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Tribally-led Maternal Mortality Review Committees (MMRCs)

Background

American Indian/Alaska Native (AI/AN) populations face a significant maternal mortality burden. Specifically, AI/AN women are two to three times more likely to die of pregnancy or birth complications than non-Hispanic white women. While these committees are extremely valuable, there are currently no Tribally-led MMRCs and very few state MMRCs have Tribal representation.

With support from the Centers for Disease Control and Prevention, Division of Reproductive Health NIHB is working to assist Tribes and Tribal organizations in exploring the possibilities of designing and implementing Tribally-led MMRCs.

Maternal Mortality Review Committees

Maternal Mortality Review Committees (MMRCs) are multidisciplinary committees that currently convene at the state or local level to comprehensively review deaths of women during or within a year of their pregnancy. The goal of the review process is to identify and implement recommendations to inform public health and clinical improvements to reduce maternal deaths and to improve wellness. MMRCs have shown that two out of every three pregnancy-related deaths are preventable.

Tribally-led Maternal Mortality Review Committees (fact sheet, pdf)


What have we done so far?

  1. In February 2020, NIHB held a stakeholder meeting at the California Rural Indian Health Board. NIHB contacted Area Indian Health Boards for recruitment, and representatives from 11 IHS areas were able to attend. The meeting served to provide more information about MMRCs and discuss the possibilities of Tribally-led MMRCs. Meeting participants brainstormed possible models for Tribally-led MMRCs and NIHB developed this document based on the discussion. Potential Models for Tribally-led MMRCs
  2. NIHB hosted an MMRC informational webinar in October, 2020 called Safe Motherhood: An Informational Webinar on Maternal Mortality in Indian Country. You can view the webinar below.
  3. Funding opportunity:

    NIHB is requesting applications for a new opportunity for supporting maternal American Indian and Alaska Native maternal health through Tribal-led MMRCs. NIHB anticipates funding for up to 12 proposals from Tribes, Tribal consortia, and Tribal organizations for up to $7,500 each. Through this opportunity, grantees will participate in a self-assessment over an 8-month period to explore key components of Tribal-led MMRCs and assess their readiness to establish and sustain a Tribal-led MMRC. The application deadline is Friday, September 17, 2021 at 11:59pm Eastern Time.

    Eligibility:

    To be considered eligible for this funding opportunity, the following criteria must be met:

      1. Applicants must be an official Tribal entity defined as a federally recognized Tribal Government, Tribal organization, or inter-Tribal consortium as defined in the Indian self-determination and Education Assistance Act, as amended.
      2. Applicants must have a strong interest and/or demonstrated commitment to improving AI/AN maternal health outcomes.

    Pre-Application Webinar:

    NIHB hosted a pre-application webinar on Tuesday, August 31, 2021 from 2:00pm-2:45pm EST to walk through the application process. To watch a recording of this webinar, click here.

    Please read the full funding description and download the application package by clicking the link below:

    RFA Tribal-led MMRC Self-Assessment

    If you have any questions, please contact Mattie Curry at [email protected].


Policy

Preventing Maternal Deaths Act (PL115-34)

In 2018, Congress passed the Preventing Maternal Deaths Act (PL115-344) that includes specific language supporting the creation of state and Tribal MMRCs. It also reauthorized funds and revised certain programs by the Centers of Disease Control and Prevention (CDC) that support state and local surveillance of maternal mortality.

https://www.congress.gov/bill/115th-congress/house-bill/1318/text

Maternal Health Quality Improvement Act

The Maternal Health Quality Improvement Act (H.R. 4995) was passed by the House and is currently in committee in the Senate. This act includes language from H.R. 4215, Excellence in Maternal Health Act. It serves to amend the Public Health Service Act to improve obstetric care and maternal health outcomes. This will also authorize grants to identify, develop, and disseminate maternal health quality best practices, support training for health professionals, and operating innovative evidence-based programs that deliver integrated services to pregnant and postpartum women.

https://www.congress.gov/bill/116th-congress/house-bill/4995/text

Data to Save Moms Act

The Data to Save Moms Act of 2020 (H.R.6165), still in the House and a part of the “Momnibus” package, includes specific language on funds for Tribes, Tribal Organizations, and Urban Indian Organizations to have MMRCs. Specifically, the bill will establish the Task Force on Maternal Health Data and Quality Measures, along with grants for MMRCs, to address maternal mortality and morbidity among women in minority populations. The task force will evaluate maternal health data issues and provide recommendations to improve care. The Department of Health and Human Services (HHS) will be able to award grants for establishing MMRCs with the purpose of including community representation on the committees. The MMRCs must also consult with community-based organizations about social determinants adverse maternal health outcomes and review not only maternal deaths, but certain cases of severe maternal morbidity as well.

https://www.congress.gov/bill/116th-congress/house-bill/6165


Resources

Changing Woman Initiative (CWI)

The Changing Woman Initiative is a Native American, woman lead non-profit organization, founded by Nicolle Gonzales, with the mission of renewing cultural birth knowledge to empower and reclaim indigenous sovereignty of women’s medicine and life teachings to promote reproductive wellness. They offer services such as traditional home births and access to a women’s clinic, along with working towards building a traditional birthing center. On their website they feature digital stories to capture the birth stories of several women. To watch the videos, click the link below.

Digital Stories: http://www.changingwomaninitiative.com/digital-stories.html

Review to Action

Review to Action is a resource supported by the Association of Child Health Programs (AMCHP) and Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM), administered by the CDC, partnership. Its goal is to promote and support state-led MMRCs as the best way to understand and address maternal mortality. Review to Action also has a resources center to support planning and implementing an MMRC. To learn more, click the link below.

https://reviewtoaction.org/

Black Maternal Health Momnibus Act of 2021, Full Package

The Black Maternal Health Momnibus Act of 2021 builds on existing legislation to comprehensively address all facets of the maternal health crisis. The package contains 12 individual bills, including the Data to Save Moms Act, sponsored by Black Maternal Health Caucus members. These bills will also greatly impact maternal health for Tribal communities. Through the Black Maternal Health Caucus website, you can read about each of the 12 bills contained in the Momnibus package in more detail.>

To learn more, click here

CDC's Maternal Health Webpage

The CDC has a webpage specifically for maternal mortality, and the different ways they are addressing the issue. Their webpage also contains different surveillance and assessment resources for monitoring and addressing maternal mortality. To learn more, click the link below.

https://www.cdc.gov/reproductivehealth/maternal-mortality/index.html

This webpage is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $200,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.




Public Health Inquiries:

Tyler Dougherty, MPH
Director of Public Health Policy and Programs

National Indian Health Board
910 Pennsylvania Ave, SE
Phone: 202-922-0100
Washington, DC 20003
[email protected]