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National Quality Forum Releases Final Maternal Morbidity and Mortality Project Report

Multistakeholder Expert Committee finalizes new frameworks to guide the improvement of maternal morbidity and maternal mortality measurement in the U.S.

The continued erosion of maternal health outcomes over the past decade, coupled with vast disparities associated with race, ethnicity, and geography, demand urgent attention.”
— Dana Gelb Safran, ScD, NQF President and Chief Executive Officer
WASHINGTON, DC, UNITED STATES, October 19, 2021 / -- National Quality Forum (NQF) has released the final report from the Maternal Morbidity and Mortality project. This comprehensive report provides practical recommendations for enhancing maternal morbidity and mortality measurement to improve maternal health outcomes in the U.S.

With funding from the Centers for Medicare & Medicaid Services (CMS), NQF convened an expert Committee of diverse stakeholders to guide this work. Throughout a 24-month period, NQF conducted an environmental scan of the quality measurement landscape for maternal morbidity and mortality, including clinical and nonclinical risk factors, existing measures, and innovative measurement programs related to this work. The final report includes two key measurement frameworks that account for the various influences on an individual’s health outcomes related to maternal morbidity and mortality. These influences include health literacy, race, ethnicity, and other social determinants of health that are shown to exacerbate health disparities. The report includes recommendations and tangible steps for short and long-term measurement approaches throughout the maternal life cycle. Throughout the course of this project, NQF solicited input via public commenting from NQF Members and other stakeholders.

Maternal mortality encompasses the death of a woman during pregnancy, childbirth, or up to one year after the pregnancy ends, whereas maternal morbidity refers to unexpected short- or long-term negative outcomes that result from pregnancy or childbirth. Since 2000, maternal morbidity and mortality indicators have both steadily increased in the U.S., with the maternal mortality ratio reaching 17.4 maternal deaths per 100,000 live births in 2018, which is two to ten times higher than nearly a dozen other developed countries with comparable inputs. Additionally, severe maternal morbidity (SMM), which is defined by the Centers for Disease Control & Prevention (CDC) using 21 health indicators and International Classification of Diseases (ICD) codes, affects more than 60,000 women annually in the U.S.

Even more concerning is the persistent racial, ethnic, socioeconomic, and geographic disparities in maternal morbidity and mortality outcomes. Non-Hispanic Black women experience maternal mortality more frequently than the population as a whole (37.3 deaths per 100,000 live births). Women living in rural areas are also at greater risk for maternal mortality or SMM.

“The continued erosion of maternal health outcomes over the past decade, coupled with vast disparities associated with race, ethnicity, and geography, demand urgent attention. The insights and recommended measurement approaches gleaned through experts and diverse stakeholders offer practical guidance for public and private sector efforts to catalyze improvement and monitor progress,” said Dana Gelb Safran, ScD, NQF President and Chief Executive Officer.

“Improvement in Maternal Mortality and Morbidity Measurement is integral to achieving and addressing gaps in health equity and improving women’s health. These frameworks serve to provide recommendations for improvements in measurement and are a starting point in moving the quality measurement landscape forward,” said Lee Fleisher, MD, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality.

NQF has an extensive history of convening multistakeholder groups to develop consensus on diverse and challenging healthcare topics of national interest. In addition to launching the Maternal Morbidity and Mortality project in 2019, NQF continues to demonstrate commitment to national efforts that result in significant improvements for every person receiving care in the U.S. Learn more about other ongoing projects and how to become involved.


About National Quality Forum
The National Quality Forum (NQF) works with members of the healthcare community to drive measurable health improvements together. NQF is a not-for-profit, membership-based organization that gives all healthcare stakeholders a voice in advancing quality measures and improvement strategies that lead to better outcomes and greater value. Learn more at

Kiyan Pirgheybi
National Quality Forum
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