The Washington State Department of Health (DOH) has released its 2023 Maternal Mortality Review report, and found that behavioral health conditions, including suicide and overdose, remain the leading causes of pregnancy-related deaths and that 80% of pregnancy-related deaths were preventable, which means that, if it weren’t for a clinical or social factor, the chance death could have been averted.

The MMRP reviews pregnancy-associated deaths from any cause during or within one year of pregnancy and determines which were pregnancy-related deaths due to a pregnancy complication, a chain of events initiated by pregnancy, or aggravation of unrelated condition(s) caused by the psychological effects of pregnancy.

“The maternal mortality rate in Washington is lower than the national rate, but we need to do more to prevent any such death,” said Lacy Fehrenbach, Chief of Prevention, Safety and Health, Washington State Department of Health. “Addressing root causes of inequities and improving access to high-quality care in pregnancy, delivery, and postpartum are key ways our state can make progress toward that goal.”

The 2023 report examines cumulative data from 2014-2020 pregnancy-associated and pregnancy-related deaths and contains policy and funding recommendations from 2017-2020 deaths.

The MMRP identified 224 pregnancy-associated deaths from 2014-2020 and classified 97 of these as pregnancy-related.

The 97 pregnancy-related deaths, which were deaths due to pregnancy complications, were caused by a chain of events initiated by pregnancy or aggravation of unrelated conditions or conditions by the physiological effects of being pregnant.

Some of the report’s other findings include:From 2014 to 2020, there were 15.9 pregnancy-related deaths per 100,000 live births in Washington, which was lower than the U.S. rate of 18.6 pregnancy-related deaths per 100,000 live births in this same timeframe.

The leading underlying causes of pregnancy-related deaths were behavioral health conditions (32%), predominantly by suicide and overdose. Other common causes were hemorrhage (12%) and infection (9%).

31% of pregnancy-related deaths occurred between 2 and 42 days after pregnancy and 31% occurred 43 days to one year after pregnancy. The report explained that this distinction was made because six weeks, or 42 days postpartum, is an important marker since many people transition their postpartum care back to their primary or family physician.

The pregnancy-related mortality rate was greater for individuals over the age of 30. American Indian and Alaska Native people experienced higher maternal mortality rates than any other race/ethnic group

The report included six priority recommendations that would bring these death totals down:

1. Undo racism and bias.

2. Address mental health and substance use disorder.

3. Enhance healthcare quality and access.

4. Strengthen clinical care.

5. Meet basic human needs.

6. Address and prevent violence.

An addendum from the American Indian Health Commission was also included in the report which outlines policy recommendations to address factors contributing specifically to Native maternal mortality

The report is based on reviews conducted by DOH’s Maternal Mortality Review Panel (MMRP). DOH publishes maternal mortality reports every three years, as required by the Washington State Legislature.