Finding Answers, Saving Lives: Highlights From Missouri’s 2025 PAMR Annual Report
Published Jul 10, 2025
Each year, the Missouri Pregnancy‑Associated Mortality Review Board takes a close look at the lives lost during or within one year of pregnancy. More than just numbers, these reviews help uncover the stories behind maternal deaths — why they happen, who they affect, and most importantly, what can be done to prevent them.
The 2025 PAMR Annual Report underscores not only the scope of maternal mortality in Missouri, but also the steps being taken to improve outcomes for women and families statewide.
Understanding the Scope of Maternal Mortality
On average, 70 women in Missouri died while they were pregnant or within one year after their pregnancy each year from 2018 to 2022. The most deaths happened in 2020, with a total of 85 deaths recorded that year. From 2018 to 2022, with 350 deaths total, the pregnancy-related mortality ratio was 32.3 deaths per 100,000 live births — significantly higher than the U.S. rate of 22.3 (CDC, 2022). Perhaps most strikingly, the review panel determined that 80% of all pregnancy-related deaths were preventable.
Mental health conditions, including substance use disorders, were the leading cause of pregnancy-related deaths, accounting for one in three cases. Cardiomyopathy, hemorrhage, infection and homicide followed. The inclusion of homicide among the top five causes of death highlights the urgency of considering environmental and neighborhood safety and domestic violence interventions and services as part of maternal care.
The timing of these deaths also revealed important trends. The vast majority — 82% — of these deaths occurred between 0 and 365 days postpartum, with 43% of deaths occurring after six weeks postpartum, while 18% happened during pregnancy. This finding emphasizes the critical need for longer-term follow-up care for new mothers — an option now with expanded Medicaid benefits through one year postpartum.
In the effort to support postpartum women and their families, the MO PQC established the Missouri Optimizing Postpartum Care Task Force in 2024. The task force, comprised of maternal health stakeholders from across the state, met for more than a year with the charge to further broaden the definition of the postpartum period and outline the standard of postpartum care and continuity of care through the full 12 months post-delivery. Their recommendations for clinical and nonclinical health care providers will be forthcoming in a postpartum pathways report and discussed during the upcoming MO PQC Maternal & Infant Symposium. The MO PQC also is offering stipends to support hospitals and organizations that are actively addressing postpartum care needs.
Addressing Disparities in Maternal Health
The PAMR report also highlights stark racial disparities. Black women in Missouri were 2.5 times more likely to die from pregnancy-related causes compared to white women. And while this is a continued decline from the previous three PAMR reports, there is work to be done to ensure equitable access to lifesaving interventions and care. Specifically, integrating doula care services into clinical and social care settings has been shown to improve equitable access and health outcomes for Black women.
Women living in micropolitan counties (areas that contain an urban cluster of at least 10,000 but fewer than 50,000 people) had the highest ratio of pregnancy-related deaths, showing inequities in health care access based on where mothers live. In Missouri, 41.7% of counties are defined as maternity care deserts where women are without access to birthing facilities or maternity care providers.
To assist nonbirthing hospitals in maternity care deserts, the MO PQC, in collaboration with SSM Health and the Missouri Hospital Association, is offering free virtual training on emergency childbirth for hospital and EMS staff. In addition, the MO PQC is surveying nonbirthing hospitals to see what training and resources are needed so they can best serve moms and babies in emergency birth situations and planning in-person instructor and team training opportunities for emergency department staff and physicians.
Substance use, particularly overdose, continues to be a leading cause of pregnancy-related death. Most overdose deaths occur well after delivery, often after the typical window for follow-up care. This signals a need to rethink how Missouri supports postpartum women facing addiction and mental health challenges.
In 2024, the MO PQC launched a second cohort of its SUD quality improvement initiative, which involves hospitals implementing the Eat, Sleep, Console model of care along with the Alliance for Innovation on Maternal Health’s Care for Pregnant and Postpartum People with SUD patient safety bundle.
Strengthening the Response
In 2025, PAMR expanded its efforts in data sharing, training and outreach. A new interactive dashboard allows for broader public access to maternal mortality data. The team also conducted 44 outreach activities, including social media campaigns and conference presentations, to raise awareness and share findings with health care professionals and community partners.
Missouri continued its collaboration with MHA and the MO PQC to implement quality improvement initiatives targeting severe maternal complications such as hemorrhage and hypertension. Additionally, Missouri contributed data to national studies led by the CDC, helping place the state’s trends in a national context. The MO PQC, in partnership with the Hospital Industry Data Institute, also released hospital and provider-specific data dashboards to analyze and target reductions of severe maternal morbidity, which are often precursors to mortality.
Looking Forward
Missouri is investing in its maternal health infrastructure by hiring new staff, improving case-finding and incorporating nonclinical factors that impact health into reviews. These efforts are supported by federal grants that recognize the importance of maternal mortality surveillance in driving change.
The MO PQC’s new campaign, Ask Me 5, is another key piece in addressing maternal health across the state. The initiative is designed to improve maternal health outcomes through five essential health questions that build trust, open dialogue and address critical health concerns.
Ask Me 5 is important for both health care providers and patients, informing providers of the primary health concerns and how to ask about them, while also empowering patients to ask questions about their well-being, so moms and their families can get the care and resources they need. The campaign is based on the findings of maternal deaths over a five-year period.
What Comes Next?
The PAMR Board and the MO PQC remain focused on learning from these tragic deaths. With 80% of pregnancy-related deaths deemed preventable, the call to action is clear. Through stronger data, better postpartum support, and attention to mental health and violence prevention, Missouri is laying the groundwork for a healthier future for moms and families.
Join the MO PQC for a webinar further reviewing the findings of the 2025 PAMR report Tuesday, Sept. 9, with Dr. Traci Johnson, chair of the MO PAMR Board.