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Seven years ago, when President Donald Trump signed the Preventing Maternal Deaths Act into law, it was hailed as a crucial step toward addressing the nation’s maternal mortality crisis.
The law pumped tens of millions of dollars a year into a program to help fund state committees that review maternal deaths and identify their causes. The committees’ findings have led to new protocols to prevent hemorrhage, sepsis and suicide. Federal money has allowed some states to establish panels for the first time.
The committees’ work only became more urgent after the Supreme Court overturned the constitutional right to abortion. Last year, Georgia’s committee determined the state’s abortion ban contributed to the preventable death of 41-year-old Candi Miller.
But now the program that enabled this progress — known as Enhancing Reviews and Surveillance to Eliminate Maternal Mortality, or ERASE MM — is in danger, maternal health advocates say.
The program’s funding expires on Sept. 30, and efforts to renew it have thus far not succeeded. Congress included money to extend ERASE MM in a broader stopgap funding measure that almost passed in December 2024 before being scuttled by Republican opposition. The program isn’t paid for in the Trump administration’s budget proposal for 2026. Late last week, the Senate Appropriations Committee introduced a bill to fund the Department of Health and Human Services for the next fiscal year that includes money for ERASE MM, but the measure hasn’t moved forward yet.
Adrienne Griffen, executive director of the Maternal Mental Health Leadership Alliance, said she fears how little attention the program’s fraught future has drawn amid waves of layoffs at federal health agencies and ferocious debate over impending Medicaid cuts.
“We were concerned when the president’s budget did not include these programs,” Griffen said. “While we are happy with the progress, there is still a lot that needs to happen.”
The Centers for Disease Control and Prevention, which is responsible for awarding ERASE MM grants and guiding the work of state maternal mortality committees, didn’t answer specific questions from ProPublica about the future of the program. Andrew Nixon, communications director for HHS, the CDC’s parent agency, said in a statement that HHS “is committed to improving maternal and infant health outcomes.”
“We are currently reviewing the maternal and infant health portfolio to identify the most effective ways to collect and analyze data and improve the health and safety of mothers and infants,” the statement said.
HHS Secretary Robert F. Kennedy Jr. didn’t respond to requests for comment on whether advocates’ concerns are warranted.
The Trump administration’s budget proposal jettisons not only ERASE MM but a slate of programs known as the Safe Motherhood initiative, which aims to reduce risks such as premature births and infections that affect mothers and infants. All previously had bipartisan support. That’s left some members of Congress mystified about why their funding is in jeopardy.
At a June budget hearing, Rep. Greg Landsman, D-Ohio, pressed Kennedy on why the administration had proposed eliminating the programs, including ERASE MM.
“I genuinely believed this was zeroed out either accidentally or by some sort of oversight,” Landsman said, asking Kennedy to work with members of the House Committee on Energy and Commerce to restore funding.
After their exchange at the hearing, Landsman told ProPublica that Kennedy had agreed to meet to discuss restoring the funding.
“We want to save this investment,” he said. “It’s critical for expecting moms.”
ERASE MM came about in 2019 after reporting by ProPublica and others showed that hundreds of American women were dying each year from preventable causes related to pregnancy. U.S. maternal mortality rates had risen sharply over two decades as rates in other affluent nations had dropped.
Other countries, particularly the United Kingdom, had reliable national data on maternal mortality, as well as robust case-review systems designed to turn information into improvements in care. In the U.S., by contrast, only two-thirds of states had review processes at all and even those sometimes went years between reports or operated inconsistently.
ERASE MM was designed to plug these holes, ensuring that lessons from maternal deaths didn’t go unlearned.
Over the last five years, the CDC has distributed nearly $90 million to fund the work of state review committees. At least by federal standards, the program is relatively inexpensive; it divvied up a total of about $40 million last year between 46 states, an average of $870,000 apiece.
The members of maternal mortality review committees — usually a mix of physicians, nurses, mental health professionals and advocates — volunteer their time. ERASE MM grants typically pay to hire the staffers who gather records from hospitals, medical examiners, police and other agencies and abstractors who redact private information from case summaries.
Committees are advisory in nature, but their findings have made a difference, advocates say. In recent years, many states have developed mental health initiatives for pregnant people and new mothers based on maternal mortality reviews. Recommendations by New Hampshire’s committee, for example, led to a program in which OB-GYNs collaborate with psychiatrists on treatments for post-partum depression or substance use disorder.
In Indiana, which used ERASE MM funds to establish a maternal mortality review committee in 2018, the panel’s work spurred state officials to expand an initiative to have nurses make post-partum home visits to new mothers.
Indiana is one of at least five states that rely entirely on federal dollars to pay for their maternal mortality reviews (the others are South Carolina, Iowa, Missouri and Utah). Committee members in several states expressed alarm that this money may evaporate.
Before ERASE MM, Utah had a joint committee that reviewed both infant and maternal deaths, said Dr. Marcela Smid, a maternal-fetal health specialist. Utah set up a maternal mortality review committee for the first time in 2019 using funds from ERASE MM, which Smid chairs. It found increasing numbers of maternal deaths by suicide, leading to programs for better mental heath and substance use disorder screening and treatment. Since 2021, the committee has received about $1.7 million from the CDC.
“If we get defunded, I suspect it would be devastating,” Smid said.
As part of reviews, committee members consider the legal and socioeconomic context in which a woman dies. Those steps were critical in Georgia when the committee reviewed deaths that had occurred after Roe v. Wade was overturned in 2022 and the state prohibited abortion. The CDC hasn’t directed committees to ask explicitly about such laws, but committee members say the process has provided a window that could be lost if ERASE MM ends.
Case reviews are typically confidential, but ProPublica reported last year that Georgia’s committee had concluded the abortion-related deaths of Miller and Amber Thurman, 28, had been preventable.
Reviewers found both women had taken abortion pills and suffered a rare complication when they failed to expel all the fetal tissue from their bodies. Miller decided not to go to the doctor when she began having symptoms of sepsis because she feared repercussions related to the state’s abortion ban, the review committee found. Thurman went to the hospital but died after doctors waited 20 hours to perform a dilation and curettage to clear her uterus; the procedure, also used to perform abortions, had become entangled in restrictions subjecting doctors to criminal penalties if they violated the law.
Even before the threat to ERASE MM’s funding emerged, four states, including Florida and Texas, had opted out of accepting money from the program. The Florida Department of Health didn’t respond to questions from ProPublica about why it had done this. The Texas Department of Health said the state Legislature had instructed it not to take the funds and instead allocated funding to create its own system. Texas, which accounts for about 10% of U.S. maternal deaths, also stopped sharing data collected by its maternal mortality review committee with the CDC shortly after restricting abortion access.
Officials at the Texas Department of Health also have chosen not to have the state’s maternal mortality review committee examine cases from 2022 and 2023, a period that includes two preventable deaths ProPublica reported on last year. The panel was nearly four years behind on case reviews, and state officials said skipping two years would help it catch up. The state also forbids its panel from investigating deaths related to abortion.
Dr. Thomas Westover, a maternal-fetal medicine specialist who also sits on the maternal mortality review committee in New Jersey, said he worries that if ERASE MM goes away, there will be no consistency from state to state in how maternal deaths are reviewed or what data is collected on them.
“You’ll have states that pick and choose what to review,” Westover said. He noted that some states likely would ignore accidental deaths to manage their caseloads, while others, like Texas, choose to exclude deaths related to abortions, making data less comparable nationally. “That’s a bad decision.”
As part of ERASE MM, the CDC gives state review committees detailed guidance on what contributing factors to consider when assessing maternal deaths, including obesity, mental health issues, substance abuse and homicide.
This information fuels analysis that goes well beyond what’s in death certificates, said Amy Raines-Milenkov, an associate professor at the University of North Texas Health Science Center and longtime maternal health scholar-practitioner. Based on this information, Texas expanded nurse home visits to post-partum mothers that’s similar to Indiana’s initiative.
“What we choose to measure is what we value in society,” Raines-Milenkov said.
Maternal health advocates say they’re working together to bring national attention to the potential funding threat to ERASE MM. Griffen, the executive director of the Maternal Mental Health Leadership Alliance, said she’s hopeful with more meetings on Capitol Hill that a solution can secure the program.
Women’s lives depend on it, she said.
Kavitha Surana contributed reporting. Mariam Elba contributed research.