Title V and Maternal Mortality: Federal Funding to Save Lives

Title V of the Social Security Act provides funding to improve the health and well-being of U.S. mothers, children, and families. Established in 1935, Title V is the oldest federal-state partnership program, providing block grants to states and territories to support maternal and child health (MCH) services such as perinatal care, immunizations, and newborn screening. Used strategically, Title V funds can provide critical support for a range of maternal and children’s health needs and help reduce maternal mortality and morbidity.

Title V’s flexible funding allows states and territories to tailor their programs to meet the specific priorities of their MCH populations. Grantees conduct comprehensive needs assessments, develop a plan to address the needs, and report on their progress and outcomes using a set of national and state-specific performance measures. Currently, Title V is helping to fill identified MCH gaps for 59 states and jurisdictions nationwide.

Title V funding to address maternal mortality

Maternal mortality, defined as the death of a woman during pregnancy or within one year after the end of a pregnancy, is a serious public health problem in the U.S. According to the Centers for Disease Control and Prevention (CDC), the maternal mortality rate in the U.S. was nearly 33 deaths per 100,000 live births in 2021, higher than in any other developed country.

In addition, racial and ethnic disparities persist. Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women. Leading causes of maternal death include hemorrhage, hypertension, infection, cardiovascular disease, and suicide. Many of these causes are worsened by social determinants of health such as poverty, lack of access to quality health care, racism, and discrimination.

Title V funding can play a vital role for states and territories in addressing maternal mortality and improving maternal health outcomes. Here are some current uses of Title V funds:

• Establishing or enhancing maternal mortality review committees (MMRCs) to collect and analyze data on maternal deaths and recommend actions to prevent future deaths.
• Implementing evidence-based practices and quality improvement initiatives to improve the delivery and coordination of maternal health care services.
• Expanding access to home visits, care coordination, and case management programs for high-risk peripartum individuals.
• Promoting maternal mental health and substance use disorder screening, referral, and treatment.
• Increasing awareness and education on the signs and symptoms of pregnancy-related complications and the importance of seeking timely care.
• Engaging community partners and stakeholders to address the social and environmental factors that affect maternal health and well-being.

Where Title V is succeeding

California’s Title V program, the largest in the nation, has achieved success with multiple funded initiatives. In 2006, California established the California Maternal Quality Care Collaborative (CMQCC), a public-private partnership that brings together healthcare providers, hospitals, health plans, public health agencies, and consumer groups to improve maternal health and reduce disparities. With support from Title V and other sources, CMQCC has developed and implemented several initiatives to improve the quality and safety of maternal care, such as:

• The California Maternal Data Center, a web-based platform that collects and analyzes data on maternal health indicators and provides feedback and benchmarking to hospitals.
• The California Pregnancy-Associated Mortality Review, a statewide maternal mortality review committee (MMRC) that reviews maternal deaths and identifies opportunities for prevention and improvement.
• The California Toolkit to Transform Maternal Care, a series of evidence-based guidelines and resources to help hospitals implement best practices for the management of common and serious maternal complications, such as hemorrhage, preeclampsia, and sepsis.
• The California Birth Equity Collaborative, a statewide initiative that aims to reduce racial and ethnic disparities in maternal and infant outcomes by addressing implicit bias, cultural humility, and respectful care in maternity care settings.

As a result of these efforts, California saw a significant reduction in its maternal mortality rate, from nearly 17 deaths per 100,000 live births in 2006 to nearly six deaths per 100,000 live births in 2016, a 65% decrease. Although the rate increased due to the COVID-19 pandemic, California’s overall progress demonstrates how Title V funding can help support innovative and collaborative approaches to improve maternal health and save lives. However, California has not yet reversed its racial gap in maternal mortality. For example, the Black-white ratio of maternal deaths were four-to-six times greater than those of other racial/ethnic groups.

Title V and maternal mortality policy recommendations

Even though Title V is a critical source of funding for maternal and child health initiatives in the U.S., Title V alone cannot solve the complex and multifaceted problem of maternal mortality. It is essential that federal and state policies procure additional funding and support for their Title V programs so they can effectively address all their MCH needs.

Policymakers, healthcare providers, and advocates must work together to tackle the challenges. Policy recommendations to increase Title V’s effectiveness in addressing maternal mortality could include:

• Increasing and sustaining additional federal and state funding for Title V to ensure that states and territories have sufficient resources to implement and evaluate their MCH programs and activities.
• Expanding Medicaid coverage and access to comprehensive and continuous health care for individuals before, during, and after pregnancy, especially for low-income and uninsured patients who face higher risks of poor maternal outcomes.
• Strengthening data collection and reporting systems for maternal mortality and morbidity to improve the quality and timeliness of data and facilitate the identification of trends and gaps.
• Engaging and empowering patients, families, and communities as partners and advocates in tackling systemic issues and identifying needed policy changes to improve maternal health and reduce disparities.
• Addressing social determinants of health that affect maternal health and well-being, such as poverty, racism, violence, and environmental hazards by incorporating equity initiatives into maternal health policies and programs.
• Investing in healthcare provider and clinician education to elevate care, reduce variation, and increase competency in evidence-based maternal and child health practice protocols.

How healthcare education can improve maternal outcomes

Healthcare education is a powerful tool for improving MCH outcomes and reducing maternal mortality. Title V programs have shown that strengthening training on evidence-based practices for healthcare professionals enables them to provide safer and more effective care for pregnant and postpartum patients, reduce variation, and ensure high reliability.

Maternal mortality in the U.S. often stems from a lack of access to quality care. Better education works to improve both access and quality — reducing disparities, improving effectiveness, supporting the implementation and evaluation of evidence-based practices and policies, and building the capacity and competency of the healthcare workforce. These efforts support the missions of both Title V and the nation’s healthcare systems.