New York must improve follow-up to programs addressing maternal deaths, state audit says

A new state audit says New York needs to do more to curb deaths of women from problems associated with childbirth or pregnancy, pointing to a recent increase in maternal mortality rates and racial disparities in those figures.

Although New York has expanded access to doula care and started other maternal mental health initiatives, the state Department of Health is not doing enough to evaluate all of its maternal health programs, according to an audit from state Comptroller Thomas DiNapoli’s office. The lack of evaluation means that the state is not able to fully gauge how its efforts are impacting the maternal health crisis, the audit said.

"Despite New York’s efforts to reduce maternal deaths and pregnancy related health conditions, progress has stalled," DiNapoli said in a statement. "The Department of Health needs to strengthen its oversight of policy initiatives and take steps to help ensure all mothers, regardless of race or ethnicity, have access to the highest level of care."

"From 2018 to 2021, during the COVID-19 pandemic, maternal deaths were estimated to have increased up to 33% in New York, according to CDC estimates. According to DOH data, 78% of deaths during or after childbirth were preventable in 2018," the audit said.

In 2020, Black women in New York had a pregnancy-related mortality rate of 54.7 deaths for every 100,000 live births — roughly five times the figure for white women, the state said.

The Health Department responded to the audit by saying, "The State Department of Health is committed to combating maternal mortality and continues to engage in a multifaceted effort to eliminate inequities and improve health outcomes." The department also responded to individual recommendations in the report.

The audit, which took place between 2018 and 2023, outlines how improved evaluation and rollout of maternal health recommendations are important factors in the state's effort to make childbirth safer.

Lack of follow-up evaluations of these programs could "affect the outcomes for birthing people across the state," said Dr. Dawnette Lewis, director of Northwell Health’s Center for Maternal Health.

In 2010, the state started taking the first steps toward dealing with maternal mortality with the Maternal Mortality Review Initiative, the audit said. In 2018, it started a task force on the issue, which made recommendations such as racial bias training for hospitals and better data collection of perinatal outcomes. In the following years, a statewide expert group and a maternal review board were formed — each coming up with recommendations.

Three state groups tasked to help deal with maternal mortality issued roughly 30 recommendations. Auditors’ review of 27 recommendations found that 37% were "partially implemented" or not implemented, the report found. Some of those not put in place included curricula for health care providers and the encouragement of birth preparedness, the report said.

The audit noted that the DOH has implemented 63% of the recommendations, including an investment of about $14 million to fund an initiative to improve the health of pregnant women and their families.

Still, the report found that while the department said it wants to reduce the rate of severe maternal morbidity — pregnancy issues that can include postpartum depression and medical complications with health consequences — it doesn't have data on the phenomenon. The DOH said it has hired someone to report on severe maternal morbidity, the audit said.

The report also found the Department of Health could increase its outreach to birth hospitals and others to see why they might not have participated in programs such as one on hemorrhaging — a leading cause of pregnancy-related deaths, according to the state.

Martine Hackett, a co-founder of the Birth Justice Warriors — which works to address the maternal health crisis — said more localized data on maternal health would be helpful to address the issue in the Long Island region.

Overall, Hackett, also chair of Hofstra University's Department of Population Health, said the audit is a necessary tool that’s shining a light on the specific action the Department of Health is taking and how that can impact lives.

"I think it's legitimate to acknowledge what hasn't happened, but we also have to, you know, say that there have been some significant changes that ... we still probably have yet to see what the benefits of those have been," she said.

By Tiffany Cusaac-Smith

tiffany.cusaac-smith@newsday.com@T_Cusaac

Education: Howard University 

Tiffany Cusaac-Smith came to Newsday in 2023 after being a race and history reporter at USA TODAY, where she wrote enterprise and spot articles examining how the past shapes the present. Previously, she worked as the race and justice reporter at the USA TODAY Network of New York, covering issues such as criminal justice reform, housing, environmental justice, health care and politics. At The Journal News/lohud.com in Westchester County, she covered Yonkers, the state's third-largest city. She also worked at The Associated Press in Atlanta.

Honors and Awards: Criminal justice reporting fellowship with the National Press Foundation;  New York News Publishers Association award for distinguished investigative reporting;  Contributed reporting for Best of Gannett honor; Member of Table Stakes, a program funded by the Knight-Lenfest Local News Transformation Fund and managed by the American Press Institute to transform local news.