Report on the Status of the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program

Introduction: Maternal Health Initiatives and Alignment with Sustainable Development Goals

The Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) program, established under the Preventing Maternal Deaths Act of 2018, represents a critical national effort to address the maternal mortality crisis in the United States. This initiative directly aligns with the United Nations’ Sustainable Development Goal 3 (Good Health and Well-being), specifically Target 3.1, which aims to reduce the global maternal mortality ratio. The program’s future is currently in jeopardy as its funding is set to expire on September 30, threatening progress toward this and other related SDGs.

Program Impact on SDG 3: Good Health and Well-being

Data-Driven Interventions and Institutional Strengthening

The ERASE MM program provides federal funding to state-level maternal mortality review committees (MMRCs). This investment strengthens public health infrastructure, a key component of SDG 16 (Peace, Justice and Strong Institutions), by creating effective and accountable institutions to analyze and prevent maternal deaths. The program’s achievements include:

• The development of new clinical protocols to prevent common causes of death such as hemorrhage and sepsis.
• The establishment of MMRCs in states that previously lacked them.
• The distribution of nearly $90 million over five years to 46 states, with an average of $870,000 per state last year.
• The funding of essential staff who collect and prepare case files for review by volunteer medical and public health experts.

Addressing Mental Health and Non-Communicable Diseases

The work of the MMRCs has been instrumental in advancing SDG Target 3.4, which calls for the promotion of mental health and well-being. By identifying underlying causes of death beyond immediate clinical factors, committees have spurred targeted interventions.

• New Hampshire: Committee recommendations led to a program where OB-GYNs collaborate with psychiatrists to treat postpartum depression and substance use disorder.
• Utah: The MMRC, established with ERASE MM funds, identified an increase in maternal deaths by suicide, resulting in new programs for mental health and substance use disorder screening.
• Indiana: The state’s MMRC, created in 2018 with program funds, prompted the expansion of an initiative for postpartum home visits by nurses.

Monitoring Access to Reproductive Healthcare

Following the 2022 Supreme Court decision overturning the constitutional right to abortion, the ERASE MM program has provided a vital framework for assessing the impact of restrictive laws on maternal health. This function is directly relevant to SDG 3.7 (Universal access to sexual and reproductive health-care services) and SDG 5 (Gender Equality). A review committee in Georgia determined that the state’s abortion ban contributed to the preventable death of Candi Miller, who reportedly feared legal repercussions for seeking care after taking abortion pills and developing sepsis. This demonstrates the program’s unique capacity to provide evidence on how policy changes affect health outcomes.

Funding Uncertainty and Threats to SDG Progress

Expiration of Federal Support

The ERASE MM program’s authorization and funding are set to expire, and it was not included in the administration’s 2026 budget proposal. This development, along with the proposed elimination of the broader Safe Motherhood initiative, poses a significant threat to the United States’ ability to meet its maternal health objectives and commitments under the SDGs. The potential loss of this relatively inexpensive but high-impact program has alarmed maternal health advocates and members of Congress.

Consequences of Defunding

The termination of ERASE MM funding would have severe consequences, reversing progress on multiple Sustainable Development Goals.

1. Erosion of Institutional Capacity: States that rely entirely on federal dollars for their MMRCs, including Indiana, South Carolina, Iowa, Missouri, and Utah, may be forced to dismantle these critical review bodies. This would weaken the institutional frameworks required by SDG 16.
2. Loss of Standardized Data: Without the CDC’s guidance under ERASE MM, data collection on maternal deaths would become inconsistent. This would undermine national analysis and policy coherence, a setback for SDG 17.14 (Enhance policy coherence for sustainable development).
3. Diminished Oversight: The ability to analyze complex contributing factors to maternal deaths—including mental health, substance use, and the impact of state laws—would be lost, leaving a significant gap in public health intelligence.
4. Stagnation of Preventative Care: Progress in developing targeted, evidence-based interventions for new mothers would likely halt, impeding further reductions in preventable deaths.

State-Level Disparities and the Importance of National Coherence

Divergent State Approaches

The national framework for maternal death review is already facing challenges from states opting out of the federal program. Florida and Texas have declined ERASE MM funding. Texas, which accounts for approximately 10% of U.S. maternal deaths, has also stopped sharing its MMRC data with the CDC and has chosen not to review deaths from 2022 and 2023. Furthermore, the state forbids its panel from investigating deaths related to abortion. These actions create significant data gaps and exacerbate health inequities, running counter to the principles of SDG 10 (Reduced Inequalities).

The Case for a Unified Framework

The ERASE MM program provides a standardized methodology, guiding committees to consider a wide range of contributing factors. This ensures that data is comprehensive and comparable across states. Without this national standard, states may “pick and choose what to review,” as one expert noted, rendering the data less reliable for national policymaking. A unified framework is essential for a cohesive national strategy to improve maternal health outcomes for all.

Conclusion

The ERASE MM program is a cornerstone of the U.S. strategy to combat maternal mortality and is intrinsically linked to achieving key Sustainable Development Goals, including those concerning health, gender equality, and strong institutions. The impending expiration of its funding threatens to dismantle a vital data and public health infrastructure, erase years of progress, and leave the nation unable to effectively monitor and respond to the ongoing maternal health crisis. Continued investment in this program is critical for ensuring the health and lives of mothers across the country.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being – The article’s central theme is the maternal mortality crisis in the U.S. and the efforts to prevent maternal deaths through the ERASE MM program.
• SDG 5: Gender Equality – The article discusses how restrictions on reproductive rights, specifically abortion bans, directly impact women’s health and have led to preventable deaths.
• SDG 10: Reduced Inequalities – The article highlights the disparities in maternal health outcomes between the U.S. and other affluent nations, as well as inequalities in care and data collection among different U.S. states.
• SDG 16: Peace, Justice and Strong Institutions – The article focuses on the role, funding, and effectiveness of institutions like the ERASE MM program and state-level maternal mortality review committees, which are designed to create accountability and improve public health systems.

Specific SDG Targets

SDG 3: Good Health and Well-being

1. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

   The article directly addresses this target by focusing on the “nation’s maternal mortality crisis.” It notes that “U.S. maternal mortality rates had risen sharply over two decades as rates in other affluent nations had dropped.” The entire purpose of the Preventing Maternal Deaths Act and the ERASE MM program is to understand the causes of these deaths (such as hemorrhage, sepsis, and suicide) and implement protocols to reduce the maternal mortality rate.

SDG 5: Gender Equality

1. Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.

   The article connects the lack of access to reproductive healthcare directly to maternal deaths. It states that the work of maternal mortality committees “only became more urgent after the Supreme Court overturned the constitutional right to abortion.” It provides the specific case of Candi Miller, whose death was linked to Georgia’s abortion ban, and Amber Thurman, who died after doctors delayed a necessary procedure “entangled in restrictions subjecting doctors to criminal penalties.” This demonstrates a failure to ensure access to reproductive health services, leading to fatal outcomes.

SDG 10: Reduced Inequalities

1. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices.

   The article highlights significant inequalities in health outcomes. It points out the disparity between rising U.S. maternal mortality rates and dropping rates in “other affluent nations.” Furthermore, it describes inequalities within the U.S., where state policies create different levels of risk for pregnant women. The article notes that if the federal program ends, “You’ll have states that pick and choose what to review,” and some, like Texas, already “forbids its panel from investigating deaths related to abortion.” This creates an unequal system of protection and accountability based on geography.

SDG 16: Peace, Justice and Strong Institutions

1. Target 16.6: Develop effective, accountable and transparent institutions at all levels.

   The article is a case study of the development and potential dismantling of such institutions. The ERASE MM program was created to fund “state committees that review maternal deaths and identify their causes,” making the system more effective. The potential loss of funding for ERASE MM threatens these institutions, as some states “rely entirely on federal dollars to pay for their maternal mortality reviews.” The article also points to a lack of transparency and accountability in states like Texas, which “stopped sharing data collected by its maternal mortality review committee with the CDC,” undermining the goal of a strong, transparent national system.

Indicators for Measuring Progress

SDG 3: Good Health and Well-being

1. Indicator 3.1.1: Maternal mortality ratio.

   This is the primary indicator discussed. The article is framed around the “maternal mortality crisis” and rising “maternal mortality rates.” The ERASE MM program is designed to ensure “reliable national data on maternal mortality” is collected, which is essential for calculating this indicator accurately.

2. Indicator 3.1.2: Proportion of births attended by skilled health personnel.

   This is implied through the discussion of preventable deaths and the quality of care. The deaths of Miller and Thurman, due to fear of seeking care and delays in receiving it, suggest failures in the provision of skilled and timely health services. The creation of “new protocols to prevent hemorrhage, sepsis and suicide” and initiatives for “post-partum home visits to new mothers” are direct efforts to improve the effectiveness of skilled health personnel.

SDG 5: Gender Equality

1. Indicator 5.6.2: Number of countries with laws and regulations that guarantee full and equal access to women and men… to sexual and reproductive health care.

   The article explicitly discusses the legal framework in the U.S. following the overturning of Roe v. Wade. It details how “the state’s abortion ban contributed to the preventable death of 41-year-old Candi Miller” and how a necessary medical procedure for Amber Thurman “had become entangled in restrictions subjecting doctors to criminal penalties.” This directly relates to how laws and regulations are failing to guarantee access to essential reproductive healthcare.

SDG 10: Reduced Inequalities

1. Implied Indicator: Disparities in maternal mortality data collection and review processes between states.

   The article provides evidence for measuring this inequality. It states that before the federal program, “only two-thirds of states had review processes at all.” It also highlights current disparities, noting that four states, “including Florida and Texas, had opted out of accepting money from the program,” and Texas “stopped sharing data… with the CDC.” This creates a measurable inequality in how maternal deaths are investigated and addressed across the country.

SDG 16: Peace, Justice and Strong Institutions

1. Implied Indicator: Existence and funding of national and sub-national institutions for public health surveillance.

   The article provides concrete data points to measure this. The ERASE MM program itself is the institution, and its funding is a key metric. The article states the CDC “has distributed nearly $90 million to fund the work of state review committees” and that the program’s funding “expires on Sept. 30.” The fact that “Indiana is one of at least five states that rely entirely on federal dollars” shows the direct link between funding and the continued existence of these state-level institutions.

Table of SDGs, Targets, and Indicators

Source: propublica.org