The American College of Obstetricians and Gynecologists rightly criticized Health and Human Services Secretary Robert F. Kennedy Jr.'s announcement at the end of last month that his department will no longer recommend the Covid vaccine for pregnant women. Covid was the leading cause of maternal mortality in 2021, and the ACOG correctly pointed out that the vaccine is safe and that it provides needed protection for expectant mothers and their unborn children.
Where are pregnant women in Kennedy’s “Make America Healthy Again” plan?
The decision by Kennedy’s agency to delete the recommendation that pregnant women be vaccinated against a virus that was recently the leading cause of maternal death should prompt us to ask: Where are pregnant women in Kennedy’s “Make America Healthy Again” plan?
As a maternal health physician, public health expert and equity leader, I’m as unhappy as ACOG is with the specific decision the HHS has made to stop recommending the Covid vaccine for my pregnant patients. Contracting Covid during pregnancy increases the risk of complications, including death. But I’m even more outraged and alarmed by something else HHS has done on Kennedy’s watch: omit maternal mortality review committees (MMRCs) and perinatal quality collaboratives (PQCs) from the new structure of HHS. Maternal mortality review committees show us what is killing mothers and how we can stop it. Perinatal quality collaboratives give us the tools to act. They help hospitals and providers implement lifesaving solutions.
These programs are not bureaucratic add-ons, but the main reason our nation has made progress in reducing maternal deaths. And yet, in a new proposed budget, programs run by the Centers for Disease Control and Prevention, such as the pregnancy risk assessment monitoring system, maternal mortality review committees and perinatal quality collaboratives are conspicuously missing.
Together, these programs have led to measurable improvements in maternal outcomes across the country. From 2021 to 2023, the U.S. saw statistically significant decreases in maternal mortality. That’s not a coincidence — it’s the result of a national, coordinated strategy rooted in evidence and accountability. The removal of this infrastructure is more than a policy shift — it’s a dismantling of the very system that allowed us to fight back against a maternal health crisis. And the stakes are especially high for Black women and rural mothers, who face the greatest disparities in maternal outcomes. Without MMRCs, we lose the ability to track those disparities. Without PQCs, we lose the mechanism to fix them. In smaller hospitals, especially, quality improvement isn’t a given — it’s something PQCs make possible by helping teams implement patient safety bundles that might otherwise remain unused.
Forty-six states and six U.S. territories have MMRCs supported by a CDC grant. This funding provides support to perform case reviews of maternal deaths, while the CDC provides the infrastructure, including a database that allows the results of such reviews to be aggregated. Data from MMRCs in 38 states in 2020, for example, showed that the leading cause of pregnancy-related deaths was mental health conditions, inclusive of suicide and accidental overdose, and 84% of those deaths were deemed preventable. Those findings gave rise to federal programs such as the maternal mental health hotline which, I’m thankful, will continue to be supported in the proposed HHS budget.
The CDC also provides funding to support 36 state-based PQCs. This is an example of how the programs work together: In Louisiana, our maternal mortality review identified obstetric hemorrhage as our leading cause of pregnancy-related deaths in 2018. As a result, the Louisiana Perinatal Quality Collaborative (LaPQC) through the reducing maternal morbidity initiative and the safe births initiative worked to implement the AIM obstetric hemorrhage patient safety bundle. As a result, Louisiana mothers experiencing hemorrhage saw a 39% decrease in severe maternal morbidity (SMM), with a 58% decrease among Black women. These aren’t anecdotes. They are blueprints for saving lives.
The U.S. already has the highest maternal mortality rate among high-income countries.
Like the decision to stop recommending the Covid vaccine, if the decision to remove these programs from the budget stands, we will reverse course. The U.S. already has the highest maternal mortality rate among high-income countries. Removing these programs is likely to make the national crisis worse. We cannot allow that. My message to policymakers is simple: You can’t “Make America Healthy Again” if you ignore the risks of pregnancy and childbirth. Reinvest in the programs that are working. Fund the programs that show us why mothers are dying and what to do to keep more mothers alive. Preserve the public health infrastructure that has already started to move the needle in the right direction. If we as a country fail to act, then more mothers will die — and the tragic part is, we’ll know we had the tools to prevent it.