Oklahoma's maternal mortality rate has improved, following national trends, according to the state's annual report. But it remains elevated compared to national data, as women face factors like limited health care access, higher poverty and uninsured rates, and maternity care deserts.
Data from Oklahoma Vital Statistics shows a decline in maternal deaths from 31.9 per 100,000 live births from 2020 to 2022, to 29 per 100,000 from 2021 to 2023. Nationally, that rate was 24.6 per 100,000.
The three-year rolling mortality rate remains elevated because of increases in 2021. That is linked in part to COVID-19-related deaths. Excluding those, Oklahoma's maternal mortality rate decreased by 9.3%, compared to 4.3% nationally.
Oklahoma's definition of maternal death includes the death of a woman while pregnant or within 42 days of a pregnancy's termination "from any cause related to or aggravated by the pregnancy or its management." It excludes accidental or incidental causes.
The rate of those deaths varies by race. White Oklahoma women had the lowest maternal mortality rate at 19.2 per 100,000 live births – a nearly 16% decrease from last year's report.
Black women across the state have the highest rate, with 71.6 per 100,000 live births.
Oklahoma has a process to identify and explore the circumstances surrounding maternal deaths through its Maternal Mortality Review Committee. The group has statutory authority to review pregnancy-associated deaths and obtain documents from them, such as medical examiner reports and medical and law enforcement records.
But the report notes there are limitations to the data it can gather on Indigenous Oklahomans, as state statute does not necessarily apply to tribal organizations and providers because of Indigenous data sovereignty.
The committee reviewed 100 deaths occurring during pregnancy or within one year of its end from 2018 to 2022. Of those, 43% were pregnancy-related, meaning they were caused by complications. The top causes were hemorrhage, infection and cardiac conditions.
Nearly 70% were deemed preventable.
Contributing factors at the patient and family level included a lack of vaccination, and an absence of, delay in or limitations for perinatal care. There were also general delays in accessing care, alongside some related to religious and cultural beliefs, substance abuse and financial challenges.
At the provider level, there were themes of delays in treatment and not following the standard of care for diagnosis, treatment and follow-ups.
Oklahoma's Maternal Mortality Review Committee offered recommendations to improve access to quality pregnancy-related health care to support a reduction in maternal deaths. Those include:
- Implementing obstetric early warning score systems in facilities to monitor vital signs and other clinical indicators.
- Screening every pregnant patient for mental health conditions and substance use disorders, documenting screenings and referring them to resources in the perinatal period.
- Health care workers should provide consistent touchpoints to encourage engagement with available resources throughout the perinatal period.
- The committee should establish an advisory group to address perinatal mental health and substance use.
- The committee should advocate for legislative action to prioritize housing support for pregnant and postpartum individuals.
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