Issued November 2022
The Department of Health’s recently released “New Jersey Maternal Mortality Report 2016-2018” brings to light important factors related to New Jersey’s unfortunate distinction as a state with one of the highest disparities in maternal mortality between White, Non-Hispanic (NH) and Black, Non-Hispanic Birthing Persons (BP) [AHR, 2021 in (1)]. As cited in the report, in New Jersey, Black, NH BP die from pregnancy-related complications at nearly seven times that of white, NH BP, compared to the national rate, where NH BP are three to four times more likely than white, NH birthing people to experience pregnancy-related mortality [Howell, 2018 in (1)].
The Center for Great Expectations applauds the report’s authors, as well as the many professionals who serve on the New Jersey Maternal Mortality Review Committee and contributed to its development and publication. The report highlights crucial factors contributing to the high rate of maternal mortality including lack of provider/patient knowledge, lack of continuity of care/care coordination, lack of standardized policies and procedures, substandard clinical skill/quality of care and lack of assessment. The committee also found contributing factors among pregnancy-associated, but not related cases including lack of continuity of care/care coordination, complications of substance use disorder (SUD), complications of mental health conditions, lack of provider/patient knowledge and lack of standardized policies and procedures.
With deep respect and appreciation for the importance of these issues, we call for of an examination of factors related specifically to substance-use-disorder-related deaths, all of which are preventable and are the leading underlying cause of death among the pregnancy-associated, but not related deaths. Inclusion of these elements, as outlined below, in state policy-creation and decision-making is a vital component of an effective approach to reducing maternal mortality in New Jersey.
To begin, we must invite a discussion around stigma, discrimination and the lack of substance use treatment for pregnant and parenting persons with substance use disorders. As Emily Baumgaertner states in her October 21 article published in The New York Times, “Pregnant women are more likely to die of a drug overdose than the average woman of childbearing age, but less likely to be accepted for medication-based treatment.” Additionally, many hospitals and OBGYNs lack training in trauma-informed care and in understanding the link between trauma and substance use, resulting in stigmatized and shaming language, as well as policies and practices that are punitive toward pregnant persons with SUDs.
A second factor contributing to our state’s exceedingly high mortality rate is fear of child custody removal which prevents many pregnant persons from engaging in prenatal care. Nationally, 50,000 baby removals occur each year, and about half are associated with substance use. A recent report detailing a plan by the Biden administration to increase access to substance use treatment stated that having a substance use disorder in pregnancy “is not, by itself, child abuse or neglect,” and that “criminalizing S.U.D. in pregnancy is ineffective and harmful.” (2)
Third, while the report cites access to care as another reason for the New Jersey’s high maternal mortality rate, it does not acknowledge current funding and licensing practices, inhibiting families from using crucial in-home substance use treatment services. Currently, to our most current knowledge, free in-home SUD counseling and relationship-based interventions for parent-child dyads are only available in 9 New Jersey counties. In 8 of these counties, services are only available for mothers who initiate care up to 16 weeks postpartum and with opioid use disorder. In one county, services are appropriately offered to families with children up to age 6 and with any SUD. We need to expand these services across NJ to include, at minimum, the full year postpartum and all SUD. Limitations on the age of the child at intake, the substance used by the mother, and lack of licensing for in-home substance use treatment are barriers to these vital services reaching families in need.
Lack of housing and homelessness are not mentioned as factors leading to the maternal mortality crisis. However, our clinical experience and expertise has led us to the conclusion that, without meeting the basic need for housing, one cannot be expected to effectively engage in the treatment of substance use, underlying trauma and mental health disorders. We implore policy makers, decision-makers and care providers to acknowledge and respond to the need for high quality, trauma-informed residential “mommy and me” treatment programs where infants and young children can live with their mothers and receive relationship-based interventions that promote infant mental health. Mothers should not be asked to choose between attending residential treatment and being separated from their babies, and babies should not be subjected to the attachment rupture that occurs when they are separated from their mothers. We also call for the funding and development of additional supportive programs with high quality in-home SUD and relationship-based treatments.
In all, we applaud the New Jersey Maternal Mortality Review Committee and the NJ Department of Health for their work in determining the identified factors contributing to high maternal mortality rates in New Jersey. We join this group and others across the state in their commitment to creating changes for mothers and babies and call for a closer look at the root causes of maternal deaths related to substance use. We offer our leadership and support in developing enhanced systems of care in New Jersey.
(1) New Jersey Maternal Mortality Review Committee. (2022) New Jersey Maternal Mortality Report 2016-2018. Trenton, NJ. New Jersey Department of Health.
(2) Baumgaertner, E. (2022, October 21). “Biden Administration Offers Plan to Get Addiction-Fighting Medicine to Pregnant Women.” The New York Times.