Healthy Women, Healthy Pregnancies, Healthy Futures

Healthy Women,Healthy Pregnancies,Healthy Futures:SUMMARY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES’ACTION PLAN TO IMPROVE MATERNAL HEALTH IN AMERICADATE OF RELEASE: DECEMBER 2020OVERALL VISIONAs part of the Administration’s broader efforts to improve health in America, the United States (U.S.)Department of Health and Human Services (HHS) is announcing its vision for ensuring the U.S. is oneof the safest countries in the world to give birth.THE PROBLEM658 WOMEN DIEDin the U.S. in 2018as a result ofpregnancy or itscomplications.More than 25,000CASES OF SEVEREMATERNALMORBIDITYoccured in 2017.While the United States has one of the mosttechnologically advanced heath care systems inthe world and should be able to ensure the deliveryof safe, high-quality maternity care, the maternalmortality rate remains stubbornly high. In 2018,the U.S. maternal mortality rate was 17.4 deathsper 100,000 live births, totaling 658 deaths. This ishigher than most other developed and high-incomecountries. Data show that as many as two-thirds ofpregnancy-related deaths are preventable. Moreover,for every maternal death, many more womenexperience serious complications around the time ofdelivery known as severe maternal morbidity.aspe.hhs.govMaternalmortality in theU.S. IS HIGHERTHAN MOSTother developedand high incomecountries.

KEY TARGETS FOR IMPROVEMENTTHE ACTION PLAN AIMS TO ACHIEVE 3 AMBITIOUS, YET ATTAINABLE TARGETS:TARGET 1:TARGET 2:TARGET 3:Reduce the maternal mortalityrate by 50 percent in 5 yearsReduce the low-riskcesarean delivery rate by25 percent in 5 yearsAchieve blood pressure control in 80percent of women of reproductiveage with hypertension in 5 years#1 HHS is focusing on reducing the rate of maternal mortality as its topline target for improvingmaternal health outcomes. Addressing the factors contributing to maternal mortality will translate intoreductions in maternal morbidity that can have important short-term and long- term implications forthe health of mothers and babies. In order to meet the ambitious targets we have set, it will be criticalto address the drivers of poor outcomes for at-risk populations, particularly racial and ethnic minorities.#2 We selected reducing low-risk cesarean deliveries1, as our second target because unnecessarycesareans can result in significant complications, disability, or death. The U.S. has one of the highestrates of cesarean deliveries in the world.#3 We are focusing on improving rates of blood pressure control for women of reproductive agewith hypertension for our third target, since uncontrolled hypertension puts women at higher risk ofexperiencing a number of serious pregnancy complications and at higher lifelong risk of cardiovasculardisease, and cardiovascular disease is a leading cause of pregnancy-related death.13.5BlackAsian/Pacific Islander12.7American Indian/Alaska NativeWhiteHispanic11.240.829.7WA23.1RACIAL DISPARITIES:Pregnancy-relatedmortality for BlackAmericans and AmericanIndian and Alaska Nativewomen are about3 and 2 times higher,respectively, comparedto White, Asian/PacificIslander, and HispanicWomen.Pregnancy Related Deaths per100,000 Live Births by Race/Ethnicity, 2007-2016Source: Petersen, E.E., Davis, N.L., Goodman, D, et al. Racial/Ethnic Disparities inPregnancy-Related Deaths — United States, 2007–2016. MMWR Morb Mortal WklyRep 2019;68:762–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6835a3external icon.MT22.7OR23.8MN22.933%of all pregnancy-relateddeaths were associatedwith cardiovascularconditions in 20112013. The percentagefor severe maternalmorbidity was 23.2percent in V27.3VA25.8MA25.4RI27.8CTNJ .9AK16.7FL30.4HI22.416.731.216.731.8Low-risk cesarean deliveryrates ranging from 16.7 to 31.8per 100 deliveries accross theU.S. exceed the WHO’s globaltarget of 10 to 15 percentThe WHO target rate range is based on allcesarean sections.We are specifically focusing on nulliparous, term, singleton, vertex (NTSV) cesarean deliveries, which occur among women who are pregnant for the firsttime, are at a minimum 37 weeks of gestational age, and giving birth to a single baby (not twins or multiples) that is in the vertex position (positionedin the uterus with the head down). We use this rate because it accounts for the most common medical indications for cesarean delivery: preterm ormultiple births and fetal positioning. The majority of women with a previous cesarean birth have repeat cesareans for subsequent births. Thus, avoiding alow-risk cesarean delivery reduces the likelihood of subsequent cesarean deliveries.1Healthy Women, Healthy Pregnancies, Healthy Futures: Summary of the U.S. Departmentof Health and Human Services’ Action Plan to Improve Maternal Health in AmericaME25.0NC23.3TN26.4AR28.4LA29.3NH27.0NY28.92

SPECIFIC GOALSHOW WILL HHS ACHIEVE THESE TARGETS?In order to achieve HHS’ overall vision,future actions must confront criticalchallenges in addressing the maternalhealth crisis. Key challenges include: Racial disparities Access to care, especially in rural areas Health insurance coverage Variation in clinical practice patterns Data quality and timeliness to informefforts to improve careThe Department’s Action Plan includes four goalsdesigned to achieve the overall vision, whichreflect the importance of bringing a life courseperspective to improving maternal and infanthealth outcomes. A life course approach alsoacknowledges the important roles that socialand economic risk factors and buffers play inaffecting maternal health outcomes. Each goalhas corresponding objectives and HHS actions tohelp achieve each goal. Examples of action itemsfor each objective are highlighted in the last twopages of this document.GOAL 1Healthy Outcomes for All Womenof Reproductive AgePOSTPARTUMGOAL 2Healthy Pregnancies and Birthspoints for women withmedical and social serviceproviders to ensure warningscreenings and treat allGOAL 3young girls, adolescents,Healthy Futuresaccessible informationon parenting skills, self-and women for a varietyof health risk factorssigns are identified andaddressed, and by providingPRE-PREGNANCYperform recommendedmaintain ongoing touchGOAL 4Improve Data and Bolster Researchesteem building and stressmanagement, as well asother family supportsDURING PREGNANCYcontinue prevention efforts intopregnancy to prevent or mitigatethe development of complicationsHealthy Women, Healthy Pregnancies, Healthy Futures: Summary of the U.S. Departmentof Health and Human Services’ Action Plan to Improve Maternal Health in America3

GOAL 1: HEALTHY OUTCOMES FOR ALL WOMEN OF REPRODUCTIVE AGEObjective 1.1: Improve preventionand treatment of cardiovasculardisease for women of reproductiveage, such as by more effectivelycontrolling blood pressure andpreventing hypertensionExample of HHS Action: Launch the initial implementation of anational 3.3 million prize competition in Fiscal Year 2020 to identifyeffective, innovative models to ensure women with hypertensionduring pregnancy and postpartum receive appropriate monitoringand follow-up care. This competition will allow the Departmentto identify, validate, and promote replication of programs thatsuccessfully target gaps in management of hypertension.Objective 1.2: Encourageevidence-based preventive anddisease management servicesfor other significant medicalrisk factorsExample of HHS Action: Disseminate new models and promisingpractices of integrating pre-pregnancy health screening and followup into primary care and other clinical settings through the HealthResources and Services Administration’s Preconception CollaborativeImprovement & Innovation Networks, including creation of a providerpractice bulletin and consumer/patient education materials.GOAL 2: HEALTHY PREGNANCIES AND BIRTHSObjective 2.1: Align providerpayment with positive outcomesand quality improvementachievements, such as reducinglow-risk cesarean deliveriesExample of HHS Action: Develop and publicly report quality measuresrelated to maternal mortality and morbidity in the CMS HospitalInpatient Quality Reporting Program, including a comprehensivematernal morbidity electronic clinical quality measure; a structuralmeasure on participation in a Perinatal Quality ImprovementCollaborative Program; and a cesarean delivery measure.Objective 2.2: Supportefforts to expand adoptionof evidence-based clinicalbest practices in maternalhealth and obstetricsExample of HHS Action: Invest in the Alliance for Innovation onMaternal Health (AIM) program by: Expanding participation in the AIM hospital-based safety bundlesto all 50 states, Washington D.C., Territories and Tribal Communities; Developing new AIM hospital-based safety bundles oncardiovascular disease and maternal sepsis; Implementing additional AIM patient safety bundles at all IndianHealth Service (IHS) federal facilities; and Developing and deploying new AIM bundles to address care at anational level provided in outpatient and other community settings.Objective 2.3: Improve accessto high-quality prenatal careand delivery services for at-riskpopulationsExample of HHS Action: Develop a program of Rural ObstetricReadiness in 2021 for rural IHS sites that include an EmergencyDepartment but do not have on-site Labor and Delivery services.This “OB Ready” program will include staff development withongoing training and drills, resource development with assuranceof access to necessary equipment and medications, and integrationwith regional maternity care and transportation networks.Healthy Women, Healthy Pregnancies, Healthy Futures: Summary of the U.S. Departmentof Health and Human Services’ Action Plan to Improve Maternal Health in America4