu/docs/librariesprovider2/newsroom-documents/maternal-mortality-in-colorado-2014-2016.pdf?sfvrsn=209887b9_2

[3] Colorado Maternal Mortality Review Committee Report. Maternal Mortality in Colorado, 2014-2016 (July 2020). https://nursing.cuanschutz.edu/docs/librariesprovider2/newsroom-documents/maternal-mortality-in-colorado-2014-2016.pdf?sfvrsn=209887b9_2

[4] Frawley, K., Murphy, H., Vanderwielen, L. (2020). Diverse Colorado Voices: Community-based solutions for the perinatal period.