Testimony: Improving Maternal Health in New York City

October 23rd, 2025

Testimony: Improving Maternal Health in New York City

Mia Wagner

Testimony before the New York City Council

Chair Farah N. Louis and Members of the Committee on Women and Gender Equity

Chair Marcedes Narcisse and Members of the Committee on Hospitals

The Community Service Society of New York (CSS) would like to thank the City Council for the opportunity to provide comments on opportunities to improve maternal health in New York City. CSS is an 180-year-old organization that aims to build a more equitable New York for low- and moderate-income individuals, assisting over 130,000 New Yorkers annually in accessing health care. We achieve this through a live-answer helpline and partnerships with over 50 community-based organizations operating in every county of New York State. Annually, CSS and its partners save consumers over $80 million in health care costs.

The September 2025 annual report on Pregnancy-Associated Mortality in New York City issued by the NYC Maternal Mortality Review Community (M3RC) showed that the number of pregnancy-associated deaths increased by 13.7 percent in 2022. In addition, the report showed that among those who died within a year of pregnancy, 42 percent were Black, despite Black New Yorkers only accounting for 17 percent of births that year. The committee also found that most deaths could have been prevented, indicating the urgency of regulatory intervention to improve outcomes and health equity.

In addition to disparities by race and ethnicity, maternal health outcomes in New York City vary by neighborhood. For example, between 2016 and 2020, the Crown Heights community district in Brooklyn reported a pregnancy-associated mortality ratio of 114.5 deaths per 100,000 live births (the second highest in New York City). The adjacent community district of Fort Greene/Brooklyn Heights reported only 47.8 pregnancy-associated deaths per 100,000 live births over the same time period.^[1] These inequitable outcomes further underscore the need for regulatory intervention.

CSS supports the proposed initiatives to improve the reporting and tracking of adverse maternal health events in New York City, with minor adjustments to enhance transparency and ensure thorough data collection. CSS recommends three additional immediate actions the City can take to reduce maternal mortality and racial disparities in maternal outcomes.

I. Res 1082-2025: Resolution calling on the New York State Department of Health (NYSDOH) to confidentially share data regarding adverse maternal health events from the New York Patient Occurrence Reporting and Tracking System (NYPORTS) with the M3RC.

With a recommendation, CSS supports this initiative to improve access to data for the M3RC. Currently, NYPORTS is a State-run system, and NYSDOH does not provide NYPORTS data to the New York City Department of Health and Mental Hygiene (NYCDOHMH) or NYCDOHMH entities, including M3RC. Given the findings on preventable deaths included in the September 2025 M3RC report, it is critical that the City can access data on patient safety incidents, including surgical errors, medication errors, unexpected deaths, and near misses related to maternal care. With NYPORTS data, NYCDOHMH and M34C could develop a better understanding of the circumstances surrounding maternal deaths in New York City and develop actionable policies to address them.

Advocates have expressed concerns regarding a bill to regulate the sharing of health information (S929/A2141). The bill passed both chambers of the New York State Legislature this session and may complicate the NYSDOH's ability to share NYPORTS data with the M3RC.

Recommendation: CSS recommends that the City Council amend the resolution to request that the Legislature and Governor Hochul include a chapter amendment to explicitly allow data sharing between government entities before signing S929/A2141 into law.

II. Res 1085-2025: Resolution calling on New York City Health and Hospitals (H+H) facilities to report to NYPORTS on adverse maternal health events based on an expanded and standardized definition of adverse maternal health events, including adverse events at least 30 days postpartum.

With a recommendation, CSS supports the initiative to require H+H facilities to report to NYPORTS on adverse maternal health events, using an expanded and standardized definition of these events. Currently, there is no widely agreed-upon definition of maternal health, of what constitutes an adverse maternal health event, or the timeline in which an intervention or complication should be considered related to maternal health. Res 1085-2025 calls upon H+H to fill in this data gap and work with NYPORTS and maternal health advocates to standardize these definitions. CSS supports this initiative to ensure the State and City have the most accurate data possible to track adverse maternal health events.

The resolution specifies that the definition of adverse maternal health events should cover events at least 30 days postpartum. Nationally, 52 percent of maternal deaths occur postpartum.^[2] According to the September 2025 M3RC report, the leading causes of late maternal deaths-occurring between six weeks and one year postpartum-are distinctly different from the leading causes of maternal deaths during and immediately after pregnancy. The M3RC report also includes many recommendations related to ensuring maternal health during the postpartum period.

There are three commonly used measures of maternal deaths: (1) pregnancy-associated mortality (deaths during pregnancy and up to one year postpartum); (2) pregnancy-related mortality (deaths during pregnancy and up to one year postpartum that are related to pregnancy); (3) and maternal mortality (deaths during pregnancy and up to 42 days postpartum that are related to pregnancy.

Collecting data on adverse maternal health events for up to a year postpartum provides critical information about racial inequities in maternal health outcomes. A 2021 NIH-funded study found that late maternal deaths were 3.5 times more likely among Black women than White women. It demonstrated that the risk of postpartum cardiomyopathy was six times higher among Black women, compared to White women.^[3] For these reasons, only requiring data collection for adverse maternal health events for a minimum of 30 days postpartum risks missing critical data to understand the landscape of adverse maternal health events in New York City.

Recommendations: CSS has two recommendations. First, the City should amend the resolution to require H+H to track adverse maternal health events through one year postpartum to ensure pregnancy-associated and pregnancy-related events are captured in the NYPORTS data. To do so, the City should require H+H to track adverse maternal health events up to one year postpartum for any readmissions to the H+H system. If provided access to the NYPORTS data, the City should use death certificates, vital records linkage, and hospital discharge data to link any adverse maternal health events.

Second, CSS recommends that the City Council amend this definition to include adverse maternal health events at least one year postpartum for patients who are readmitted to the H+H system. In addition, the City should continue to use death certificates, vital records linkage, and hospital discharge data to identify pregnancy-associated deaths.

III. Res 1086-2025: Resolution calling on the NYSDOH to create a new and separate occurrence code for maternal mortality and standardize the definition of events reportable to the NYPORTS.

With a recommendation, CSS supports the initiative to call on NYSDOH to track maternal mortality using a separate code and to standardize events reported to NYPORTS. Currently, there are significant inconsistencies in NYPORTS reports of adverse medical events by facility, with rates up to 20 times greater between otherwise comparable hospitals in New York City. While maternal death is a category in NYPORTS, the language around classification is unclear and likely being interpreted differently across hospitals. The NYSDOH and M3RC classify a pregnancy-associated death as the death of a birthing person from any cause during pregnancy or within one year of the end of pregnancy, regardless of the outcome of the pregnancy. This definition differs from the State Maternal Mortality Review Board, aligned with the World Health Organization, which defines maternal death as the death of a birthing person while pregnant or within 42 days of termination of pregnancy.

Recommendation: CSS recommends that the City Council adopt the M3RC definition for a pregnancy-associated death to capture data up to a year postpartum for the reasons outlined in section II.

IV. Res 1087-2025: Resolution calling on the NYSDOH to conduct regular audits of NYPORTS data, and to require hospitals to fill in missing data retroactively.

With recommendations, CSS supports the initiative to call upon NYSDOH to audit NYPORTS data and require hospitals to fill in missing data. An audit of the NYPORTS data, with publicly available findings, has not been conducted since the 2009 New York State Comptroller's report. This report found that 84 percent of occurrences that were supposed to be reported within 24 hours, including deaths, were reported late. It also found that New York City hospitals, in particular, underreported medication administration errors.^[4]

CSS recommends that the City Council, if given access to NYPORTS data by DOH, issue annual reports that break out NYPORTS findings and all data on maternal deaths by race and ethnicity. The 2025 M3RC report concerningly omits a table of the underlying causes of pregnancy-associated deaths by maternal race and ethnicity. This data, which has been included in previous NYCDOHMH/ M3RC reports on pregnancy-associated mortality, consistently shows variation in the cause of death by race and ethnicity. Specifically, while mental health conditions have been the leading overall cause of death, and the leading cause of death for White women, cardiovascular conditions have been the leading cause of death for Black women.^[5] Given that the City has found that mental health conditions are the overall leading cause of death again, it is critical that the City release data to show if this finding holds across racial and ethnic groups.

Recommendation: CSS urges the City to return to its practice of publicly reporting data by race and ethnicity alongside underlying cases of pregnancy-associated deaths. This data should be publicly reported on the NYCDOHMH website and on the forthcoming website of the Office of Healthcare Accountability.

V. Immediate actions the City can take to reduce maternal mortality and racial disparities in maternal outcomes.

Access to quality data is an essential step towards reducing maternal mortality in New York City. However, data collection and access are not enough to prevent maternal mortality. The 2025 M3RC report found that 86.4 percent of pregnancy-associated deaths had some chance of being prevented. The City needs to act immediately to prevent maternal mortality and address racial disparities.

CSS has three additional recommendations for the City Council to consider.

1. Require that all patients who have given birth in New York City who are uninsured or have Medicaid coverage be discharged with an automatic blood pressure cuff.

According to the 2025 M3RC report, the second leading cause of pregnancy-associated deaths in New York City in 2022 was cardiovascular conditions. One national study found that cardiac conditions make up over half of postpartum deaths occurring between 43 days and one year after birth.^[6]

NIH researchers found that the risk of postpartum cardiomyopathy is six times higher among Black women, compared to White women.^[7] A previous NYC report includes a table of the underlying causes of pregnancy-associated deaths by maternal race and ethnicity from 2016 to 2020. While the report finds that the overall most common cause of pregnancy-associated death is mental health conditions, this does not hold for Black or Asian/Pacific Islander women. Mental health conditions are the most common cause of pregnancy-associated deaths among White-non-Hispanic women. For Black women, there was over double the proportion of pregnancy-associated deaths due to cardiovascular conditions as there was for White women, and it was the leading cause of death.^[8]

A proven method to catch postpartum hypertension early is to send patients home with an automatic blood pressure monitor, instructions on blood pressure self-monitoring, and guidance on warning signs. A 2024 study found that using remote blood pressure measurement was cost-effective in 99 percent of simulations.^[9] Another study of patients with postpartum hypertension found that remote monitoring led to decreased Emergency Department visits and readmission rates by over 80 percent.^[10] Patients in a home blood pressure monitoring program are significantly more likely to have blood pressure recorded within the first 10 days postpartum. Further, patients in the program are more likely to provide multiple blood pressure values which allows for improved clinical decision making.^[11] The 2025 M3RC recommends the NYSOH and NYCDOHMH create a campaign to raise public awareness on postpartum warning signs, with a focus on cardiovascular disease and postpartum depression. While important, public awareness alone is not enough to prevent postpartum maternal mortality.

Recommendation: CSS recommends that the City ensure that blood pressure is remotely monitored for all people who give birth in New York City by sending them home with a blood pressure cuff.

2. Require that all patients with Medicaid who have given birth in New York City be offered a pre-discharge scheduled home visit.

As discussed above, racial disparities are particularly pronounced in postpartum maternal mortality, with cardiovascular conditions as a leading cause of death for Black women postpartum. The 2025 M3RC report includes a series of recommendations related to postpartum care. However, the report's recommendations focus on creating a network of maternal medical homes to coordinate postpartum care, not on home visits. It is essential to provide a variety of ways to access postpartum care.

Home visits have been shown to reduce Emergency Department visits in the first 12 weeks postpartum for low-income patients. This reduction in Emergency Department visits is cost-effective and may improve postpartum care delivery. Patients who receive a home visit are likely to have improved health literacy, education about what to expect in the postpartum period, and their health concerns triaged before they seek emergency care.^[12]

Recommendation: CSS recommends that the City require hospitals to schedule a postpartum home visit for all patients with Medicaid before discharge.

3. Leverage NYCDOHMH's surveillance systems to document and investigate "near misses" and preventable maternal deaths

NYCDOHMH is one of the largest public health agencies in the world, with 220 years of experience, a $1.6 million annual budget, and over 7,000 employees. It has been on the forefront of investigating, surveilling, and remediating major epidemics, including typhoid, multi-drug resistant tuberculosis, and M-Pox. As the nation's oldest municipal public health agency, NYCDOHMH serves a critical role in setting the standard of care for municipalities across the country.

Unfortunately, the maternal mortality frequency and racial disparities in maternal deaths have continued to worsen despite the steps the City has taken to address these crises. While the M3RC reviews and makes recommendations to prevent future deaths, the City needs to go further to leverage its surveillance expertise and public health authority to investigate and remediate maternal mortality as it has done with communicable diseases in the past.

Thank you for the opportunity for the public to comment on this matter. Should you have any questions, please do not hesitate to contact Mia Wagner at [email protected].

Notes

1. Pregnancy-Associated Mortality in New York City, 2016-2020, Maternal Mortality Review Committee, New York City Department of Health and Mental Hygiene. September 2024. https://www.nyc.gov/assets/doh/downloads/pdf/ms/pregnancy-associated-mortality-report-2016-2020.pdf

2. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries, The Commonwealth Fund. November 2020. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries

3. NIH-funded study highlights stark racial disparities in maternal deaths, NIH. August 2021. https://www.nih.gov/news-events/news-releases/nih-funded-study-highlights-stark-racial-disparities-maternal-deaths

4."The High Costs of Weak Compliance With the New York State Hospital Adverse Event Reporting and Tracking System," Office of New York City Comptroller William C. Johnson. March 2009. https://comptroller.nyc.gov/wpcontent/uploads/documents/03-09-09-nyports-policy-report.pdf.

5. Pregnancy-Associated Mortality in New York City 2018-2020, Maternal Mortality Review Committee. Page 30. https://www.nyc.gov/assets/doh/downloads/pdf/ms/pregnancy-associated-mortality-report-2016-2020.pdf.

6. Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC7377107/.

7. NIH-funded study highlights stark racial disparities in maternal deaths, NIH. August 2021. https://www.nih.gov/news-events/news-releases/nih-funded-study-highlights-stark-racial-disparities-maternaldeaths.

8. Pregnancy-Associated Mortality in New York City 2018-2020, Maternal Mortality Review Committee. Page 30. https://www.nyc.gov/assets/doh/downloads/pdf/ms/pregnancy-associated-mortality-report-2016-2020.pdf.

9. Mei JY, et al. Remote blood pressure management for postpartum hypertension: a cost-effectiveness analysis. Am J Obstet Gynecol MFM. 2024 https://pmc.ncbi.nlm.nih.gov/articles/PMC12150216/.

10. Mei, Jenny Y., et al. "Standardized clinical assessment and management plan to reduce readmissions for postpartum hypertension." Obstetrics & Gynecology 142.2 (2023): 384-392. https://journals.lww.com/greenjournal/fulltext/2023/08000/Standardized_Clinical_Assessment_and_Management.20 .aspx. Hoppe, K., et al. "Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension," American Journal of Obstetrics and Gynecology, Volume 223, Issue 4, 2020, Pages 585- 588, https://www.sciencedirect.com/science/article/abs/pii/S0002937820305548.

11. Corlin, T., et al. "Postpartum remote home blood pressure monitoring: the new frontier," AJOG Global Reports, Volume 3, Issue 3, 2023, https://www.sciencedirect.com/science/article/pii/S2666577823000928.

12. Rokicki S, et al., "Home Visits and the Use of Routine and Emergency Postpartum Care Among Low-Income People: A Secondary Analysis of a Randomized Clinical Trial," JAMA Network Open. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11667346/#zoi241429r34.

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