Ledes from the Land of Enchantment

N.M. ‘far above the national rate’ even as maternal deaths increase across the country

Public health experts said maternal deaths in New Mexico continue to be “overwhelmingly preventable” according to findings for an annual report from a committee reviewing deaths of people during and after pregnancy.

In a presentation last week before the Health and Human Services interim committee, public health experts said the state needs to ensure more access and expand health care to address disparities such as: age, race and substance use disorders.

“86% of pregnancy-related deaths have been determined to be preventable by our committee,” said Abigail Reese, who manages the Maternal Health Program for the New Mexico Department of Health.

The New Mexico Maternal Mortality Review Committee is a volunteer board, which reviews every death occurring during pregnancy or within one year. The committee tracks causes, contributing factors, determines how preventable deaths are and makes recommendations to prevent more deaths.

State legislation passed in 2018 restarted the board after a long hiatus. The committee received five years of funding in 2019 from the federal government to address high maternal mortality rates, which are worsening in the United States.

Nationally, Black women are most impacted. This group reports maternal mortality related deaths at a rate 2.5 higher than other people, according to a 2021 report for Centers for Disease Control and Prevention. Native American and Native Alaskan women are second highest nationally, with a death rate double that of other people.

Racism in health care, discrimination and structural factors such as higher rates of poverty and longer distances to travel for quality health services are all factors in Black and Indigenous people’s deaths across the U.S., researchers said.

The grim findings

New Mexico has higher rates of maternal mortality per capita compared to the nation and more people unable to access adequate care during pregnancy, Reese said.

Nationally, the pregnancy-related mortality ratio through 2019 was 17.3 deaths per 100,000 live births. For New Mexico through 2020, the ratio is 31.2 deaths per 100,000 births.

“We’re far above the national rate, that it’s something we need to consider urgent,” Reese said.

Fewer people are dying from pregnancy-related causes, and most deaths are within the first year after giving birth, accounting for 79% of deaths. This includes deaths from suicide and overdoses – which are difficult to determine if intentional or accidental, Reese said.

“Mental health conditions, especially substance-use disorders, remain the most significant contributing factors to maternal mortality in our state,” Reese said.

Substance use was a factor in more than half of deaths, and was a “huge driver” in pregnancy related deaths.

“That means we need to do more to direct treatment and resources and support to people who are navigating substance use while pregnant and in the postpartum period,” Reese said.

Reese presented graphs of the findings between 2015 and 2020. They showed mental health deaths outstripped cardiac conditions, hemorrhage and other medical conditions in the 44 deaths directly related to managing the pregnancy.

Injuries including deaths in car crashes, overdoses and intimate partner violence were factors in 68 of the deaths between 2015 and 2020.

Other concerning trends are high mortality ratios for Native American women, and people over the age of 35.

Graphic showing New Mexico’s pregnancy-associated mortality rates broken down by race and ethnicity. (Courtesy of New Mexico Department of Health)

The “significant discordance,” Reese said, was about Native American maternal deaths in New Mexico, a ratio of 129.3 deaths per births.

“There is no explanation, as we all know, based at all in biology, so we need to get to the bottom of why this is happening,” Reese said. “It is consistent with national data as well and is our responsibility to solve.

The committee is now reviewing how the coronavirus pandemic shaped maternal mortality in the state, Reese said, noting that she only had preliminary data for 2021, but that it was concerning.

“We have identified 48 deaths to review, and that is more than twice the number of any previous year,” she said.

Increasing prevention and care

Preventing maternal deaths in New Mexico means addressing the system as a whole. Reese said it does not just mean increasing access to care, and addressing biases in a hospital or clinical setting.

The committee’s findings showed that many cases it reviewed had environmental stressors, such as intimate partner violence, unemployment and state welfare involvement.

A graphic showing environmental stressors which may have contributed to pregnancy-related deaths in New Mexico. (Courtesy of New Mexico Department of Health)

“People are dealing with lots of stressors, and they go beyond their immediate health condition and health care needs, which helps us remember that our services need to be trauma-informed and comprehensive and think about people in the full context of their lives,” Reese said.

In 2025, the state will convene a new maternal health task force, under a five-year $981,000 federal grant for maternal health innovation to the state’s health department. The task force will be the “implementation space,” Reed said, for recommendations from the committee.

Requiring certified nurse midwives to take anti-bias training to keep their certifications, is another suggestion recommended by the study. Reese said adding that would not require additional state funding.

Medicaid factors

Alanna Dancis, a nurse practitioner and chief medical officer for New Mexico’s Medicaid program, said that recommendations will need to focus on increasing substance use and behavioral health treatments.

Most of the deaths reviewed between 2015 through 2020 were people covered by Medicaid, which Reese stressed was not a casual relationship. Medicaid is a federal program run by states which provides health care for low-income people and children, people with disabilities and older people.

The department of health, behavioral services and other state departments will offer more recommendations for how to use medicaid to reduce maternal deaths.

“This particular council that we are forming is going to be about pregnancy and pregnant people and their mortality, and really focusing in on that problem,” Dancis said.

In 2022, New Mexico expanded Medicaid coverage during pregnancy to cover appointments through 12 months after giving birth. This was funded partly by $14.4 million in the state budget and additional matching federal funds, said New Mexico Department of Human Services spokesperson Marina Piña.

New Mexico included the expansion in its latest waiver for Medicaid managed care, called Turquoise Care. That coverage begins in July 2024. Federal officials are still reviewing the application for the program but the state Department of Human Services expects partial approval before July and “a full approval” in January 2025, according to Piña.

The waiver request expands the Medicaid home-visiting programs to allow people who’ve already given birth to enroll. These programs include parent coaching and services for people with substance use and behavioral health issues.

Another concern is the patchwork of providers to give necessary care, whether for substance use, medical help or childcare support. In the past decade, at least six New Mexico hospitals closed their maternity wards, meaning many women have to travel farther to receive treatment and give birth.

Labor pains: Delivery rooms closed at a Gallup hospital as employees resign

There are hopes to pay hospitals to slow and stop closures of maternity wards, Dancis said. She told lawmakers the state is planning for payments to rural hospitals with obstetrics wards, saying that will try to address hospital concerns with higher overhead, and requiring specialized care for a low volume of patients.

She also said the state is in the beginning stages of a broader telehealth program to “reduce people’s need to be on the road and traveling for services.”

At the end of the presentation, Sen. Gerald Ortiz y Pino (D-Albuquerque) asked if drugs used in medication-assisted treatments to treat opioid addiction – such as methadone and suboxone – impact a fetus if used during pregnancy.

Reese responded that she is “not a clinical expert in this issue,” but said that they are life-saving treatments.

“It is absolutely recommended and best practice for people who are navigating an opioid-use disorder to have this treatment made available to them,” she said.

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