The Centers for Disease Control and Prevention (CDC) has initiated a 30-day public comment period for a significant revision to its Maternal Mortality Review Information Application (MMRIA). This critical federal action, published in the Federal Register on May 20, 2026, provides stakeholders with an additional opportunity to weigh in on the data collection instrument central to understanding and preventing pregnancy-associated deaths across the United States. The MMRIA system is integral to the work of state-level Maternal Mortality Review Committees (MMRCs) in their efforts to reverse a decade-long trend of unacceptably high maternal mortality rates.
The Imperative for Data in Combating Maternal Mortality
For over a decade, the United States has faced persistently high rates of deaths occurring during pregnancy or within one year after the end of pregnancy. These tragic outcomes affect families and society deeply. Findings from MMRCs consistently show that a significant majority, approximately four out of five, of pregnancy-related deaths are preventable. This stark reality underscores the urgent need for comprehensive data collection and analysis to inform effective prevention strategies.
The MMRIA serves as a standardized data system that allows MMRCs across the nation to systematically abstract relevant clinical and nonclinical data pertaining to these deaths. This information is drawn from a wide array of sources including death certificates, autopsy reports, birth certificates, and various medical records such as prenatal care, emergency room visits, and hospitalization records. Additionally, non-medical data points like social and environmental profiles, mental health histories, and informant interviews are crucial for painting a complete picture. The system facilitates the creation of detailed case narratives for committee review and documents crucial committee decisions regarding the pregnancy-relatedness of deaths, contributing factors, and recommendations for preventing similar future occurrences.
The Role of Maternal Mortality Review Committees
MMRCs are multidisciplinary bodies operating at the state or jurisdiction level. Their membership typically includes public health officials, obstetricians, gynecologists, maternal fetal medicine specialists, nurses, midwives, forensic pathologists, and mental and behavioral health professionals. Other stakeholders, such as social workers and patient advocates, may also participate. These committees work in partnership with state vital records offices and epidemiologists to identify and examine deaths among women of reproductive age that occur during pregnancy or within one year post-pregnancy. Through this rigorous process, potential cases of pregnancy-related deaths, defined as maternal deaths from any cause related to or aggravated by pregnancy or its management, are identified and thoroughly investigated. This collaborative, multidisciplinary approach is designed to foster partnerships aimed at improving quality of care and addressing both medical and non-medical drivers of maternal mortality, ultimately leading to more effective health outcomes.
The Paperwork Reduction Act Review and Public Input
The CDC's action falls under the purview of the Paperwork Reduction Act of 1995, which mandates federal agencies to seek public comment on information collection requests to ensure necessity, minimize burden, and enhance utility. This current notice represents a 30-day extension for public and affected agency comments. The CDC had previously published a similar notice on January 13, 2026, which garnered 105 comments, highlighting significant public interest and engagement in this vital area.
The Office of Management and Budget (OMB) is particularly interested in public feedback concerning several key aspects of the MMRIA project. These include evaluating the necessity of the proposed information collection for the CDC's functions and its practical utility, assessing the accuracy of the agency's estimate of the information collection burden, enhancing the quality, utility, and clarity of the collected information, identifying ways to minimize the burden on respondents through technological means, and assessing information collection costs. This detailed request for feedback underscores the federal government's commitment to transparency and efficiency in data collection efforts.
Updated Burden Estimates Reflect Real-World Data
The revision requested by the CDC seeks to continue collecting information through MMRIA for an additional three years. A notable aspect of this revision is an increase in the estimated annual burden hours for the participating jurisdictions. The total estimated burden has risen from 33,482 hours in the last approval to 41,789 hours, an increase of 8,307 hours.
This increase is attributed to a shift from indirect death estimates to actual case counts among the 52 jurisdictions receiving funding through CDC-RFA-DP24-0053. These jurisdictions are mandated to compile specific information about pregnancy-associated deaths into MMRIA. Annually, an average of 2,832 such deaths are anticipated to be entered into the system across these funded entities. Each death requires an estimated 15 hours of abstraction for 11 jurisdictions that manually abstract all data. For the 41 jurisdictions where the CDC uploads vital records, the abstraction time is reduced to an estimated 14 hours per death. Additionally, all 52 jurisdictions require an average of 24 minutes (0.4 hours) to enter committee decisions into MMRIA. Importantly, there is no direct financial cost to respondents other than their time spent participating in the data collection process.
Implications for Future Maternal Health Policy
The refinement and continued use of a robust system like MMRIA are critical for driving evidence-based public health interventions. Standardized data allows for national comparisons, identification of trends, and the development of targeted prevention strategies that can be implemented at state and local levels. The multidisciplinary insights gathered by MMRCs, facilitated by MMRIA, can inform clinical practice guidelines, public health campaigns, and potentially influence legislative initiatives aimed at improving maternal health outcomes.
By accurately capturing the contributing factors to maternal deaths, from medical complications to social determinants of health, MMRIA provides the granular data necessary for policymakers to allocate resources effectively and develop comprehensive programs that address the complex causes of maternal mortality. The ongoing federal review process serves as a critical juncture for ensuring that this data collection continues to be as effective and efficient as possible, ultimately strengthening the nation's capacity to protect maternal health.
