Maternal deaths are increasing in the U.S., and in Arizona, which has one of the nation’s highest pregnancy-related death rates, they are rising faster than the national average.
A report released earlier this year from the Arizona Department of Health Services’ Maternal Mortality Review Program found that pregnancy-related deaths increased by 44% between 2016 and 2019. Black and Native American moms were already at a higher risk of death during or within a year of pregnancy but saw a more rapid increase in the maternal mortality rate than other racial and ethnic groups in Arizona.
The issue of maternal mortality in Arizona remains a critical concern, reflecting challenges that the state is grappling with despite advancements in health care.
The prescription is clear: We need to take a comprehensive approach to maternal health care. This involves providing extensive prenatal and postpartum support, mental health and substance use treatment services, ensuring timely care coordination between healthcare providers, and addressing social factors that influence health.
Most maternal deaths are preventable. The Arizona Department of Health Services’ report highlights the importance of standardized care protocols and community education. Many organizations across the state are making changes and implementing new programs to improve pregnancy outcomes and save lives.
Hospitals and providers are important partners in this work. The Arizona Hospital and Healthcare Association leads the Arizona Alliance for Innovation on Maternal Health Collaborative, focusing on evidence-based practices and safety bundles to improve maternal health outcomes before, during, and after labor and delivery. By sharing knowledge and implementing best practices, hospitals aim to reduce maternal mortalities and enhance overall care.
Arizona’s Medicaid agency, the Arizona Health Care Cost Containment System, known as AHCCCS, has implemented several initiatives to improve maternal health for members, including a focus on perinatal mental health conditions — the number one underlying cause of maternal mortality. AHCCCS is also implementing new quality and community initiatives to address health disparities such as expanding obstetrics and gynecology care in rural areas.
One of the most critical areas to improve is mental health support for people before and after giving birth. The physical causes of death, such as hemorrhage and preeclampsia, often receive the most attention when discussing maternal health. While these areas are vital to address, mental health complications actually contribute to more deaths — a fact many people are surprised to learn.
AHCCCS emphasizes postpartum care to assess and treat members’ physical, psychological and social well-being after pregnancy, regardless of how the pregnancy ends. In 2023, AHCCCS extended postpartum care to 12 months.
This policy change means that members who previously would have only had 60 days of postpartum coverage are now eligible for healthcare coverage for a full year — a crucial period for Arizonans recovering from childbirth. It extends the opportunity to address complications that contribute to postpartum morbidity and mortality, ensures access to ongoing mental health care, and provides an opportunity to manage infant care.
It is critical to raise awareness about maternal health. Educating communities, patients and providers, implementing outreach programs, and initiating culturally responsive projects can empower pregnant and postpartum people to seek timely care.
By focusing on preventive measures, equal access to care, and community engagement, we can make Arizona a safer and more equitable place to give birth and raise a family, impacting generations to come.
Rachael L. Salley, MPH, is the Maternal Child Health Manager for AHCCCS, Arizona’s Medicaid agency.
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