Group seeking more money, answers to high maternal mortality in North Dakota • North Dakota Monitor

A state-funded group that researches maternal mortality wants the Legislature to increase its funding five-fold to $240,000 for the 2025-2027 budget cycle.

North Dakota’s 26-member maternal mortality review committee collects and analyzes data on pregnancy-related deaths in the state. It’s affiliated with a national program under the Centers for Disease Control and Prevention.

While the state’s annual maternal deaths are consistently in the single digits, North Dakota’s overall maternal death rate is still significantly higher than the national average, according to Dr. Dennis Lutz, chair of obstetrics and gynecology at University of North Dakota School of Medicine and Health Sciences.

The review committee is working to collect information that could help speak to why, but still faces several barriers to gathering accurate and complete data, said Lutz, who oversees the committee.

Its budget for the 2023-2025 biennium was $48,000. The committee wants to grow this number to cover expenses including recruiting additional staff, continuing medical education as well as travel costs.

It has plans to add two new staff members — one to act as a liaison to the Indian Health Service, and another to specialize in social work, Lutz said.

“I know it sounds like a lot of money,” he told lawmakers during a Health Care Committee meeting this month in Bismarck. “But on the other hand, if it’s preventative, and if we can reduce maternal deaths and complications and problems with newborns along the way, it’ll be well worth the money.”

Since North Dakota’s fertility rate is about 12,000 births per year, the funding would be equivalent to roughly $10 per delivery, he added.

Rep. Gretchen Dobervich, D-Fargo, a member of the Legislature’s interim Health Care Committee, said she’s spent the last year working on a tribal maternal mortality committee project with the CDC.

She said many North Dakotans face obstacles to quality maternal health care, especially Native residents and those who live in rural areas. A September article published by the North Dakota News Cooperative noted that more than two-thirds of counties in North Dakota were considered maternal health care deserts in 2022.

“As access to prenatal, natal and postnatal care gets more difficult for women to access, it is important for us to find solutions,” Dobervich said.

She said she’s interested in supporting Lutz’s request, but wants to hear more specifics about the maternal mortality review committee’s proposed budget.

In 2022, there were six maternal deaths in North Dakota, said Lutz. That included two traumatic deaths, one case of sepsis and a cardiac arrest.

Only one of those deaths has been confirmed as having been pregnancy-related under CDC criteria, according to a committee report. The CDC defines a pregnancy-related death as any death that occurs during pregnancy or within one year of having been pregnant.

The other five deaths could have been associated with pregnancy, but are still under investigation.

“Sometimes it takes us two or three years to research these cases and figure out what really happened,” Lutz said.

Lutz said the committee is aware of five maternal deaths that occurred in 2023, though those numbers are preliminary.

Based on the committee’s research, North Dakota’s average maternal mortality rate from 2008 to 2022 was about 50 women per 100,000 births, Lutz said.

“That’s a high number anywhere — one of the highest in the country, actually,” he said.

American Indian mothers accounted for about 30% of maternal deaths in North Dakota over that 15-year span, the committee found. By comparison, just about 8-12% of North Dakota births are to American Indian mothers.

Roughly 60% of maternal deaths in North Dakota over that time span were to white mothers, while 5% of deaths were to Black mothers.

The United States’ overall maternal mortality rate has been increasing for more than two decades, though experts aren’t sure why, said Lutz. In 2022, the national maternal mortality rate was about 22.3 deaths per 100,000 births according to data from the CDC. That’s higher than most wealthy nations.

The CDC estimates that about 80% of pregnancy-related deaths are preventable. Within the American Indian and Alaska Native population, this figure is estimated to be roughly 93%. 

It can be extremely difficult to nail down what caused a maternal death, Lutz said. Sometimes, death records are filled out wrong, or are incomplete.

“For example, we’ve had exam cases where a coroner says the patient was pregnant, but she’s 80 years old. Well, obviously she wasn’t pregnant,” Lutz said.

To improve the accuracy of death records, the committee is working with the North Dakota Department of Health and Human Services, but also with local coroners and funeral home directors, he said.

The fact that many medical records are protected from release under law also makes it difficult for the committee to decode the circumstances behind a death.

“Our biggest problem right now is that over a third of all maternal deaths in this country are related to mental health issues — that could be suicide, it could be due to overdoses,” Lutz said. “And because we often have no way to get those records legally — at least their mental health records — we end up calling all those maternal deaths.”

The committee is interested in collecting data on maternal morbidity as well, Lutz said — instances where a mother experiences a health condition during pregnancy, labor or after delivery.

One National Institutes of Health article from 2021 that analyzed data on mothers who gave birth in California between 2007 and 2012 found about 1.3% experienced severe maternal morbidity as defined by the Centers for Disease Control.

Sen. Kristen Roers, a nurse, said the committee might benefit from investing more resources in this area.

“We need to do a better job on our morbidity data, so that we can see what those trends are where you can possibly put an intervention in place,” the Fargo Republican said.

Lutz noted it’s very hard to get information on morbidity cases since they aren’t reported to the state.

“We would have to have the permission of hospitals to look at all their data,” he said, “and I don’t know that they would be willing to do that.”

The committee presents its research to the North Dakota Society of OB/Gyn in hopes that its insights can help educate medical professionals to prevent maternal deaths.

“Most OBGYNs have never had a maternal death in their career. If you’ve never experienced something, how do you prevent it?” Lutz said.

The committee doesn’t yet have data that could speak to how the state’s abortion ban may have affected maternal health care for North Dakota mothers, he said. The law was active from April 2023 to September 2024, when it was declared unconstitutional and vacated by a state judge.