Council of the District of Columbia
Committee on the Judiciary & Public Safety

Testimony for the Record in Support of Bill 22-0524, The “Maternal Mortality Review Committee Establishment Act of 2017”

December 7, 2017

Submitted by Andria Cornell
Senior Program Manager, Women’s Health
Association of Maternal & Child Health Programs (AMCHP)

Good afternoon Chairperson Allen and distinguished Councilmembers – I am grateful for this opportunity to testify on behalf of the Association of Maternal & Child Health Programs (AMCHP) in support of the Maternal Mortality Review Committee Establishment Act of 2017.

For fifteen years, AMCHP has collaborated with national partners to build the capacity of state- and jurisdiction-based teams to conduct maternal mortality and morbidity surveillance, including establishing and sustaining maternal mortality review committees.

The United States’ rising maternal mortality ratio, as reported from national surveillance systems, continues to generate alarm and confusion. Unfortunately, national surveillance systems only provide basic information about causes of death and their associated risk factors; they can’t tell us why the risk of death is seemingly increasing for our nation’s mothers. Further, these surveillance systems can’t point to specific factors that contributed to individual deaths, determine preventability, or identify opportunities to prevent more deaths. It is for these reasons that maternal mortality review committees are so vital to the prevention of maternal mortality.

Maternal mortality review is a standard and comprehensive surveillance system that requires diverse partnerships all throughout its many steps. This process includes,

1. First, identifying all deaths of women during pregnancy, childbirth, or the year that followed in close partnership with the jurisdiction’s Office of Vital Records.
2. Then, a case abstractor, typically a health professional with labor and delivery experience, requests important records related to each individual case. These records might include prenatal, inpatient, or outpatient health records, autopsy reports, or interviews with family members or friends.
3. The case abstractor then uses this information to tell one cohesive story about this mother and the events that led to her death. This story is called a case summary.
4. That case summary is then presented to the review committee – de-identified – during one of their regular meetings. Ideally, the committee is comprised of individuals with diverse expertise from across the jurisdiction, having a variety of clinical and psychosocial specializations and disciplines. Using their collective expertise, the committee deliberates to determine ultimately, “What happened?” In addition to this deliberation, review committees focus on three key questions:
   1. Was this death pregnancy-related (if she had not been pregnant, would she have died)?
   2. Was this death preventable?
   3. And what actions if implemented may have changed the course of events?

It is the results of this discussion that sets review committees apart as a surveillance activity, and why we refer to the process as honoring the lives of these women.

5. Throughout this process, the information from the records that the case abstractor used, the case summary, and the decisions of the committee need to be documented in a centralized and standardized way so that information can be combined across cases to identify trends in causes, contributors, geography, and opportunities to intervene.

Establishing a maternal mortality review committee is a time-consuming and resource-intensive task. However, the District of Columbia is already on a strong path. For more than three years, AMCHP has enjoyed collaborating with the extensive network of provider champions working in the DC-area committed to improving the health and wellbeing of their patients. Many of them are here today. The legislation that has been introduced has been meticulously crafted to ensure that the review committee has the authority, protections, and make-up to enable it to access a broad array of records to be able to tell women’s stories and to engage experts across sectors.

I would like to assure the Council that the maternal mortality review committee for the District of Columbia will have ready access to an eager technical assistance team. Last year, AMCHP partnered with the CDC and CDC Foundation, with funding from the Merck for Mothers program, to launch an initiative entitled, “Building U.S. Capacity to Review and Prevent Maternal Deaths.” Together we have built two key resources for review committees:

1. We launched ReviewtoAction.org, a website that centralizes model resources and tools for maternal mortality review committees.
2. And under the leadership of the CDC team, we released the Maternal Mortality Review Information Application or MMRIA, a standard data system for review committees that supports the essential functions I previously described.

AMCHP looks forward to partnering with the Office of the Chief Medical Examiner, the Department of Health, and the provider leaders among many others in applying these resources and tools for the review committee’s success.

Before closing, I’d like to make two final points. The first is with regard to the value of action. Maternal mortality surveillance is a cyclical process, and cannot end at simply counting and characterizing deaths. It is the action that is taken from the review process – putting the recommendations of the committee to work in hospitals, communities, or policies – that is the return on the investment of the review committee. Secondly, a signature issue for AMCHP is health equity in maternal mortality; and we know this is a priority topic for the District of Columbia as well. We’re collecting innovative practices and connecting public health leaders with these resources, which include activities like applying a reproductive justice framework to review committee processes, as is used in Virginia, or the bundle developed by the Alliance for Innovation on Maternal Health on Reducing Peripartum Racial and Ethnic Disparities.

In closing, AMCHP applauds the introduction of the Maternal Mortality Review Committee Establishment Act of 2017, and the District of Columbia in joining over half the states and a growing number of cities in the U.S. in taking this critical step forward in preventing maternal death and improving the health of pregnant and new mothers. Thank you for the opportunity to provide testimony.