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Public officials are pushing for new strategies as more women are dying before, during, or after giving birth in Pennsylvania.
Fueled by mental health conditions, including substance use disorders, deaths among new and expectant moms jumped by over 25% from 2013 to 2020.
The state Maternal Mortality Review Committee, which examines all maternal deaths, found that 107 women died while pregnant or within a year of giving birth, in the most recently published 2020 data.
Now, government leaders, health care providers, community groups, parents, and legislators are collaborating on a statewide plan to address those deaths. The plan is set to be released this month.
“It's going to take all of us to make a difference and have an impact in the outcomes of all moms and babies,” said Dr. Margaret Larkins-Pettigrew, SVP and Chief Strategic Social and Workforce Programs Officer at AHN/Highmark Health. “This has got to be a movement for all of us, all the allies that believe moms and babies need to have an opportunity to be the best they can be.”
The plan is spearheaded by the state Department of Health, Department of Human Services, Department of Insurance, and Department of Drug and Alcohol Programs and is bolstered by upcoming maternal health legislation.
Almost 94% of deaths directly related to pregnancy — representing about a third of maternal deaths — are preventable, according to the Maternal Mortality Review Committee.
The plan uses unpublished 2021 data on maternal deaths from the committee and more recent research from other sources, but it shies away from prescribing solutions, according to a DHS spokesperson.
Instead, those will come out of working groups aimed at tackling five areas: access to care, behavioral health and substance use, social determinants of health and health-related social needs, expanding and diversifying the maternal health workforce, and addressing rural and maternity care deserts. The groups met for the first time on April 30.
Priorities, such as addressing behavioral health and substance use, come from troubling trends: The leading cause of deaths among new and expectant moms are mental health conditions, including substance use. In 41% of cases, substance use disorder was a contributing factor in the death.
Gov. Josh Shapiro and other elected officials are also advocating for legislative solutions.
Shapiro proposed $5 million in the 2025-26 budget to fund maternal health initiatives, including implementing universal postpartum depression screenings and improving subsequent treatment.
And a wave of bills is making its way through the House, backed by Rep. La’Tasha Mayes, a Democrat whose 24th District is in the City of Pittsburgh.
Mayes and other legislators are introducing nine bills related to maternal health: providing supply kits to new mothers, addressing maternal health deserts, expanding public breastfeeding law to include pumping and storing milk, and more.
It’s the second iteration of a package of bills introduced in the 2023-24 session — dubbed the PA Momnibus — which had five of eight bills passed through the House of Representatives and two signed into law.
“I think all of them have the opportunity to pass out of the House,” Mayes said. “These are all viable bills, either they're evidence-based, they received support last year, or they are bringing a new aspect of the issue to the legislative process, like substance abuse.”
One of the bills specifically addresses substance use, implementing a pilot program of treatment courts for mothers to provide support for women in the criminal justice system.
Many of the bills are rooted in the PA Black Maternal Health Caucus’ concerns about health issues for Black women, who are twice as likely to die before, during, and after birth as white women in Pennsylvania.
It’s been a damning point of conversation for the City of Pittsburgh, where a 2019 Gender and Equity report found that Black women's maternal mortality is higher than 97 percent of similar cities.
“There's implicit bias, which is connected to the racism, sexism and classism in our health care system,” Mayes said. “The implicit bias is when the doctor or nurse or provider ignores what you say about your own body or [doesn’t] listen to your pain.”
She pointed to stereotypes of Black women having higher pain tolerance or being drug-seeking as barriers to care. Diversifying the workforce, particularly through expanded doula and midwifery services, has been a priority for Mayes.
Diverse health care professionals, especially midwives, are “the type of perinatal workforce that's needed to support moms of all backgrounds and all races, but Black moms in particular,” she said.
Trusting a health care provider is necessary for patients to trust in the recommendations being made for their health, said Yazmin Bennett-Kelly, director of Healthy Start’s Allegheny BIRTH Initiative.
“Distrust amongst Black women and community members when it comes to health care institutions is so deeply rooted, and it is so evident in our culture and our society,” she said. "To have representation in the folks that are caring for you, that are providing care, it just naturally builds trust.”
Generally, Pennsylvania is a mixed bag compared to national averages for maternal health care.
Over 12% of women had no birthing hospital within 30 minutes, higher than the national average, according to a 2023 report from maternal health nonprofit March of Dimes. Nationally, around a third of counties are defined as “maternity care deserts,” but that number is 7.5% of counties in Pennsylvania.
Wilkinsburg community health advocate for Healthy Start and mother of two Toni Watkins said some of the issues — and solutions — are generational. She grew up with a family that placed an emphasis on health and did the same for her daughters when they had kids.
She and her daughters went to needed doctor’s appointments and took prenatal vitamins. And if there were problems, she was tapped into what resources were available.
“I was able to get the help they need because I am an advocate, and I was able to dial into resources through Healthy Start,” she said.
Watkins knew of some women who didn’t take vitamins or didn’t attend prenatal appointments until the eighth month of pregnancy.
Almost 16% of women in Pennsylvania received inadequate prenatal care, either beginning in the fifth month or later or receiving less than half the appropriate number of visits, according to the March of Dimes report.
And when they do, that information might not be communicated well by health care providers. Medical jargon, poor explanation, and a lack of follow-ups can hamper a patient’s health during pregnancy and beyond, Bennett-Kelly said.
“They're not really getting as much information as they should be receiving,” she said. “If you attend an appointment and you have no clue what you're being told, how are you supposed to know the best way to care for yourself and the child that you're growing?”
