August 03, 2023

Missouri’s maternal mortality report published

Top causes of pregnancy-related death: mental health, cardiovascular issues and homicide

Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services
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JEFFERSON CITY, MO – The Missouri Department of Health and Senior Services (DHSS) has published A Multi Year Look at Maternal Mortality in Missouri: 2018-2020 Annual Report on behalf of the state’s Pregnancy-Associated Mortality Review (PAMR) Board. The report is an aggregate of three years’ worth of work of the PAMR and is based upon the most recent data available. Analysis of data and related patient records indicates the top causes of pregnancy-related death are mental health (including substance use disorders or SUDs), cardiovascular issues and homicide.

The PAMR Board is a multidisciplinary board of experts from across the state tasked with examining the causes and contributing factors associated with maternal mortality and ultimately forming recommendations that could prevent these deaths from occurring in the future.

The 2018-2020 annual report contains data, including the timing and leading causes of pregnancy-related deaths, and factors that contributed to these deaths, such as mental health conditions and SUD. The report also reflects the disparities that exist in our state and among our most vulnerable populations, including our Black and publicly insured communities.

Key findings include:

  • An average of 70 Missouri women died while pregnant or within one year of pregnancy each year, with the highest number recorded in 2020 (85 deaths).
  • Mental health conditions, including SUDs, were the leading underlying cause of pregnancy-related deaths, followed by cardiovascular disease and homicides.
  • All pregnancy-related deaths due to mental health conditions, including SUD, were determined to be preventable.
  • Black women living in Missouri are three times more likely to die within one year of pregnancy than white women.
  • The number of suicide deaths doubled when comparing 2017-2019 with 2018-2020. This corresponded with an increase in the number of firearm deaths.
  • Women on Medicaid in the state of Missouri are 10 times more likely to die within one year of pregnancy than those with private insurance.

The PAMR Board found that the pregnancy-related mortality ratio (PRMR) was 32 deaths per 100,000 live births from 2018-2020, which is up from 25.2 deaths in the 2017-2019. Eighty-four percent of pregnancy-related deaths were determined to be preventable, which is nine percent higher than the last multi-year report.

Included in the report are recommendations made by the PAMR Board based on case reviews, including six directed at Missouri lawmakers. By the end of the 2023 session, four of these recommendations were funded by the General Assembly and Governor Mike Parson. In addition to funding being appropriated for the following Medicaid adjustments, $4,350,000 in general revenue was also approved for DHSS to implement a maternal mortality prevention plan. The recommendations now being implemented include the following:

  • Provide funding for a statewide Perinatal Quality Collaborative by 2023.
  • Establish and fund a statewide Perinatal Health Access Project to aid healthcare providers in providing evidence-based mental health care, including SUD treatment to Missouri women.
  • Extend Medicaid coverage to one year postpartum for all conditions (including medical, mental health and SUD), even if the woman did not start treatment prior to delivery, to aid women whose condition is exacerbated in the postpartum period.
  • Fund Medicaid expansion by 2023.

The 2018-2020 annual report can be viewed at Health.Mo.Gov/data/pamr.



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Mission of the Missouri Department of Health and Senior Services (DHSS): To promote health and safety through prevention, collaboration, education, innovation and response.