The NCSL Blog


By Kate Bradford

Nashville—States have made tackling the infant and maternal mortality crisis a priority, though the issue remains challenging.

Addressing the MaLeft to right: Dr. Rick Foster, Dr. Joia Crear-Perry, Dr. Michael Warren, and Senator Toi Hutchinson. ternal and Infant Mortality Crisis, a session held during NCSL’s Legislative Summit in Nashville, provided insight into how some state legislatures are addressing the issue.

In the U.S. and worldwide, infant mortality rates are improving. During the past decade in the U.S., infant deaths within the first year of life have fallen by 15%. While this rate is on a steady decline, it is higher than in many developed countries.

“We have reason to celebrate, but still a long way to go,” noted panelist Dr. Michael Warren, associate director of the Maternal and Child Health Bureau within the Health Resources and Services Administration.

Meanwhile, after decades of improvement, the maternal mortality rate in the U.S. has been on the rise since the 1990s. Every year, between 700-900 women die from pregnancy-related causes during or within one year of pregnancy.

Racial and geographic disparities persist among these rates. In 2017, the infant mortality rate for black infants reached the same rate as for white infants in 1980, a near 40-year lag. Black women are more than three times as likely to die from pregnancy-related complications than white women.

“You cannot fix what you do not see,” remarked Senator Toi Hutchinson (D-Ill), NCSL’s immediate past president. 

Panelists highlighted the importance of recognizing that wide social, economic and cultural factors shape maternal experiences and health outcomes.

If a mother isn’t healthy, including the time before a pregnancy, both the mother and child stand a higher risk of morbidity and mortality. Dr. Joia Crear-Perry, founder and president of the National Birth Equity Initiative, named a variety of social and societal risk factors affecting maternal health, such as unemployment, food insecurity, low educational attainment and lack of access to transportation and health care. She also named societal and institutional racism as a factor that influences health.

With this in mind, state legislatures are leading various efforts to support their maternal and child health populations. California stands out amid the crisis. Together with the Stanford University School of Medicine, the state in 2006 founded the California Maternal Quality Care Collaborative (CMQCC)—an organization committed to ending preventable morbidity, mortality and racial disparities in maternity care. Since then, California’s maternal mortality rate declined and it currently boasts one of the lowest maternal mortality rates in the country, though the gap between white and black women has remained.

Across the country, South Carolina is experiencing success in reducing infant mortality. Thanks to a collaborative model for improving maternal and child health, the South Carolina Birth Outcomes Initiative (SCBOI), the state has seen a 30% reduction in infant mortality, according to panelist Dr. Rick Foster, executive director of the Alliance for a Healthier South Carolina and Senior Population Health Advisor for the South Carolina Hospital Association. Started in 2011, SCBOI aims to address infant mortality and low birth weight babies while reducing health costs and improving maternal health. Various programs under SCBOI reduce early-elective deliveries and screen pregnant women for risk factors such as substance abuse, depression and domestic violence, all while saving state dollars.

Two lawmakers offered remarks about specific legislative topics surrounding this issue in their states. Representative Emilia Sykes (D-Ohio) spoke about ensuring and extending Medicaid coverage after birth and increasing minimum wage and paid family leave. Representative Cindy Ziemke (R-Ind.) discussed removing Medicaid copayments and the importance of facilitating tobacco cessation.

On top of state action, several federal programs support maternal and child health. In 2014, MCHB launched the Alliance for Innovation on Maternal Health, a national organization to promote consistent and safe maternity care among states and their hospital networks. Additionally, the Maternal, Infant and Early Childhood Home Visiting program provides evidence-based home visiting services to families, offering prenatal support and assistance to mothers on how to best care for their babies.

Though the maternal and infant mortality crisis is longstanding, progress continues to be made. So far during the current 2019 legislative session, 21 states have enacted new bills related to maternal and infant mortality and morbidity. For more up-to-date information on this, NCSL provides an interactive maternal and child health database that includes bills from 2018 to the current session.

Additional Resources

Kate Bradford is a research analyst I in NCSL’s Health Program.

Email Kate.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.