Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective

Reducing SMM is critical to improving maternal health. SMM is now a national outcome measure for Title V, it is part of new Healthy People 2030 Goals, and it is one of the few quality indicators that focuses on maternal health (versus neonatal, perinatal, or obstetric care)—all of which attest to the importance of understanding its causes. To make progress on understanding SMM, we need a solid conceptual orientation that spans the continuum of broad structural to specific clinical factors and centers equity; better consensus on its definition and measurement; a confluence of population-level data on SMM, sociodemographic variables, and place; and better understanding of patient and community experience of SMM. The time is right for progress, now that the urgency of the U.S. maternal health crisis is broadly understood. Media attention and public demand to improve maternal health and achieve racial equity is growing. Congress has proposed multiple pieces of legislation to improve maternal health, including omnibus bills addressing improved care for Black women, supported by the Black Maternal Health Caucus. The National Institutes of Health launched its IMPROVE initiative in 2020, the Patient-Centered Outcomes Research Institute’s reauthorization includes a focus on maternal health, and the CDC launched its “Hear Her” campaign. The Health Resources and Services Administration–supported Alliance for Innovation on Maternal Health initiative and the CDC National Network of Perinatal Quality Collaboratives support the development and implementation of toolkits to improve the quality of maternal care. Heightened intolerance of racism and concerns about the impact of the COVID-19 pandemic on maternal health and health equity will likely further galvanize action to improve maternal health. Documenting and calling attention to the U.S. maternal health crisis are critical steps on the path to improving maternal health and mitigating inequities, but they are not sufficient on their own. Achieving progress toward addressing this largely preventable crisis requires coordinated, multifaceted action. It is essential that we act using a multilevel framework informed by evidence, centered on equity and the voices of the people who are most affected, to ensure health across the life course for every person giving birth in the United States.