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California has the lowest maternal mortality rate in the nation, but the state announced an ambitious plan to further halve maternal mortality by the end of 2026.

The initiative, called , was released September 17 by the Office of the California Surgeon General, Diana E. Ramos, MD, MPH, MBA, along with the . California Gov. Gavin Newsom (D) also proclaimed yesterday as .

According to the report, the primary goal is to help "reproductive-age individuals in California understand the possible health risks they may encounter in future pregnancies," and secondly, to reduce maternal mortality by 50%.

"Although California has made significant progress on improving maternal health outcomes, we're still losing too many mothers, especially Black women who are three times more likely to die from pregnancy-related complications compared to white women," Ramos told MedPage Today in an email. That's "not just a statistic, it's a crisis," she said, adding that 80% of maternal deaths in California and across the U.S. are preventable. Plus, a whopping eighth of all births in the U.S. happen in California.

Before becoming California's surgeon general, Ramos was an ob/gyn who saw preventable maternal deaths firsthand.

For this initiative, Ramos' office convened with 17 leaders across industries in a Perinatal Advisory Group to discuss maternal health. These discussions identified themes and priorities like building trust with patients and communities, identifying problems early, incorporating technology, and having more diverse community partners.

To accomplish the goal of significantly reducing maternal deaths in just a few years, California will take a multipronged approach both inside and outside of healthcare settings. One key strategy is an open-source, at-home pregnancy medical risk questionnaire, available in English and Spanish, that will help Californians determine whether they're likely to have a low-, medium-, or high-risk pregnancy. Depending on results, the questionnaire would recommend different pathways. The goal is to have half of reproductive age people take the questionnaire by the end of 2026.

"Most women don't know they may have a high-risk pregnancy until after they've already conceived, and by then, complications might already be on the horizon," Ramos explained. "When patients are informed, they can work with their healthcare providers to be active participants in their health." Heart disease is the leading cause of pregnancy-related death across ethnicities in California, so the focus will be on heart health from preconception through the postpartum period.

Another part of the plan is to bring more awareness to the resources and programs that already exist -- especially for marginalized groups. For instance, Ramos' office plans to raise awareness about and increase access to community health workers as well as doula services, which were added as a benefit to California's Medicaid program in 2023.

The state will also implement universal usage of the Obstetric Morbidity Index -- a tool for determining the risk for pregnant women throughout pregnancy -- when women enter healthcare facilities. This will help establish "a medical maternal risk standard of care for all women" and can help providers refer pregnant people to different birthing facilities based on their risk.

Recent research has shown that maternal mortality rates are highest among Black women and "unacceptably high" among all racial and ethnic groups in the U.S. The maternal health blueprint noted that maternal mortality trended upwards for Hispanic and Asian and Pacific Islander women from 2016 to 2019. During the pandemic, maternal mortality worsened across groups and nearly half of pregnancy-related deaths in California were tied to COVID-19, Ramos said.

In the initiative's press release, HHS Secretary Xavier Becerra said that "reducing maternal mortality isn't a 'should,' it's a 'must.'"

Ramos encouraged healthcare professionals of all stripes to "remember that you may be the only member of the health team that may see the new mom and notice signs of depression or hear them say they recently had a baby but did not keep their postpartum visit." More than half of perinatal maternal deaths occur 1 day through 1 year postpartum, and thus, she said, "a simple encouragement to keep a postpartum visit from you, an already trusted medical provider, can make the difference in saving a mom's life."

"What we're doing in California can be replicated everywhere -- breaking down silos to work collaboratively, focusing on prevention, bringing in community voices, and putting mothers and pregnant people at the forefront," Ramos said.

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