By Brooklyn Borough President Antonio Reynoso & New York State Comptroller Tom DiNapoli
Here’s what we know about our maternal health crisis: The United States has a maternal death rate greater than almost every other high-income country. The death rate here is more than 2.5 times the rates of France and Canada and 3.5 times that of the United Kingdom.
This crisis has also deeply affected our state. New York had a 33% increase in maternal deaths from 2018 to 2021. For every 100,000 live births in our state, there were 18.5 maternal deaths from 2018-2021. And, as with many health issues, there are stark racial and ethnic disparities.
Black women in New York City are dying at six times the rate of white women, and Hispanic women are dying at three times the rate of white women. About three in every four of the deaths from 2018 to 2020 were found to be preventable.
In short, the maternal health crisis is stark, alarming and in plain sight — but according to a recent audit, New York State isn’t even gathering some of the most basic and important information we need to fight it.
Here’s what we don’t know over the past decade: how many women experienced a heart attack or sepsis during pregnancy; how many women needed resuscitation, massive transfusions or ventilators to survive labor; how many women were admitted to the ICU after giving birth; or experienced serious mental health conditions that led to death.
We don’t know any of this because if these women survived — despite experiencing life-threatening, traumatizing and often expensive medical complications — their experiences would have been characterized as cases of “severe maternal morbidity,” and though morbidity cases have gone up 22% from 2008 to 2021 across the country, they are not tracked by New York’s Department of Health (DOH).
In this respect, New York has fallen behind other states in its efforts to ensure the safety of new and expecting mothers. Arizona, Connecticut, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Texas, Utah, and Wisconsin all track cases of severe maternal morbidity. Engaging with this data, these states are able to create a much more complete picture of what maternal health care looks like.
In California, collecting and making maternal morbidity data accessible has been a central component of state efforts to address outcomes and inequities in maternal health; comprehensive morbidity data is published in an online dashboard accessible to the public. California has a maternal mortality rate half that of New York.
It’s clear that New York State needs a severe morbidity tracking system of our own. The data should be easily accessible to hospital systems, policymakers, community-based organizations and other stakeholders. Like California, New York’s system should collect information that includes age, race, ethnicity, insurance, neighborhood of residence and morbidity type.
A dashboard could help to better identify mortality and morbidity risks, detect and address negative trends and develop strategies to improve health outcomes. Making this data accessible to those outside DOH would also promote more informed decisions among maternal health care providers, medical professionals, educators, community partners and lawmakers. It would foster better collaboration to improve maternal health care and, ultimately, save lives.
This data would also help us hold medical institutions more accountable when protocols are implemented. For instance, the New York State Maternal Mortality Review Board in 2022 proposed hospitals have a standard protocol to address postpartum hemorrhage or excessive bleeding — the same morbidity that goes untracked despite ranking as a leading cause of preventable maternal death.
According to a DOH survey in 2023, only 5% of birthing hospitals had implemented a standard protocol for anesthesiologists and obstetricians to follow when a woman needs a massive blood transfusion. In order for lawmakers to support effective policies and get DOH adequate resources to meet new protocols, we need the right data on hand. Data-driven decisions should be the cornerstone of any meaningful policy initiative.
Historically, New York State audits have found that DOH has not used one of its most invaluable and readily available resources — data — to gain better insights into health risks and formulate plans to mitigate them. The most recent audit into our state’s maternal health progress is no different.
Statewide morbidity data would provide us with a window into the conditions that could teeter into tragedy. Moreover, morbidity data — and the state’s commitment to tracking and analyzing it — would clarify what we mean when we promise New Yorkers we’re going to improve outcomes for new and expecting families. Maternal mortality cannot be the reigning measure of maternal health. Simply surviving pregnancy is not enough.
