Let's Count Every Body: Current Data Collection Efforts in the United States

The United States is experiencing an epidemic of maternal mortality, one that is disproportionally felt among women of color and the economically disadvantaged. American women have a documented higher lifetime risk of dying from pregnancy-related causes than 40 countries; however, U.S. agencies admit that the national maternal mortality rate may be twice as high as reported. Quality data on the number of women dying from pregnancy-related causes is difficult to collect around the world and underreporting has been documented in both developed and developing countries. The barriers and challenges to data collection vary from nation to nation, but in developed countries the underreporting is likely due to misclassification of cause of death as unrelated to pregnancy or childbirth, or omission of a current or recent pregnancy on a death certificate. Current data collection efforts in the US are flawed in that 1) there is no standardized definition for maternal mortality across monitoring systems, 2) disagreement exists between reporting agencies on length of time past pregnancy or delivery that a woman's death can be considered as pregnancy-related, 3) compulsory reporting of maternal mortality statistics is not required of States, 4) lack of consistency across States in inclusion and/or wording of pregnancy-related questions on death certificates, and 5) the absence of maternal mortality review board committees in many States. This research synthesizes the methodological summaries of definitions, methods, and systems used to monitor maternal mortality in the U.S and makes recommendations for improved data quality.