Oversight Gaps and Poor Coordination Stymie Efforts to Combat Maternal Mortality in AZ

In 2019, federal officials allocated over $2 million to Arizona’s Maternal Mortality Review Committee, aiming to address the state’s troubling maternal death rates. This funding was part of a larger national initiative, instructing the committee to enhance its case analysis processes and devise preventive measures for future fatalities.

The committee’s recommendations have included broadening access to mental health services for expectant mothers and expanding insurance coverage for practitioners such as doulas and midwives. Arizona has begun implementing some of these suggestions, but significant gaps remain due to insufficient oversight and coordination, as highlighted by health advocates.

“Our question is: Where do these recommendations go, and who is responsible for implementing them?” asked Cara English, a committee member and CEO of the Cummings Graduate Institute for Behavioral Health Studies. English emphasized the need for unified responsibility to expedite life-saving measures.

Despite the legislative establishment of the review committee, state lawmakers have not closely followed up on its findings, according to Senator Sally Ann Gonzales, a member of the Senate’s Health and Human Services Committee. This lack of action is concerning as nearly 90% of pregnancy-related deaths in Arizona are deemed preventable, often linked to systemic barriers such as inadequate access to perinatal care and socio-economic challenges.

Statistics reveal that around 71 pregnant or postpartum women in Arizona die annually, with Black and Indigenous women disproportionately represented. Rural areas are also witnessing a rise in maternal mortality rates.

“We’re not doing enough,” Gonzales stated, adding that legislators should not only focus on implementing the recommendations but also track their outcomes closely. She suggested expanding successful programs, such as home visit initiatives and campaigns aimed at reducing the stigma surrounding maternal mental health issues.

Current challenges include the lag in data reporting, with the Maternal Mortality Review Committee’s latest analysis spanning the years 2018-2019. Members are now reviewing 2021 data, a delay that complicates the evaluation of recent interventions.

Despite some triumphs, such as extending Medicaid coverage to a year postpartum and establishing a perinatal psychiatric helpline, significant hurdles remain. Elizabeth Wood, a committee member, recognized the improvements but noted, “We are definitely still getting our feet under us.”

Arizona has partnered with tribal nations to combat high maternal death rates among Native American women and now reimburses certified doulas through the Medicaid program. Such community care providers fill essential gaps, especially in rural settings where access to traditional healthcare is limited.

Advocacy organizations play a vital role, providing resources and education to families and healthcare officials, which is crucial given the state health department’s budgetary constraints. Jennie Bever, a member of the Arizona Maternal Health Policy Coalition, acknowledged the systemic challenges but remains hopeful.

On the state health department’s part, recent initiatives include educational campaigns to raise awareness of pregnancy-related complications and a resource guide for mothers dealing with substance abuse issues. However, repeated requests for detailed discussions on these matters were declined.

English, Wood, and Bever are involved with the national Policy Center for Maternal Mental Health, which focuses on equipping advocates with strategic policy training. They aim to target specific issues rather than attempting to address the multifaceted maternal mortality crisis all at once.

As mental health concerns contribute significantly to pregnancy-related deaths, efforts are underway to enhance training for OB-GYNs and other professionals regarding perinatal mental health. Moreover, Bever is advocating for Medicaid coverage of lactation counseling to support new mothers.

Despite the long journey ahead, advocates are optimistic. “It’s not going to be fixed in a day, a year, maybe even 10 years,” Bever remarked. “But I believe we can gradually address the broken pieces.”

AZCIR’s Natasha Yee contributed to this report.