The Limits of Progress: Evaluating New Jersey’s Current Policy Landscape and Its Effectiveness in Addressing the Underlying Causes of Maternal Mortality

Abstract

In 2019, former New Jersey First Lady Tammy Murphy launched Nurture NJ, a statewide initiative that brought formal recommendations and unprecedented legislative attention to the state's persistent racial disparities in maternal mortality. Despite this progress, significant gaps remain. This thesis seeks to answer a central question: to what extent do current state policies adequately address the underlying causes of maternal mortality in New Jersey, and where do critical gaps in implementation and coverage remain, particularly with respect to racial disparities in outcomes? To answer this question, the thesis organizes its analysis around two distinct classifications of maternal mortality. The first pathway examines pregnancy-related mortality, evaluating whether current policies address its key clinical and interpersonal drivers, and hypothesizes that the standardization of emergency obstetric response, the implementation of trauma-informed care frameworks, and the integration of midwives into the prenatal and birthing care workforce are the critical missing interventions. The second pathway examines pregnancy-associated but not related mortality, evaluating whether current policies address its key postpartum drivers, and hypothesizes that expanded access to substance use disorder treatment, mental health services, and continuity of care in the months following delivery are the interventions most likely to reduce preventable deaths in this classification. Together, these five hypothesized interventions are grounded directly in what the New Jersey Maternal Mortality Review Committee data identifies as the leading underlying causes of death across both classifications, and their implementation would more directly address the mechanisms driving preventable maternal deaths and the racial disparities embedded within them. Drawing on qualitative interviews with key stakeholders including clinicians, midwives, nurses, and policy advocates, along with a quantitative synthesis of data from the New Jersey Maternal Mortality Review Committee, this thesis finds that current New Jersey policies, while meaningful in scope, do not adequately address the direct underlying causes of maternal mortality across either classification. The recommendations this thesis puts forward span AIM bundle mandates, trauma-informed care requirements, midwifery licensure modernization, and expanded postpartum SUD and mental health treatment through a variety of adoptable policy recommendations. These are directly targeted at closing that gap, and represent the policy interventions most likely to reduce preventable maternal deaths and advance equity in birth outcomes across New Jersey.