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Seven years ago, when President Donald Trump signed the law on the Mother’s Death Act, it was hailed as an important step in dealing with the country’s maternal death crisis.
The law put tens of millions of dollars into the program a year, helping to reassess the mother’s death and fund the state commission to identify the cause. The committee’s findings led to new protocols to prevent bleeding, sepsis and suicide. Federal funding has allowed some states to establish panels for the first time.
The committee’s work became more urgent only after the Supreme Court overturned the constitutional rights of abortion. Last year, a Georgia commission determined that the state’s abortion ban contributed to the preventable death of 41-year-old Candy Miller.
However, the program that has now enabled this progress — known as strengthening reviews and surveillance to eliminate maternal mortality or erase MM — is at risk, mother health advocates say.
Funding for the program expired on September 30th, and efforts to renew it have not been successful so far. Congress included money to expand the MM with a wider suspension funding measure that was mostly passed in December 2024 before falling into Republican opposition. The program has not been paid in the 2026 Trump administration budget proposal. Later last week, the Senate Approval Committee introduced a bill that would fund the Department of Health and Human Services for the next fiscal year, including MM funding, but the measure has not yet progressed.
Adrian Griffen, executive director of the Maternal Mental Health Leadership Alliance, said she fears how much attention the program’s difficult future is not attracting amid a wave of layoffs at federal health agencies, amid the raid of imminent Medicaid cuts.
“We were worried when these programs were not included in the president’s budget,” Griffen said. “We are happy with progress, but there is still a lot that needs to happen.”
The Centers for Disease Control and Prevention, the director of awarding MM Elimination Grants and leading the work of the state’s Maternal Mortality Committee, did not answer specific questions from Propublica about the future of the program. Andrew Nixon, communications director for HHS, the CDC parent agency, said in a statement that HHS is “working to improve maternal and infant health outcomes.”
“We are currently reviewing mothers and infant health portfolios, collecting and analyzing data to identify the most effective ways to improve mothers and infant health and safety,” the statement said.
HHS Secretary Robert F. Kennedy Jr. did not respond to requests for comment on whether supporters’ concerns were justified.
The Trump administration’s budget proposal Jettison will not only erase MM, but also erase the slate of the program, known as the Safe Maternal Initiative. Previously, everything was bipartisan support. It mystised why some members of Congress were at risk.
At a budget hearing in June, D-Ohio MP Greg Landsman pressed Kennedy on why the administration proposed to eliminate programs that include eliminating MM.
“I really believed this was zero by coincidence or by some sort of surveillance,” Landman asked Kennedy to work with members of the House Committee on Energy and Commerce to restore funds.
After the exchange at the hearing, Landsman told Propovica that Kennedy agreed to meet to discuss funding recovery.
“I want to save money on this investment,” he said. “It’s important to expect a mom.”
After Propublica and others reported, MM’s erase appeared in 2019. The US maternal mortality rate has risen sharply over 20 years as interest rates in other wealthy countries fell.
Other countries, particularly the UK, had reliable national data on maternal mortality rates and a robust case review system designed to turn information into improved care. In contrast, in the US, only two-thirds of states had a review process, moving forward years or not operating consistently between reports.
The erase MM was designed to block these holes, ensuring that no lessons were learned from the mother’s death.
Over the past five years, the CDC has distributed nearly $90 million to fund the work of the state review board. The program is relatively inexpensive, at least by federal standards. Last year, it split a total of about $40 million between 46 states, with an average of $870,000 each.
Members of the Maternal Mortality Review Board (usually a mix of doctors, nurses, mental health professionals and advocates) volunteer to time. Erase of MM grants typically compiles personal information from case summary to hire staff who employ staff who collect records from hospitals, health checkers, police, other agencies and abstract abstract persons.
The committee is inherently advised, but their findings made a difference, supporters say. In recent years, many states have developed mental health initiatives for pregnant people and new mothers based on reviews of mortality rates during pregnancy. For example, a recommendation by the New Hampshire Commission led to a program in which OB-Gyns worked with psychiatrists on treatment of postpartum depression or substance use disorders.
In Indiana, which used MM fund elimination in 2018, the panel’s research spurred state authorities and expanded initiatives in which nurses have new mothers engaged in postnatal home visits.
Indiana is one of at least five states that rely entirely on federal dollars to pay for maternal mortality reviews (the others in South Carolina, Iowa, Missouri and Utah). Commission members from several states have expressed warning that the money could evaporate.
Before erasing MM, Utah had a joint committee to consider the deaths of both infants and mothers, said Dr. Marcela Smid, a medical expert for the mother’s fetality. Utah first established the Maternal Death Review Review Committee in 2019 using funds from Erase MM, which was packed with chairs. The number of maternal deaths due to suicide increased, leading to programs for screening and treatment for mental heath and substance use disorders. Since 2021, the committee has received approximately $1.7 million from the CDC.
“If a refund is made, I think it’s devastating,” Smid said.
As part of the review, committee members will consider the legal and socioeconomic context in which women die. These measures were taken by the committee in 2022. It was important in Georgia when the state banned abortion, considering the deaths that occurred after Wade was overturned. The CDC has not directed the committee to explicitly ask about such laws, but members of the committee say they have provided windows that could be lost once the MM is finished.
Although case reviews are usually confidential, Propublica reported last year that a Georgia commission concluded Miller and Amber Thurman abortion-related deaths. The 28-year-old was preventable.
The reviewers found that both women suffered from rare complications when they took abortion medication and were unable to expel all fetal tissue from their bodies. Miller decided not to go to the doctor when symptoms of sepsis began to develop. Thurman went to the hospital, but died after a doctor waited 20 hours to extol and curse the uterus. The procedure used to perform abortion was also entangled with restrictions on getting criminal penalties to a doctor if he violated the law.
Even before the threat of wiping MM funds emerged, four states, including Florida and Texas, had chosen to accept money from the program. The Florida Department of Health did not respond to a question from Propublica about why this did this. The Texas Department of Health said it had directed the state legislature not to receive funds and instead allocated funds to create its own system. Texas, which accounts for about 10% of mothers in the US, also stopped sharing data collected with the CDC by the Maternal Mortality Review Board shortly after restricting abortion access.
Texas Department of Health officials have also chosen not to let the state’s maternal mortality review board consider lawsuits from 2022 and 2023. The panel has been behind in case reviews nearly four years, and state officials said skipping two years will help them catch up. The state also bans the panel from investigating deaths related to abortion.
Mother’s Life
Dr. Thomas Westover, a maternal fetal medicine expert who also sits with the New Jersey Maternal Death Review Board, said he is worried that once MM disappears, there will be inconsistent state-by-state relationships about how maternal deaths are reviewed and what data will be collected for them.
“There are states where you choose what you want to review and choose,” Westover said. He said some states are likely to manage their caseloads to ignore accidental deaths, but others, like Texas, chose to rule out deaths related to abortion and not rival the data nationwide. “That’s a bad decision.”
As part of the Erase MM, the CDC will provide detailed guidance to the state review board on contribution factors to consider when assessing maternal deaths, including obesity, mental health issues, substance abuse, and homicide.
Amy Raines Milenkoff, an associate professor at the University of North Texas Health Sciences Center and a longtime maternal health scientist practitioner, said this information will facilitate an analysis that goes far beyond what is found in death certificates. Based on this information, Texas expanded nurse visits to postpartum mothers similar to the Indiana initiative.
“What we chose to measure is what we cherish in society,” said Raines Milenkoff.
Maternal health advocates say they are working together to bring public attention to the potential funding threats to erase MM. Griffen, executive director of the Maternal Mental Health Leadership Alliance, said he hopes for more meetings in Capitol Hill that the solution will secure the program.
Women’s lives depend on it, she said.
Kavitha Surana contributed the report. Mariam Elba contributed to his research.
