(Boise, ID) The rate of Idaho mothers who die while pregnant, or up to a year after giving birth, has sharply declined, an Idaho medical expert panel found in a new report released Thursday.
Compared to Idaho’s 2021 maternal death rates, the Idaho Maternal Mortality Review Committee’s new 2023 report suggests pregnancy-related deaths decreased by 44.4% and pregnancy-associated deaths decreased by 31.25%. But those statistics are based on only handfuls of maternal deaths reported each year, so differences in even a few deaths reported result in large percentage shifts.
Medical error or denial of care “were not contributing factors in any of the reviewed cases,” the report found. But most Idaho maternal deaths remained preventable, the report found.
The newly reassembled Idaho Maternal Mortality Review Committee’s report analyzed Idaho maternal deaths in 2023. The committee last issued a report analyzing data from 2021, before Idaho state lawmakers let the committee expire in 2023. State lawmakers reinstated the committee in 2024, but placed it within the Idaho Board of Medicine instead of the Idaho Department of Health and Welfare, where it was previously housed.
Staff with the Idaho Division of Professional and Occupational Licenses, the parent state government agency of the Board of Medicine, plan to speak to the Idaho Senate Health and Welfare Committee at 3 p.m. Tuesday, agency spokesperson Bob McLaughlin told the Sun on Thursday. The agency declined to make officials available for an interview this week, saying the agency would address written questions after it speaks to House and Senate committees.
Committee found two of 13 deaths weren’t pregnancy associated
The Idaho Maternal Mortality Review Committee’s report said the committee reviewed 13 deaths in 2023. But the committee found two of those deaths didn’t meet criteria to be considered pregnancy-associated.
Only five of the 11 maternal deaths the committee found were pregnancy-associated were actually “pregnancy-related,” meaning the death was due to pregnancy complications, events initiated by pregnancy, or a condition aggravated by pregnancy. The committee found the other six maternal deaths were “pregnancy-associated but not related deaths,” which means they were due to a cause unrelated to the pregnancy.
Comparing Idaho’s maternal death rate to the U.S.’s national maternal death rate is complicated, the report noted, due to differences in deaths included, Idaho’s few maternal death reports, and national rates for recent years not being published yet.
Idaho Voices for Children Senior Health Policy Coordinator Ivy Smith told the Sun in an interview on Thursday that the organization is asking the new Idaho Maternal Mortality Committee to reinstate a methodology she said is widely believed to be the most accurate at fully accounting for maternal death trends.
“Our biggest concern is that, over the past five years, there have been several different methodologies used, leading to data discrepancies which can greatly skew data and not accurately portray health trends for pregnant women within the state,” she said.
That methodology, called the Idaho Maternal Mortality Review Committee Pregnancy-Related Mortality Ratio, defines a pregnancy-related death as “the death of a women while pregnant or within 1 year of the end of a pregnancy — regardless of the outcome, duration or site of the pregnancy — from any cause related to or aggravated by the pregnancy or its management,” according to Idaho’s 2020 report.
“Without a consistent methodology being reported and used, Idahoans won’t be able to accurately compare data and therefore, be able to see how different policies or system changes are making impacts on maternal health,” Smith told the Sun.
The committee’s report recommended a range of efforts focused on “increasing awareness, education, and access to health care, particularly for at-risk populations.”
The committee’s report was due to the Idaho Legislature by Friday, as required in the new law re-establishing the committee.
This year, the Idaho Maternal Mortality Review Committee plans to review maternal death data for 2022 and 2024 for future reports.
The committee estimates there were 15 maternal deaths in 2022, and five in 2024, based on preliminary data from the Department of Health and Welfare. But the committee’s report says that figure might change pending final reviews.
Most maternal deaths remain preventable, Idaho Maternal Mortality Review Committee finds
Since 2019, 95% of the 45 maternal death cases Idaho’s Maternal Mortality Review Committee reviewed “have been determined to have some level of preventability,” the new report found.
In 2023, the committee only found one case was not preventable. Deaths are considered preventable, the committee’s report said, if the committee finds “there was at least some chance of the death being averted by one or more reasonable changes to patient, community provider, facility, and/or system factors.”
Pregnancy-related deaths are “generally more preventable than” deaths associated with but not related to pregnancy, the report found. Most of the pregnancy-related death outcomes in 2023 “may have been altered if additional healthcare interventions were sought,” the report found.
Nearly half, 45.5%, of maternal deaths in Idaho in 2023, didn’t occur in women who were pregnant — but who were between 43 days and one-year postpartum.
Almost two-thirds — 64% — of all Idaho maternal deaths in 2023 were among women who live in urban counties, while 36% lived in rural counties, the report found.
Mental health conditions remain Idaho’s leading cause of pregnancy-related mortality. What the report recommended.
In Idaho, mental health conditions remain as the leading cause of pregnancy-related mortality. Infection or sepsis — the leading cause of pregnancy-related deaths in the U.S. in 2020 and 2021 — have been the second leading cause of Idaho maternal deaths since 2018, the report found.
Idaho’s 2023 pregnancy-related death findings “highlight that women with pre-existing conditions have a higher risk of dying during pregnancy and for a year after childbirth.”
The report said patients, medical providers and health care systems “must actively work to address and manage these conditions.”
“The highest accumulated risk group for maternal deaths has been unmarried women,” the report said, citing data since Idaho’s maternal mortality review committee was founded in 2018. Unmarried women account for 47% of “all recorded deaths” from 2018 to 2021 and 2023, the report found.
One of five pregnancy-related deaths “occurred due to the woman not seeking medical care during or after the pregnancy,” the report found. “Communities exist in Idaho that do not utilize modern medicine and are at higher risk of adverse pregnancy outcomes if complications arise.”
Two of the six women who experienced pregnancy-associated deaths “had illicit substances in their system at the time of death as confirmed by positive autopsy reports,” the report found. One of these “had an extensive history of substance use disorder that may have been compounded by cycling in and out of incarceration during the pregnancy.”
The report recommends educating all women who are newly pregnant on medication safety, during pregnancy and breastfeeding, and encouraging mothers to continue taking prescribed medication until they can talk with their doctor. And it urges awareness among health care providers, especially providers in rural areas, about the importance of hemorrhage screenings during pregnancy.
The report also encourages rural medical providers to offer telehealth visits to patients who might delay or avoid care “due to distance, cost, or other barriers.”
The report recommends the Idaho Legislature consider “investigating the current access landscape for pregnant and postpartum women, including those incarcerated, for evidence-based treatments, including pharmacologic agents, for substance use disorder.”
Report data suggest ethnicity, education levels play a part in maternal death risk
In 2023, all racial or ethnic groups besides non-Hispanic whites that had pregnancy-associated death reports appeared to be at highest risk for maternal death, the Idaho Capital Sun’s review of the report found. Hispanic whites, American Indians/Alaska Natives and Asians accounted for a higher proportion of Idaho’s maternal deaths than their makeup of the population, suggesting deaths were more common among those ethnic groups.
But the report said the committee “found no direct evidence” that the 2023 pregnancy-associated deaths “were attributable to any form of discrimination.” No pregnancy-associated deaths in Idaho in 2023 were reported among non-Hispanic Blacks, Pacific Islanders or people who are bi-racial.
In 2023, the report found:
- Non-Hispanic whites accounted for 46% of pregnancy-associated deaths, but make up 80.3% of the population.
- Hispanic whites accounted for 27% of pregnancy-associated deaths, but make up 13.8% of the population.
- American Indians/Alaskan Natives accounted for 18% of pregnancy-associated deaths, but they make up just 1.7% of the population.
- Asians accounted for 9% of pregnancy-associated deaths, but they make up only 1.7% of the population.
The report found trends suggest higher levels of education attainment makes dying while pregnant, or within a year postpartum, less likely. Nearly two-thirds, 64%, of all pregnancy-associated deaths were among people who graduated high school or received GEDs, or people who attended college somewhat but didn’t receive a degree.
This story first appeared on Idaho Capital Sun.
