Through the efforts of Nurture NJ and NJDOH, New Jersey Continues to Lead the Nation in Data Transparency

TRENTON - In advance of Maternal Health Awareness Day (January 23), the New Jersey Department of Health (NJDOH) today released the updated Maternal Health Hospital Report Card with data from 2024 as well as the updated findings from the New Jersey Maternal Mortality Review Committee (NJMMRC) in a data dashboard through 2023 and a detailed analysis report on data from the years 2019-2021. Issuing rigorous data on maternal mortality, morbidities, complications, and birthing experiences is a key component of First Lady Tammy Murphy's Nurture NJ initiative-helping expectant parents evaluate birthing facilities and informing statewide action to avert New Jersey's maternal health crisis.

"Over the past eight years, we have mobilized every resource at our disposal to directly address our state's maternal and infant mortality crisis. Most importantly, we ensured the communities most impacted had a voice at the table every step of the way. While we have made incredible progress, our work to transform New Jersey's maternal and infant health care system is far from over," said First Lady Tammy Murphy. "The annual Maternal Health Hospital Report Card provides an invaluable opportunity to reflect and inform our whole-of-government response to eliminating persistent disparities and improving health outcomes for every New Jersey mom and baby."

"Improving maternal health outcomes and achieving health equity requires a sustained, coordinated effort across many fronts. This Administration has made maternal health a top priority, investing in innovative and evidence-based solutions and working closely with health care providers and community partners," said Acting Health Commissioner Jeff Brown. "While we're seeing some encouraging trends, these data show we have considerable work ahead to ensure every New Jerseyan has the best possible start."

Report Card of Hospital Maternity Care (2024)

In 2019, New Jersey led the nation in releasing an annual report on maternal health care provided at licensed acute general care hospitals, a statutory requirement for NJDOH under P.L. 2018, c.82. The Report Card is part of a larger New Jersey Maternal Data Center (NJMDC) in the Department of Health, which tracks maternal health outcomes statewide. The NJMDC analyzes this data to identify trends and disparities, sharing findings to help improve maternal care across New Jersey.

The data reveal both progress and continuing challenges in maternal health outcomes across the state's birthing hospitals. In 2024, New Jersey's 46 birthing hospitals delivered 95,385 babies, with NJ FamilyCare (New Jersey's Medicaid program) covering just over one-third of these births. Data in the Report Card comes from deliveries reported to the NJDOH through both hospitalization discharge and electronic birth records.

The updated dashboards include user-friendly features to better serve New Jerseyans, including a mobile-friendly and accessibility-oriented design and a user feedback survey to support continuous improvement. New metrics are available as well, including implementation of Alliance for Innovation on Maternal Health (AIM) bundles.

Some measures, such as the overall cesarean birth, show progress. The statewide cesarean delivery rate decreased to 32.5% in 2024 from 34.4% in 2018. While cesarean deliveries (or C-sections) can improve outcomes for people who are at a higher risk for complicated deliveries or have unexpected complications, these surgical deliveries can lead to increased risk of infections and other complications in lower-risk births.

Additionally, the State continues to work toward reducing cesarean births among first-time parents with low-risk pregnancies, known as Nulliparous Term Singleton Vertex (NTSV) cesarean births. The rate of NTSV cesarean births was 24.9% in 2024, a decrease from 27.8% in 2018. Moreover, in 2024, 41% of New Jersey hospitals met the national Healthy People 2030 target for these deliveries in 2024, which represents an increase from 38% in 2023.

Hospital performance varied significantly across the state. Sixteen birthing hospitals (of 46 total) had higher-than-average rates of obstetric hemorrhage, which was a decrease from 19 hospitals in 2023.

Maternal Mortality Review Committee Report (2019-2021) and Dashboard (2016-2023)

The New Jersey Maternal Mortality Review Committee (NJMMRC) serves to comprehensively assess maternal deaths and identify opportunities for prevention. In 1932, New Jersey became the second state in the nation to institute a maternal mortality review team. Recognizing the importance of this work, Governor Murphy signed legislation (P.L.2019, c.75) in 2019 to help improve upon the efforts of the existing review team by formally establishing the NJMMRC within NJDOH, increasing its legal authority to investigate potential pregnancy-related deaths and including 24 members representing relevant clinical specialties, maternal and child health consortia, professional organizations, and state agency subject matter experts.

The NJMMRC report for 2019-2021 includes recommendations to ensure high-quality care, implement comprehensive approaches to chronic disease care during pregnancy, build patient knowledge, address barriers to care, and implement a holistic approach to care.

In the most recent period (2019-2023), the NJMMRC identified 258 pregnancy-associated deaths during or within 365 days of a pregnancy. Of these deaths:

• 38% were determined to be pregnancy-related - meaning a death from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy;
• 55.8% were pregnancy-associated, but not related - meaning a death from a cause that is not related to the pregnancy; and
• 6.2% were unable to be determined.

31.7% of pregnancy-related deaths occurred during labor and delivery or during the postpartum period within one year of the end of pregnancy, and 86.7% of pregnancy-related deaths were determined to be preventable. The Administration, through the First Lady's Nurture NJ initiative, has strengthened care continuity through investments in doula reimbursement, increased Medicaid coverage to 365 days postpartum, the launch of Family Connects NJ, the state's universal nurse home visitation program, and improved supports for patient education about post-birth warning signs.

Demonstrating the profound impact of COVID-19 on the health of New Jerseyans, the leading underlying causes of death for the pregnancy-related cases in 2019-2023 were attributed to COVID-19 (19.4%), cardiovascular conditions (19.4%), and other infections (15.3%). Meanwhile, more than half (54.2%) of pregnancy-associated, but not related, deaths in 2019-2023 were due to overdose as a result of substance use disorder. The Administration has worked with hospital systems to promote implementation of evidence-based protocols to prevent these leading causes.

Ongoing Disparities in Maternal Health Outcomes

New Jersey is increasingly diverse, with racial and ethnic groups other than non-Hispanic white now representing 55% of all births, up from 46% in 2000. This demographic shift underscores the importance of addressing health equity in maternal health care.

The data highlights persistent racial and ethnic disparities in maternal health outcomes. Non-Hispanic Black birthing people experienced the highest rates of severe maternal morbidity with transfusion (43.6 per 1,000 deliveries) and obstetric hemorrhage (68.8 per 1,000 deliveries). These rates are significantly higher than those for non-Hispanic white birthing people, who had lower rates in several categories. Hispanic birthing people had the second-highest rates in both categories.

Likewise, from 2019 through 2023, the pregnancy-related mortality ratio (number of pregnancy-related deaths per 100,000 live births) for Black, non-Hispanic women (64.7 deaths per 100,000 live births) was 7.6 times higher than for white, non-Hispanic women (8.5 per 100,000 live births). The pregnancy-related mortality ratio for Hispanic women (23.8 per 100,000 live births) was 2.7 times higher than for white, non-Hispanic women. Based on the NJMMRC's review, among the pregnancy-related deaths in 2019-2023, 27.6% were due at least in part to discrimination, interpersonal racism, and structural racism. These disparities are among the driving factors behind the Murphy Administration's ongoing efforts to make a more equitable system of care for every mother and child in the state.

Bringing Data to Action

The Murphy Administration has prioritized improving maternal and infant health outcomes and decreasing disparities through Nurture NJ, First Lady Murphy's whole-of-government initiative launched in 2019. In 2021, the First Lady unveiled the Nurture NJ Maternal and Infant Health Strategic Plan, of which the state has started or completed over half of its 80-plus recommendations, spanning nine action areas, from clinical care and workforce development to data systems and social determinants of health.

Since 2018, Governor Murphy has signed 78 pieces of maternal and infant health legislation, including such as P.L.2019, c.75 to support data-to-action efforts through the New Jersey Maternal Care Quality Collaborative, the New Jersey Maternal Mortality Review Commission, and the New Jersey Maternal Data Center, and P.L.2023, c. 109 which established the New Jersey Maternal and Infant Health Innovation Authority to sustain and advance the work of Nurture NJ into the future.

Also, understanding it will take sustained efforts over decades to end the persistent racial disparities, First Lady Tammy Murphy released a final document to lead the work forward: Nurture NJ: The New Jersey Blueprint for Maternal and Infant Health and Path for the Next Decade.

To learn more about Nurture NJ, visit nj.gov/nurturenj.