Development and Implementation of a Statewide Maternal Autopsy Program in Alabama

The 2022 Alabama maternal mortality rate was 38.6 per 100,000 live births, the third highest in the United States. Efforts to reduce maternal mortality have included the development and maintenance of national and state-level Maternal Mortality Review Committees (MMRCs), multidisciplinary partnerships of practitioners, policy makers, public servants and academics. MMRCs classify maternal deaths as pregnancy-related, pregnancy-associated, or of undetermined cause and propose multilevel recommendations to help prevent future maternal deaths. For many women who die before, during, or after childbirth, the cause of death is complex and unclear, challenging the ability of MMRCs to develop actionable recommendations. Autopsy performed by a forensic or anatomic pathologist is the gold standard for cause of death determination. However, autopsy can be expensive, and its feasibility may be limited by lack of access to an academic medical center or local coroner's office. After the Alabama MMRC was launched in 2018, it was discovered that only 41.9% of decedents underwent autopsy; in 19.4% of deaths the MMRC was unable to determine pregnancy relatedness. This led the Alabama MMRC to make formal recommendations to increase access to autopsies for maternal deaths. Working together, state and community partners advocated for funding to develop and implement a statewide autopsy program for maternal deaths. The Alabama Maternal Autopsy Program was launched in 2023 and ensures access to autopsy services for all deaths occurring during pregnancy or up to 365 days after pregnancy. This article outlines the process used to improve diagnostic accuracy through standardization and improved access to autopsy for maternal deaths occurring during pregnancy or up to 365 days after pregnancy.