This article, titled “Determining What Matters: Data Resources for Examining Maternal Health Equity,” authored by Leremy A. Colf and Karina M. Shreffler, addresses the critical issue of maternal health in the United States. It was published on February 28, 2025, in Frontiers in Public Health.
The core problem highlighted in the article is the high and increasing rates of maternal morbidity and mortality (MMM) in the U.S., which are notably higher than in all other industrialized nations. In 2021, approximately 1,205 women died from pregnancy-related causes in the U.S., representing a significant increase from previous years. Severe Maternal Morbidity (SMM) is also a major concern, occurring 50 to 100 times more frequently than maternal mortality and affecting over 50,000 women annually. These adverse outcomes are disproportionately experienced by understudied, underrepresented, and underreported (U3) populations, particularly Black, Indigenous, and/or rural women. For instance, Black and Indigenous women are three to four times more likely than non-Hispanic White women to experience SMM, with Indigenous women in rural areas facing the highest risk for adverse birth outcomes. Women in rural areas also had a 9% higher probability of SMM and mortality between 2007 and 2015. The situation is worsened by increasing rural hospital closures and the elimination of maternal care services.
Despite the clear health impacts, the article points out current data limitations that inhibit a full understanding of these disparities and regional nuances. While relevant data (demographics, socioeconomics, maternal care utilization) are publicly available, they are scattered across disparate datasets, lack common definitions, and are technically challenging to link. Furthermore, restrictions related to HIPAA and personally identifiable information (PII) make the creation of a comprehensive national dataset difficult, as combining certain data could inadvertently enable individual identification. The fragmented nature of the U.S. healthcare system, unlike single-payer systems, adds to this challenge. There’s also a lack of national funding for public data mandates and disincentives for data sharing among data owners.
To address these challenges, the article proposes a solution: leveraging diverse, publicly available data. This includes deidentified health system utilization data (such as from the Healthcare Cost and Utilization Project (HCUP)), geocoded locations of hospitals providing maternal care services (from Centers for Medicare and Medicaid Services), and social determinants and demographic data (from the U.S. Census Bureau and CDC/ATSDR Social Vulnerability Index). This approach would create a series of linked datasets, enabling county-level investigations of maternal health equity, healthcare utilization, and health outcomes. The focus on larger, aggregate datasets at the county level helps to retain anonymity and protect patient privacy by using population-level data (e.g., percent of population or index ratios).
The benefits of such a national maternal care dataset are immense. It would allow for the identification of geographic barriers to care and support the development of evidence-based interventions to advance maternal health equity. This resource would improve research, outreach, and healthcare delivery to U3 women based on their geographic residence and proximity to care. Critically, it would help researchers to disentangle overlapping contributing factors like race, income, and rurality, thereby enabling the identification of root causes and the development of more effective interventions. The article cites the Netherlands as a successful example, where a national perinatal registry led to identifying geographic barriers, implementing evidence-based interventions, and dramatically improving maternal and child outcomes nationwide.
The authors conclude with several key recommendations to facilitate the development of such a dataset:
- Encourage or require more states to publicly share HCUP data.
- Host workshops for state departments of health to develop common data elements for interoperable publicly available state-level data.
- Establish national-level funding appropriations to implement the unfunded mandates in the Open Data Act.
- Increase grant funding for dataset development.
- Incentivize data sharing following dataset development.
This effort to build a comprehensive maternal care database, while technically challenging, is deemed a critical resource for research and policy development aimed at reducing MMM and improving maternal health equity in the U.S..
Reference: Colf, L. A., & Shreffler, K. M. (2025). Determining what matters: data resources for examining maternal health equity. Frontiers in Public Health, 13, 1499468. https://doi.org/10.3389/fpubh.2025.1499468
