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Tag: future

  • Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Introduction

    The United States faces a maternal mortality crisis, with maternal death rates significantly higher than other high-income nations. According to the CDC, maternal mortality disproportionately affects Black, Indigenous, and rural communities, with Black women experiencing maternal deaths at 2.6 times the rate of White women. The factors contributing to these disparities are complex and include unequal access to quality healthcare, socioeconomic barriers, and more. Despite advancements in healthcare, 80% of maternal deaths are preventable through timely medical intervention and comprehensive data collection. 

    What are MMRCs?

    State-based Maternal Mortality Review Committees (MMRCs) have been shown to play a pivotal role in analyzing maternal deaths to recommend evidence-based interventions. MMRCs are multidisciplinary teams that examine maternal deaths occurring during pregnancy or within one year postpartum. They utilize comprehensive data sources, including medical records, autopsy reports, and social service information. MMRCs assess preventability and contributing factors, allowing them to identify patterns and propose targeted policy solutions. Their review process centers on critical questions related to medical factors, social determinants, delays in care, and provider bias. By systematically addressing these factors, MMRCs generate insights that inform strategies to reduce preventable maternal deaths, which comprise 20% to 50% of all maternal deaths in the U.S.

    However, MMRCs face inconsistent funding and regulatory barriers, limiting their ability to track and analyze maternal deaths across states. Disparities in data collection methods and access to comprehensive patient records further hinder efforts to address maternal health inequities. Some states lack the authority to access certain medical records, while others experience delays in data sharing, reducing the timeliness and effectiveness of recommendations. Without consistent federal funding, many MMRCs struggle to maintain operations, particularly in rural and underserved areas, where maternal health disparities are often most pronounced. 

    Introduction to the Preventing Maternal Deaths Reauthorization Act

    The Preventing Maternal Deaths Reauthorization Act of 2023 (PMDR) was introduced to the House Committee on Energy and Commerce by Congresswoman Robin Kelly (D-IL) on May 18, 2023. The bill passed out of the Senate Health, Education, Labor, and Pensions (HELP) Committee in Fall 2023 and passed the House with bipartisan support in March 2024. However, the bill failed to pass the Senate before the end of the legislative calendar, rendering the bill “dead”. The reauthorization built upon the original Preventing Maternal Deaths Act of 2018, which helped establish and fund state-based Maternal Mortality Review Committees (MMRCs) to investigate maternal deaths and identify preventable causes. It sought to extend funding for MMRCs, enhance data collection, and address racial disparities in maternal health outcomes through the following provisions:

    1. Extending funding for state-level MMRCs to continue investigating maternal deaths
    2. Authorizing $58 million annually for the CDC to support state-level efforts
    3. Enhancing data collection on factors related to maternal health outcomes, particularly for minority populations
    4. Strengthening community-based interventions to reduce racial and ethnic disparities 
    5. Enhancing coordination among agencies to implement evidence-based solutions
    6. Expanding research on social determinants of maternal health 

    Arguments in Support

    Proponents of the PMDR Act of 2023 argue that the bill provides critical support for tried and true interventions to prevent maternal deaths. They emphasize that scientific literature identifies state-based MMRCs as the “gold standard” for preventing maternal deaths due to their multidisciplinary analysis. However, inconsistent funding threatens the effectiveness of MMRCs, particularly in states with high maternal mortality rates. In a letter to Congress, 125 public health and social services associations urged legislators to treat the PMDR as a top-priority bill, stressing the nation’s consistently high maternal mortality rate. Several national associations, including the American Medical Association, argue that continued federal funding is crucial to preventing maternal deaths. They highlight that past funding gaps resulted in reduced MMRC operations, hospital closures, and increased barriers to care. Supporters contend that the only way to ensure MMRCs can continue their vital work without funding disruptions is to pass the PMDR.

    Proponents of the PMDR Act also highlight its potential to promote health equity. Beyond identifying risk factors, MMRCs are critical in addressing racial, socioeconomic, and geographic disparities in maternal health by filling critical knowledge gaps on the drivers of maternal mortality in underserved populations. The PMDR Act directly supports these efforts by requiring MMRCs to report on disparities in maternal care and propose solutions. Federal support through this bill enables MMRCs to strengthen provider training, expand access to prenatal care, and address structural barriers contributing to maternal deaths. Without reauthorization, proponents argue, efforts to close maternal health gaps would be fragmented, leaving vulnerable populations without necessary protections.

    Arguments in Opposition

    The most prominent critique of the PMDR Act is that it focuses too heavily on MMRCs. Critics voiced concerns about MMRCs’ inconsistency, lack of accountability, and failure to acknowledge all social determinants of health. 

    Opponents highlight that legal and logistical challenges, such as data collection issues and lack of legal protections for participants, can create disparities in MMRC operations. Rural populations, who face higher maternal mortality rates and limited access to care, are often overlooked in MMRCs, further exacerbating disparities. Additionally, bureaucratic barriers and state laws limiting community involvement in MMRCs reduce their effectiveness in addressing maternal health challenges. 

    Others argue that MMRCs lack accountability, particularly regarding inclusivity and equitable decision-making. Advocates contend that MMRCs often exclude community representatives or organizations that challenge the status quo, prioritizing clinical expertise over individuals with lived experience. This exclusion can foster distrust, as community members may feel their knowledge and perspective are undervalued. The lack of compensation for community members to attend all-day MMRC meetings – unlike salaried clinicians – adds another barrier, further entrenching inequalities. Laws that impose burdensome requirements on MMRCs further complicate the process and reduce diversity in ideas. Opponents of the PMDR contend that these factors contribute to a lack of accountability from MMRCs, preventing them from fully creating lasting and inclusive solutions. 

    Finally, critics assert that MMRCs often fail to adequately address the underlying social determinants of health that contribute to maternal mortality. While MMRCs focus on clinical factors, such as healthcare quality and implicit bias, they can lack the frameworks to assess other social determinants like housing instability, food insecurity, or socioeconomic status. Often, these factors are deeply rooted in the broader healthcare system and community environments. Critics argue that the absence of these social factors in MMRC reviews limits the committees’ ability to develop holistic prevention solutions. Reports suggest MMRCs could benefit from incorporating a health equity framework and utilizing socio-spatial measures to address the full spectrum of challenges mothers face. Without this consideration, critics argue that MMRCs fall short of offering effective solutions to reduce maternal deaths and disparities. 

    Due to these critiques of MMRCs, critics of the PMDR argue that the bill should allocate more funding toward alternate interventions 

    Conclusion 

    The Preventing Maternal Deaths Reauthorization Act of 2023 represented an effort to extend investment in evidence-based maternal health interventions. While it received strong bipartisan support in the House, it died before a vote in the Senate, leaving MMRC funding uncertain in the years to come. While the bill was applauded for its potential to expand access to maternal care and fill critical knowledge gaps on maternal mortality factors, critics argued it placed too much emphasis on an intervention that lacked consistency and accountability to marginalized communities. 

    Future Outlook

    The Trump administration has implemented significant changes to the National Institutes of Health (NIH), including halting medical research funding and restructuring the agency, which has led to delays and uncertainties in grant approvals. These actions have raised concerns about the future of critical medical research, including studies on maternal health. Given these developments, the future of the PMDR may depend on an evolving public health funding environment. Advocacy groups and policymakers will need to collaborate to ensure that maternal health research and interventions receive the necessary support, despite the current challenges in the federal funding landscape.

  • Is Online Voting the Future? Pros, Cons, and Key Considerations

    Is Online Voting the Future? Pros, Cons, and Key Considerations

    Introduction

    As internet technology advances and digital literacy increases, more daily activities such as shopping, learning, and bill paying are moving online. While online voting is currently unavailable for most voters in the United States, experts and researchers are debating its viability. Online voting is conducted remotely from the user’s own device, often through a third-party application. 

    Who Uses Online Voting?

    There are several examples of online voting abroad, especially in Estonia, Switzerland, and Australia. In Estonia, about half of registered voters choose to use the online platform to cast their ballot. Estonian online voting is only available for early voting, and includes the option for voters to change their choice up until the voting deadline.

    Within the U.S., 10 states allow remote voting reserved for specific groups of people. Voters living abroad gain the right to vote remotely through the Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA), and several states allow voters with disabilities to cast their ballots online as well. Recently, several states opened remote online voting options for local elections in the wake of the COVID-19 pandemic.

    Pros of Online Voting

    Proponents of online voting say that it would make elections more accessible, and therefore increase voter turnout. Online voting decreases the amount of time it takes to vote—both by removing travel time for those who choose that option, and shortening lines at polling places for those who still opt to vote in person. This in turn has the potential to increase turnout, because long lines at the polling place negatively impact turnout. 

    Advocates contend that online voting will increase flexibility and privacy for voters with disabilities who would normally vote by mail—especially for those with impaired vision. Additionally, online remote voting platforms allow voters to cast their ballots from their own devices, and research suggests this would convince some people to vote who would not do so were the online option unavailable. Indeed, one study shows a 3.5% increase in voter turnout (and another an 8.2% increase) when the online option for voting is available.

    Online voting also has the potential to reduce the costs of elections for governments and voters. One study found online voting to be the most cost-effective form of voting, based on data from Estonian elections. According to the study, since usage of online voting decreases the time people take to vote, it also decreases indirect cost in terms of lost wages from time taken off to vote. As online voting is conducted remotely, it also gets rid of transportation costs from voters physically getting to the polling place. Online voting would also reduce the number of printed ballots needed, which reduces the cost of elections for the government. 

    Online voting could remove some human error from the election process. Supporters argue that online voting could prevent “messy elections” like the 2000 presidential election. There would be no uncertainty from physical counting errors, like the ones that arose in the 2000 election with “hanging chads.” Supporters say that online voting, without confusing physical aspects, would result in higher accuracy. 

    Online voting could also ensure election results are available more quickly to the public, as software and online platforms can count votes nearly instantly, unlike human counters, who require more time. Lastly, online voting could prevent voters from misunderstanding and spoiling (or even mistakenly invalidating, in the case of mail-in voting) their own ballots, therefore streamlining the election process.

    Cons of Online Voting

    The main concern of opponents of online voting is the overall security of an election, chief among these concerns being election fraud. Internet technology is complex and rapidly developing, and cybersecurity measures are often reactive and do not develop as fast as the innovations of hacking themselves. Many are concerned that elections without a paper trail are more vulnerable to election fraud, and that casting ballots over the internet would make recounts (in the event that they are needed) futile, as there would be no physical ballots to recount. Without physical proof of any particular voter’s ballot, it is possible that election fraud could occur and not be noticed, because of the lack of sufficient security protocols. Because of this, there is the possibility that hackers could change votes to manipulate election results. These vulnerabilities raise privacy concerns as well as fraud concerns. Voters’ ballots would also no longer be confidential.

    Opponents are also concerned with the involvement of third-party voting software companies in the election. Online voting is often run by for-profit companies who may value profit over election security. There is evidence of voting software companies lacking adequate security, which would compromise the integrity of an election. There is also the added potential of system failure, in which a crash of the voting software would prevent people from voting, or even invalidate their votes.

    A final potential drawback of online voting is the lack of trust that people have in the results produced from such a platform. Recently, there has been a decline in trust in U.S. elections, and online voting could exacerbate the issue because of the concerns surrounding security, privacy, and accuracy due to the threat of fraud. In the current climate of uncertainty, many believe it may be beneficial to stick with familiar voting methods.

    The Future of Online Voting

    The current election system is not without fault, but would adding online voting to the equation make things better or worse? Despite concerns, more than 300,000 registered U.S. voters used an online platform of some sort to vote in the 2020 elections, and many states have plans to increase the number of voters eligible to vote online in the coming years.