A new report from the California Pregnancy Mortality Surveillance System (CA-PMSS) project was recently released, providing information on California’s pregnancy-related deaths (including those up to one year after the end of pregnancy) occurring from 2008 through 2016. This is the first report from CA-PMSS—a project of the Maternal, Child and Adolescent Health (MCAH) Division of the California Department of Public Health which began in 2018. The Pregnancy-Related Mortality Ratio (PRMR) generated from CA-PMSS is becoming widely adopted as a more accurate measure of maternal deaths than the Maternal Mortality Ratio (MMR).

Previously, the Maternal Mortality Ratio (MMR) was calculated based on death certificate data alone, but the CA-PMSS project is able to calculate a more accurate account of pregnancy-related deaths by linking vital records and hospitalization data, supplemented with coroner and autopsy reports and medical records. The data in the report show a continued widening racial disparity in birthing outcomes between Black mothers/birthing persons and women/birthing persons of other ethnicities. 

Here are some highlights from the report:

• During the reporting period, 1,934 women died while pregnant or within one year of the end of pregnancy. Nearly one-third (608) of these deaths were related to pregnancy.
  
• In 2014-2016, the PRMR for Black women/birthing persons was four-to-six times greater than the mortality ratios for women/birthing persons of other racial/ethnic groups including White, Hispanic/Latina and Asian/Pacific Islander
  
• From 2008-2010, the pregnancy-related mortality ratio (PRMR) for Black women/birthing persons was 49 deaths per 100,000 live births as compared to 13.8 for Asian/Pacific Islanders, 13.9 for Hispanic/Latinas, and 14.2 for Whites. From 2011-2013, the PRMR for Black women/birthing persons was 45.3 deaths per 100,000 live births as compared to 10.7 for Asian/Pacific Islanders, 7.8 for Hispanic/Latinas, and 12.6 for Whites. From 2014-2016, the PRMR for Black women/birthing persons was 56.2 deaths per 100,000 live births as compared to 13.3 for Asian/Pacific Islanders, 11 for Hispanic/Latinas, and 9.4 for Whites.
  
• Across the state of California, Los Angeles-Santa Barbara-Ventura Counties had the second highest maternal mortality ratio after the South Central Valley.
• Older age, obesity, reliance on public insurance, and living in less advantaged communities may have contributed to higher PRMR for all racial/ethnic groups.
  
• The top five leading causes of pregnancy-related deaths were cardiovascular disease (28%), sepsis or infection (17%), hemorrhage (15%), hypertensive disorders (13%) and thrombotic pulmonary embolism (7%).
• Black women were overrepresented among pregnancy-related deaths from all causes, especially deaths that occurred in pregnancy prior to birth or after delivery hospitalization (7-42 days and 43-365 days after pregnancy ended).

An urgent need for the work of the African American Infant and Maternal Mortality (AAIMM) Prevention Initiative continues in an effort to correct these disproportionate pregnancy-related deaths, as well as promote ongoing access to timely data. The collective efforts of the AAIMM coalition and its partners on behalf of Black families in Los Angeles County remains impactful and meaningful as we continue to fight for safe, equitable, and healthy birthing outcomes for all.

For more information on the AAIMM initiative, please visit www.blackinfantsandfamiliesla.org.

To read more about the report and see additional highlights, please visit the CA-PMSS website.