Idaho has quietly dissolved its committee tasked with understanding maternal deaths

An Idaho panel tasked with investigating the deaths of pregnant residents was not renewed by the state Legislature and quietly dissolved last month.

The move comes a year after Idaho implemented a ban on abortion at all stages of pregnancy following the U.S. Supreme Court’s landmark decision overturning Roe v. Wade. The end of the Maternal Mortality Review Committee comes before the panel can investigate what effects Idaho’s abortion ban may have on the rate of Idahoans dying while pregnant.

The dissolution makes Idaho just one of two states in the nation without a governmental body investigating pregnancy-related deaths and looking for policy solutions to maternal mortality. States with greater abortion restrictions are associated with higher rates of maternal mortality.

Idaho’s committee included more than a dozen physicians, nurses, midwives, coroners and other experts who reviewed case studies of all individuals who died during or shortly after pregnancy. In annual reports, the committee detailed the causes of these deaths and how they could have been prevented.

According to data collected from 2017-21 over four reports, Idaho had a yearly average of 29.2 pregnancy-related deaths per 100,000 live births. This is higher than the 2014-20 national average of 18.6 and Washington state average of 15.9 pregnancy-related deaths per 100,000 live births.

In their final report released in June, the committee said the disbanding would lead to the “underestimation of pregnancy-related deaths in Idaho.”

“It stands to reason that the causes and rates of maternal mortality and morbidity will change …” reads the report.

“Without the Idaho MMRC and their review of maternal deaths, the roots of these causes and what can be done to change them are likely to remain unknown. Therefore, there will be less opportunity to implement Idaho-specific recommendations to address preventable causes of maternal death which may lead to adverse maternal and infant health outcomes.”

The Idaho committee was first established by the state Legislature in 2019 with a sunset provision requiring the program to expire in June 2023. At the time, Idaho was following a trend that has seen maternal mortality review panels established in each state except Wyoming, which shares a committee with Utah.

Washington state established its own Maternal Mortality Review Panel in 2016 with a similar three-year sunset. Once that expiration date was met in 2019, Washington’s state Legislature made the panel permanent and expanded its authority.

Idaho state Legislature took the opposite tack – allowing the legislation to sunset and the committee to dissolve. At a February hearing of the Idaho House Health and Welfare Committee, legislation to remove the sunset was debated but ultimately never called up for a vote or moved to the House floor.

The legislation was sponsored by Republican Rep. Dori Healey, who said allowing the committee to continue indefinitely would “improve the health of Idaho mothers and their babies.” She also noted the committee was fully funded by a $10,000 federal grant.

Other Republicans on the panel were skeptical the committee needed to continue. State Representative Megan Blanksma said she did not “understand the relevancy” of the committee after it had already collected data from the past half-decade.

Rep. Mike Kingsley voted for the legislation in 2019 and said he believed maternal mortality to be an “important” issue, but added the committee had “served its purpose.”

“The (2019) debate was we just need three years to study this, and then we’ll have the numbers and this will sunset. And that’s why we put a sunset clause on it. And I’ve read the reports and they all seem to identify the same thing – substance abuse, mental health. So I think this has served its purpose.”

Questioned by the committee, Chairman Stacy Seyb, an obstetrician who specializes in high-risk pregnancies, argued the committee’s work was needed to understand why pregnant people die in Idaho.

“I guess I would like to kind of understand why we don’t want to understand our own state,” he said in response to a question about the need for state-specific data.

Asked when the committee might end on its own accord, Seyb said that would not be a sign of its success.

“As someone who studies public health, I’m not sure our job ever ends. Right now we’ve got 40 deaths that we’ve looked at over the last three years. Is 40 too many? Who gets to decide that?” he asked.

Elke Shaw-Tulloch, a public health administrator for the Idaho Department of Health, also urged the committee to remove the sunset.

“Idaho is a state that cares about mothers and babies. We want them to receive the best health care and community services from prenatal care through delivery as well as the postpartum period. The work of the Idaho Maternal Mortality Review Committee, or MMRC, not only helps improve these services for Idaho moms and babies but also improves health outcomes, leading to whole and healthy families,” she said.

Renewal of the committee was opposed by the Idaho Freedom Foundation, a conservative advocacy group, on grounds the “primary purpose” of the committee is “expanding government.”

During his testimony, Idaho Freedom Foundation lobbyist Fred Birnbaum pointed to the committee’s recommendation the state Legislature expand Medicaid to cover pregnant individuals up to 12 months postpartum regardless of the pregnancy’s outcome.

“You know the old saying all roads lead to Rome. Well, all government creative committees lead to the call for more government spending,” he said.

Birnbaum also pointed to the overall small number of pregnancy-associated deaths during the MMRC’s years of study – 17 deaths in 2021 and 11 deaths in 2020.

“I’m not sure what this committee is going to accomplish. Six of those were pregnant at the time of death. So they’re on Medicaid, most of them, and they’re pregnant. So they’re already covered by Medicaid.”

Advocates for the committee argued the magnitude of the issue is obscured by the relatively small number of people in Idaho. Accounting for population differences, Idaho has a much higher rate of maternal mortality than the nation at large.

Before taking a vote, the Health and Welfare Committee continued the hearing to the next day. But the legislation was never taken up again, and authorization for the committee expired last Month. In a round-up of the session, the Idaho Freedom Foundation celebrated the committee’s end.

“Each year after its formation, the committee released reports arguing for more government – in particular, the expansion of Medicaid to include women up to 12 months after the delivery of their babies and prioritizing subsidized housing for women,” wrote IFF President Wayne Hoffman.

“The panel’s demise also means we won’t need to be taking money from the federal CDC to operate it, which is another win. Equally exciting is that the mortality review board’s proposal to expand Medicaid to postpartum women also failed to move forward,” he wrote.

The Idaho Maternal Mortality Review Committee released its final report earlier this year – investigating the deaths of pregnant Idahoans in 2021.

The report describes 17 deaths of women that year while pregnant or within one year of pregnancy. Fifteen of those deaths were preventable, according to the report.

The most common contributing factor to these deaths was a lack of knowledge regarding the significance of a health event or the need for treatment after certain health events. The second-most common factor was the pregnant person’s lack of financial resources, and the third were factors related to the patients’ mental health.

The CDC’s Pregnancy Mortality Surveillance System, which looks at maternal deaths through one year after the end of pregnancy, reports that maternal mortality rates have generally been on the rise since the 1980s. According to the Idaho MMRC 2023 report, the U.S. had 7.2 pregnancy-related deaths per 100,000 live births in 1987 and a 17.6 ratio in 2019.

Pregnancy-related deaths in Idaho have also been increasing.

The five-year average from 2003-07 to 2017-21 increased by 41.8%. It went from 20.6 to 29.2 pregnancy-related deaths per 100,000 live births, respectively. The state especially saw a spike in maternal mortality during the COVID pandemic. The ratio rose from 13.6 in 2019 to 40.1 deaths per 100,000 births in 2021.

In comparison, the Maternal Mortality Review Panel in Washington has found maternal mortality rates to be lower historically compared to national and Idaho rates.

A 2022 report from the panel analyzed the deaths of pregnant Washingtonians from 2014-20. They identified 97 individuals whose deaths were related to their pregnancy.

Leading underlying causes of pregnancy-related deaths were behavioral health conditions, predominantly by suicide and overdose. Other common causes included hemorrhage and infection.

The pregnancy-related maternal mortality rate in Washington was highest in 2018-20, with 20.5 deaths per 100,000 live births. According to the report, this trend likely reflects an “expanded definition of maternal mortality” to include deaths due to suicide, overdose and intimate partner homicide