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A new state report suggests the rate of pregnancy-related deaths during recent years in Minnesota was only about half the national average.

The report, released Thursday by the Minnesota Department of Health, found a total of 12 pregnancy-related deaths in 2017 and 2018. Given the relatively small number, the report didn't identify any trends but highlighted the need for expanded public health insurance coverage, among a series of recommendations to support maternal health.

The report also looked at pregnancy-associated deaths — meaning deaths that occurred during or within a year of pregnancy, irrespective of cause — and found significant disparities among Black and American Indian Minnesotans.

"Black Minnesotans represent 13% of the birthing population but made up 23% of pregnancy-associated deaths, and American Indian Minnesotans represent 2% of the birthing population, but 8% of pregnancy-associated deaths," the Health Department said in a statement.

Pregnancy-related deaths are those occurring during pregnancy or within one year of the end of pregnancy, that are caused by a medical complication, a chain of events initiated by pregnancy, or aggravation of an unrelated condition by the pregnancy.

The state's pregnancy-related mortality ratio (PRMR) for 2017-2018 was 8.8 pregnancy-related deaths per 100,000 births, according to the report. That compares with the national PRMR of 17.3 pregnancy-related death per 100,000 births in 2017.

The report found that 48 people died during pregnancy or within one year of the end of pregnancy, from any cause, during the two-year time period.

Of those, 33 of the deaths were unrelated to pregnancy. The leading cause of death was injury, such as from a motor vehicle crash. About three-quarters of the pregnancy-associated deaths where the cause wasn't related to pregnancy occurred six weeks to one year postpartum.

There were three deaths where experts couldn't determine if there was a relationship to pregnancy.

The report notes instances where substance use was identified as a cause or contributing factor in pregnancy-associated deaths. A committee of outside experts reviewing the data is calling for statewide improvements in identifying and treating substance use disorders and mental health conditions.

"The health of our mothers is a key indicator of the health of our state," Health Commissioner Jan Malcolm said in a statement. "Each maternal death is tragic, and the racial disparities we see in the data are alarming."

The report recommends addressing bias in systems that perpetuate racial and ethnic health disparities in the birthing population.

"In one of the healthiest states in the country, Black and Indigenous moms are dying at a rate that far outstrips their share of the population," said Rachel Hardeman, director of the Center for Antiracism Research for Health Equity at the University of Minnesota, in a statement.

"This is not a coincidence. It is a reflection of the historical legacy of structural racism that has shaped current inequities in maternal mortality," said Hardeman, co-chair of the state's Maternal Mortality Review Committee. "These deaths are 100 percent preventable, and Minnesota has the opportunity to lead the way in implementing change within our communities to alter this trajectory."

The committee is calling for Medicaid coverage to include benefits immediately beginning during the prenatal period, up to one year postpartum. This summer, the state announced that Minnesotans who qualify for Medicaid because of pregnancy can now maintain the coverage for 12 months after delivery — a significant extension from the previous postpartum coverage that ended at 60 days.