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WASHINGTON -- More must be done to decrease maternal mortality, including during the pandemic, Surgeon General Jerome Adams, MD, MPH, said Thursday.

"A woman dies every 12 hours in this country from pregnancy-related complications," Adams said on a phone call with reporters. "It's not just not acceptable, it's something we need to understand is not inevitable." According to the CDC, "two-thirds of these deaths are preventable," he added, noting that Black women, in particular, are two to three times more likely to die from pregnancy-related causes compared with many other racial and ethnic groups, regardless of educational status.

Why focus on maternal health in the midst of a pandemic? Because "without action, maternal health could actually worsen because of this pandemic," especially because many women are forgoing prenatal appointments due to fears about COVID-19, said Adams. "We must ensure that women know they can receive safe and uninterrupted prenatal care even in the midst of a pandemic. We must act now; our nation and our mothers deserve better."

Adams made his remarks during a call announcing a new Surgeon General's to improve maternal health. The call to action includes seven steps that health professionals can take:

Ensure quality preventive healthcare for all women, children, and families. Increase knowledge, awareness, and utilization of clinical practice tools such as those associated with recommendations from the U.S. Preventive Services Task Force and the CDC. Use preventive healthcare and wellness visits to conduct screenings, assess risk factors, provide support for family planning, offer immunizations, and provide education and counseling to promote optimal health.

Address disparities such as racial, socioeconomic, geographic, and age, and provide culturally appropriate care in clinical practices. Increase self and situational awareness of and attention to disparities. Provide culturally and linguistically appropriate services that respect and respond to individual needs and preferences.

Help patients to manage chronic conditions. Reduce the burden of chronic conditions, such as hypertension, diabetes, and obesity, as well as mental health and substance use disorders, on women's health across the lifespan by helping them to manage these conditions. Conduct cardiovascular risk evaluation, to include history of hypertensive disorders of pregnancy and gestational diabetes, and provide risk reduction strategies for women of childbearing age before, during, and after pregnancy.

Communicate with women and their families about pregnancy. Listen to women and their family members' concerns before, during, and after delivery. Educate about warning signs during pregnancy and the postpartum period. Use culturally acceptable and easily understandable methods of communication.

Facilitate timely recognition and intervention of early warning signs during and up to 1 year after pregnancy. Track patient vital signs (e.g., blood pressure) across healthcare visits, including prenatal, initial hospital admission, and postpartum visits. Learn to recognize and react to signs and symptoms associated with hemorrhage, pre-eclampsia, hypertension, cardiomyopathy, infection, embolism, substance use, and mental health issues.

Improve healthcare services during the postpartum period and beyond. Communicate the importance of postpartum visits, including the American College of Obstetricians and Gynecologists (ACOG) recommendation for an initial assessment within the first 3 weeks postpartum followed by ongoing care as needed and a comprehensive visit within 12 weeks after delivery. Non-obstetric providers can have an important role to play. For example, pediatricians could screen for maternal mental health during well-baby visits utilizing validated tools, such as the .

Participate in quality improvement and safety initiatives to improve care. Engage with state and/or national quality collaboratives and patient safety initiatives to improve maternal health. Consider using resources such as the Agency for Healthcare Research and Quality's , which includes patient safety bundles and simulation training.

The postpartum period needs special attention, Adams said. "People are increasingly talking about the '4th trimester'; about a third of deaths that occur related to pregnancy happen after a woman has left the hospital and gone home ... We need to increase support and recognition of the fact that people are at risk up to a year after birth. The president's budget is calling on coverage for substance use disorder up to a year post-birth, because a lot of the mental health-related complications we see do happen in that time."

The Surgeon General's Call to Action was a supplement to an released Thursday by the Department of Health and Human Services (HHS). That plan has three goals:

• Reduce the maternal mortality rate by 50% in 5 years.
• Reduce the low-risk cesarean delivery rate by 25% in 5 years.
• Achieve blood pressure control in 80% of women of reproductive age with hypertension in 5 years.

"Maternal mortality should be a 'never' event in American healthcare, and we are committed to making the United States one of the safest countries in the world for women to give birth," HHS Secretary Alex Azar said in a statement. "With the Action Plan and a historic Surgeon General's Call to Action, we've drawn on expertise across HHS to lay out a role for every American to play in improving the health and well-being of mothers and mothers-to-be."

To implement some of these policies, the administration's proposed 2021 budget includes $15 million to expand the Alliance for Innovation on Maternal Health (AIM) program, which supports development of evidence-based outpatient practices and policies to reduce maternal mortality, and $24 million to expand maternal mortality review committees to all 50 states to ensure that every pregnancy-related death is examined.

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