Since 2003, states have been incrementally adding check-boxes related to pregnancy on death certificates to indicate whether a woman had been pregnant within the last year. As of 2018, all 50 states (and DC) utilize pregnancy checkboxes.
The purpose of the pregnancy checkbox is to help identify deaths that are pregnancy-related. These deaths are then analyzed by maternal mortality review committees to identify trends in how, when, and why women are dying. As of 2018, all 50 states (and DC) utilize pregnancy checkboxes.
In January 2020, the Centers for Disease Control and Prevention (CDC) to published maternal mortality rates in January 2020 for the first time in over a decade.
While the pregnancy checkbox is supposed to provide information that is easier to compare and more accurate, the CDC reports that the checkbox has been both a “source of errors resulting in overestimation of maternal deaths as well as a source of improvement in appropriately identifying maternal deaths.”
For example, a significant number of deaths related to pregnancy were ascribed to women over age 45 (including 147 pregnancies reported to women over age 85!). As a result, the coding is being refined to improve data quality, including restricting the pregnancy-related checkbox to women under age 45.