Maternal Mortality and Morbidity Advocacy Project
- Tracy Flood
- Dec 13, 2025
- 8 min read
Updated: 1 day ago
Overview. A data-guided advocacy campaign was proposed by team members at BroadStreet working on The Maternal and Infant Health Community Data Project. Three high-priority counties across the United States were selected after analyzing data on maternal morbidity and mortality.
Big Picture Goal: Use data-guided advocacy to reduce maternal mortality and morbidity in the U.S.
Our Objective:
By the end of 13 weeks, The Maternal and Infant Health program at BroadStreet will propose an advocacy plan, in the style of non-lobbying education, for 3 prioritized counties in the U.S.
Inventory
⏰ Time: 13 weeks, (September to December 2025)
👥 Team: 25 team members
🧰 Tools:
Indicator List (author: Teresa Tse) 2026 Maternal health-related indicator data (created Oct 2026)
📊 Original Data Source(s):
Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Natality data (2019-2023). Retrieved from: https://wonder.cdc.gov/controller/saved/D149/D452F876
Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality (Multiple Cause of Deaths) (2019-2023). Retrieved from: https://wonder.cdc.gov/controller/saved/D157/D452F908
Health Resources and Services Administration (HRSA), Maternal and Infant Health Mapping Tool, retrieved from https://data.hrsa.gov/topics/maternal-child-health/mchb-mapping.
Methods:
Three teams, each composed of 7–9 team members, utilized data sources including CDC WONDER Natality, CDC WONDER Multiple Causes of Death, the Maternal and Infant Health Mapping Tool by HRSA, with indicators assembled into the Maternal Health-Related Indicator Data (October 2026) spreadsheet, developed by project manager Teresa Tse, to define what constitutes a high-priority county for maternal health.
Each of the three teams set their own definition of what counties were “high priority,” and selected one U.S. county. Three 3 counties were selected in total. For the top county, team members drafted outreach emails intended for the county’s state-level legislators advocating for elected officials to advocate for attention and resources toward maternal health needs.
Steps
The 3.5 month project (13-weeks) was completed in 3 distinct steps or phases:
Step 1: Create a Logic Model on Maternal Health
Step 2: Prioritize Counties for Maternal Health Advocacy
Step 3: Propose an Advocacy Plan
Steps 1: Logic Model on Maternal Health
To deepen the understanding of the drivers of maternal health, each team developed a logic model, with members responsible for researching data within a specific section of the socioecological model (figure 1). Two important drivers of health were prenatal care and postpartum care. Other drivers of health were also explored including the physical environment, social and economic factors, health conditions, clinical care quality and access, health behaviors, and relevant policies and programs.
Once logic models were assembled, quality assurance was then conducted in pairs, allowing team members to review one another’s work and ensure accuracy and consistency across the data.
Step 2: Prioritizing counties for Maternal Health Data-Guided Advocacy
Team members from each of the three teams collaboratively decided upon definitions of "what is a high priority are" and "where are maternal health resources needed.” Each team explored county-level data to decide on that definition.
Team 1 Definition of Priority Counties
How were counties selected? Team 1 defined “areas of high priority” as counties with the highest Maternal Mortality Ratio (MMR) for the years 2019-2023. Maternal Mortality Ratio is defined as the number of maternal deaths for every 100,000 live births. Team 1 found U.S. and county-level maternal mortality data from 2019-2023. Counties were sorted from highest to lowest MMR. Three counties were identified that the following counties had some of the highest MMR:
Shelby County, TN
Essex County, NJ
Bexar County, TX
Team 1 chose Shelby County, TN for their proposed advocacy campaign.
Data caveats and limitations. Maternal mortality is a rate event. Most counties in the U.S. were missing data on MMR (96%, n=3007 out of 3142 counties reviewed). Because CDC WONDER suppresses data for counties with small populations or few events, reliable maternal mortality data are primarily available for larger, more populated counties. Therefore, CDC WONDER is a useful tool for identifying high-population counties with elevated maternal mortality rates.
Table 1. Counties with the Highest Maternal Mortality Ratio, 2019-2023
County, State | Maternal Mortality Ratio (MMR), 2019-2023 | U.S. MMR (Benchmark), 2019-2023 | Comparison to the U.S. |
Shelby County, Tennessee | 56.29 | 23.54 | Higher |
Essex County, New Jersey | 46.71 | 23.54 | Higher |
Dallas County, Texas | 34.36 | 23.54 | Higher |
Maternal Mortality Ratio (MMR) defined as the number of maternal deaths for every 100,000 live births (Data Sources: CDC Wonder Natality, and CDC Wonder Multiple Causes of Death, 2019-2023) | |||
Table 1. Counties identified by Team 1 as high-priority were based on Maternal Mortality Ratios (MMR) during 2019–2023. Data were sourced from the Centers for Disease Control and Prevention WONDER Multiple Cause of Death and Natality (Births) datasets. Team 1 selected Shelby County, Tenessee for a proposed advocacy outreach campaign to state legislators.
Team 2 Definition of Priority Counties
How were counties selected? Team 2 defined “areas of high priority” as counties with a maternal mortality rate higher than the U.S. average, and where additional risk factors, including household poverty, percentage of uninsured women, and maternal age distribution, unfavorably compared to the national benchmarks. These factors induce a higher vulnerability across the population. The counties that met the criteria were then ranked from highest to lowest according to Maternal Mortality Ratio (MMR).
Essex County, NJ
Davidson County, TN
Hudson County, NJ
Team 2 chose Essex County, NJ for an advocacy proposal.
Data caveats and limitations. See Team 1 description of missing data.
Table 2. Counties with high maternal mortality and drivers of health
County, State | Maternal Mortality Ratio (MMR), 2019-2023 | Household Poverty (%), 2018-2022 | Uninsured Women (%), ages 18-49 years, 2021 | Births to Those of Advanced Maternal Age (%), 2019-2023 |
Filter criteria: | Greater than 23.54 | Greater than 8.8 | Greater than 11.6 | Greater than 19.83 |
U.S. Benchmark | 23.54 | 8.8 | 11.6 | 19.83 |
Essex County, New Jersey | 46.71 | 11.9 | 13.9 | 28.75 |
Davidson County, Tennessee | 37.91 | 10.4 | 14.1 | 20.51 |
Hudson County, New Jersy | 34.53 | 10.5 | 12.8 | 29.94 |
Maternal Mortality Ratio (MMR) defined as the number of maternal deaths for every 100,000 live births (Data Sources: CDC Wonder Natality, and CDC Wonder Multiple Causes of Death, 2019-2023). Data on household poverty and uninsured women (ages 18-49 years) are from HRSA Maternal and Infant Health Mapping Tool. Births to those of advanced maternal age defined as percent of births where the mother is 35 years or more (CDC Wonder Birth files, 2019-2023). | ||||
Table 2. Counties were identified by Team 2 after filtering for those with Maternal Mortality Ratios (MMR) higher than the U.S. average for the years 2019–2023, along with additional drivers of health such as household poverty, percentage of uninsured women, and maternal age distribution that were higher than the U.S. benchmarks. Team 2 selected Essex County, New Jersey as the priority county for advocacy outreach to state legislators.
Team 3 Definition of Priority Counties
How were counties selected? Team 3 defined an “area of high priority” as a county with with maternal mortality ratio above the national average, prenatal care below the national average, uninsured women (ages 18-49 years) above the national average, and at least 20 maternal deaths reported (to avoid unreliable values). The counties were then ranked from highest to lowest Maternal Mortality Ratio (MMR).
Shelby County, TN
Essex County, NJ
Dallas County, TX
Using different prioritization criteria, Team 3 also selected Shelby County, TN as their focus for advocacy.
Table 3. Counties with high maternal mortality and drivers of health
County, State | Maternal Mortality Ratio (MMR), 2019-2023 | Maternal Deaths (#), 2019-2023 | Early Prenatal Care (% of births), 2020-2022 | Uninsured Women (%), ages 18-49 years, 2021 |
Filter Criteria: | Greater than 23.54 | Greater than 20 | Less than 76 | Greater than 11.6 |
U.S. Benchmark | 23.54 | - | 76 | 11.6 |
Shelby County, Tennessee | 56.29 | 35 | 63.9 | 14.3 |
Essex County, New Jersey | 46.71 | 23 | 66.8 | 13.9 |
Dallas County, Texas | 34.36 | 63 | 63.4 | 28.6 |
Maternal Mortality Ratio (MMR) defined as the number of maternal deaths for every 100,000 live births (Data Sources: CDC Wonder Natality, and CDC Wonder Multiple Causes of Death, 2019-2023). Early prenatal care defined as the percent of live births with first trimester prenatal care entry. Data on early prenatal care and uninsured women (ages 18-49 years) are from HRSA Maternal and Infant Health Mapping Tool. | ||||
Table 3. Counties identified as high-priority areas based on maternal mortality ratios above the U.S. average, early prenatal care initiation below the U.S. average, percentage of uninsured women (ages 18-49 years) above the U.S. average, and at least 20 maternal deaths reported (2019–2023) to ensure data reliability. Team 3 selected Shelby County, Tennessee for advocacy outreach to state legislators.
After collecting data aligned with their definition of high-priority, teams visualized the results to identify and highlight counties with the greatest need for maternal health resources.
Step 3: Advocacy
Each team selected a priority county. Teams 1 and 3 both selected Shelby County, TN, and Team 2 selected Essex County, NJ. Team members then identified contact information for elected officials and, specifically, state-level legislators serving their respective counties. Outreach emails were drafted to advocate for maternal health resources. Letters were sent to 29 elected officials and state legislators (14 Tennessee, 15 New Jersey) by Tracy Flood, President and Co-Founder of BroadStreet.
Letter for Shelby County, Tennessee
SUBJECT: Mothers Need Your Help in Shelby County!
BODY:
Dear elected official,
We are a collaborative of data analysts from across the U.S. looking at counties across America where maternal mortality is high. Shelby County, TN was in the top 3 counties in the United States and so we are reaching out to legislators for Shelby County, TN.
Shelby County’s maternal mortality rate is high: 56 deaths per 100,000 live births. Tennessee’s state average is also high: 42 deaths per 100,000 live births. For reference, the county average is over twice the national average of 24 deaths per 100,000 live births (CDC WONDER, 2019-2023).
Solutions exist: Expanding Medicaid would strengthen access to prenatal and postpartum care, and could significantly improve maternal health outcomes in Shelby county and the state of Tennessee (2025 March of Dimes Report Card for Tennessee; Medicaid Expansion is Associated with Reduced Maternal Mortality, 2020).
Do you have any policies that you are pursuing that would help reduce maternal mortality in Shelby County?
Thank you for your time and consideration.
Respectfully,
Tracy Flood, MD PhD and BroadStreet Institute Maternal and Infant Health Team
Letter for Essex County, New Jersey
SUBJECT: Mothers Need Your Help in Essex County!
BODY:
Dear elected official,
We are a collaborative of data analysts from across the U.S. looking at counties across America where maternal mortality is high. Essex County, NJ was in the top 3 counties in the United States and so we are reaching out to legislators for Essex, NJ.
Essex County’s maternal mortality rate is high: 47 deaths per 100,000 live births. This is nearly twice the New Jersey state average of 24 and the national average of 24 deaths per 100,000 live births (CDC WONDER, 2019-2023).
New Jersey has already done a lot to expand insurance coverage to strengthen access to prenatal and postpartum care (2025 March of Dimes Report Card for New Jersey; Medicaid Expansion is Associated with Reduced Maternal Mortality, 2020). The disparities seen in Essex County may be associated with low rates of early prenatal care, low insurance coverage, and low income rates compared to the U.S. (Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review, 2020; Data from HRSA Maternal and Infant Health Mapping Tool and CDC WONDER).
Do you have any policies that you are pursuing that would help reduce maternal mortality in Essex County?
Thank you for your time and consideration.
Respectfully,
Tracy Flood, MD PhD and BroadStreet Institute Maternal and Infant Health Team
Conclusion
Through data-driven analysis of publicly-available data and teamwork, we gained a deeper understanding of the factors contributing to suboptimal maternal health, identified counties with high maternal mortality and morbidity, and advocated for priority counties by sending outreach emails to elected officials.
Attribution
A huge thank you to the team members and leaders of the BroadStreet Maternal and Infant Health Track, 2025 Autumn Track Program.
Methods Author List:
References
Centers for Disease Control and Prevention. (2024). CDC WONDER natality data (2016–2024). U.S. Department of Health and Human Services. https://wonder.cdc.gov/natality.html
Centers for Disease Control and Prevention. (2024). Multiple cause of death data (2018–2024), CDC WONDER online database. U.S. Department of Health and Human Services. https://wonder.cdc.gov/mcd.html
March of Dimes. PeriStats. https://www.marchofdimes.org/peristats
Health Resources and Services Administration. Maternal and infant health mapping tool. U.S. Department of Health and Human Services. https://mchb.hrsa.gov/data-research/mchb-data/maternal-and-infant-health-mapping-tool
Datawrapper GmbH. Datawrapper. https://www.datawrapper.de/
