Supplement1 December 2020Looking Outward to Look Within: The Health Resources and Services Administration Maternal Mortality Summit, and What It Means for Women EverywhereFREEDoris Chou, MDDoris Chou, MDUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland (D.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-3259 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2015, when world leaders approved and became signatories to the Sustainable Development Goals 2015–2030 (SDG) Framework, a critical nuance was noted (1). Unlike the Millennium Development Goals, which focused on improving the status of lower-resourced countries between 1990 and 2015, this global pact intends for all countries, regardless of resource level, to collectively contribute to the global agenda. High-, middle-, and low-income countries alike are expected to report on and improve their populations' and countries' status across 17 goals as measured by targets with more than 200 indicators (2).In that framework, SDG 3.1/3.2 assesses the state of maternal and child health services and outcomes (2). As a vital barometer of any health system, SDG 3.1/3.2 asks whether a country can sustain itself by ensuring its future: the lives of women and their newborns. Unfortunately, the promise of the future often goes unfulfilled. In the United States, it is estimated that 2 women die every 3 days because of pregnancy (3–5). The absolute numbers may appear to be small, but any maternal death is unacceptable.To address this issue, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services convened the HRSA Maternal Mortality Summit in June 2018. The purpose of the summit was to “discuss evidence-based approaches and identify innovative solutions to decreasing maternal mortality and morbidity rates in the U.S. and globally” (6). Participants included U.S. domestic experts as well as those from Brazil, Canada, Finland, India, Rwanda, and the United Kingdom.Although at first glance the experiences of Canada, Finland, and the United Kingdom are natural comparisons, U.S.-based practitioners readily found commonalities among all the shared experiences in the root causes of ill maternal health. Before the summit, it is unlikely that the general U.S. public would spontaneously identify with maternal health experiences from Brazil, India, and Rwanda. However, many of the participants found resonance in the discourse around the effects of nutrition, education, and social and cultural forces that shape care-seeking and implementation of medical advice (issues of access, accessibility, and acceptance). Above all, constructs of ethnicity, race, social status, and “women's agency and autonomy” amplified throughout the country-led discussions. The same themes could be found both between countries and across U.S. states.During the summit, countries shared openly on the challenges of measuring and documenting maternal deaths. All countries discussed the limitations of any one measurement system to accurately capture all the maternal deaths as it directly affects the ability of programs and efforts made by countries to address the causes of maternal death (and morbidity). The discussants shared how shifting demographics, social determinants, and risk factors could result in inequities, which often contributed to maternal morbidity and deaths.Nevertheless, maternal ill health is preventable. A positive pregnancy brings benefits not only to the individual, but also to her community, society, and country. Sweeping and long-standing changes do not come easily; there is no single “magic bullet.” Concerted and transparent efforts are needed to change the rhetoric from “It's not my/our problem” to asking the difficult questions of “Why does maternal ill health occur?” and “How can we move forward?” by focusing on what can be done rather than focusing on what cannot.The World Health Organization (WHO) works worldwide to promote health, keep the world safe, and serve vulnerable persons. With partners, the WHO developed the Ending Preventable Maternal Mortality (EPMM) initiative to support countries as they determine the processes to assure appropriate resource allocation to strengthen health systems and enable them to move toward universal health coverage for all who are in need, with the aim of improving maternal and newborn health (7). Integrating EPMM principles and strategies enables countries to realize improved maternal health by prioritizing country leadership and supportive legal, regulatory, and financial mechanisms and integrating maternal and newborn health care to preserve the mother–baby dyad (7). The EPMM initiative calls for a human rights framework to ensure that high-quality sexual, reproductive, maternal, and newborn health care is accessible and available to all who need it and for the empowerment of women, girls, families, and communities (7).Focusing the EPMM lens on the United States, the HRSA summit highlighted essential areas to address. These include general health among women and the effects of inequities and disparities. Additional concerns are the availability of a robust health workforce and the relevant policies and financial implications that drive the overall U.S. health agenda. Readers of this supplement will find thoughtful consideration of these themes and articulation of some of the efforts undertaken to address American maternal mortality and morbidity.The first article provides a narrative landscape review of U.S. maternal health epidemiology (8). The robust series of papers that follow distill the U.S context of racial/ethnic, socioeconomic, and geographic disparities in the care and health outcomes of reproductive-aged women (9–11) and consider the availability of timely access to skilled health personnel and high-quality care, which provide opportunities for prevention and intervention (10–12). Finally, changes in care for mothers of the sickest newborns (13) and maternal comorbid conditions (14, 15) provide concrete strategies to improve health outcomes.Within HRSA sits the Maternal and Child Health Bureau, whose mission is to “improve the health of America's mothers, children, and families” (16). With the summit and this supplement, the HRSA and the United States have taken a step toward ensuring that maternal health is a priority both domestically and internationally. The global community welcomes the continuation and development of this initiative from the landmark meeting.Maternal mortality remains a scourge for every country. Although it can strike any woman, anywhere, fundamentally some predictable patterns can be addressed, with the result that fewer women will die during pregnancy and childbirth. Multilateral sharing and learning from mutual experiences provide potential paths forward in order to reach the collective SDG maternal mortality goal of a global maternal mortality ratio of less than 70 deaths per 100 000 live births (2, 7).