You cannot solve a problem you have stopped measuring.
This principle is foundational to public health practice. It is the reason that disease surveillance systems exist, that vital statistics are collected, that pregnancy outcome data is gathered from hospitals and health departments and reported to the federal government. It is the reason that the United States, despite its many failures in maternal health outcomes, has maintained since the 1980s a system of data collection that at least makes it possible to understand where the failures are occurring, which populations are bearing the greatest burden of preventable maternal death, and which interventions are reducing that burden when they are implemented.
In 2025, that system was paused.
The CDC's Pregnancy Risk Assessment Monitoring System, known as PRAMS, collects state-specific population-based data on maternal attitudes, behaviours, and experiences before, during, and shortly after pregnancy. It is the primary national surveillance system for tracking the factors associated with maternal and infant mortality and morbidity, and it has been operating continuously since 1987. STAT News reported that state health departments were told by the CDC to cease data collection in January 2025, with researchers abruptly locked out of the database without official notice. The Commonwealth Fund's comprehensive explainer on what PRAMS is and why it is at risk documented the shutdown and its implications: without PRAMS, it will be difficult to identify emerging infant and maternal health issues and develop evidence-based programmes and policies.
The System That Was Paused
The length of time PRAMS has operated continuously, generating the maternal health surveillance data that makes it possible to understand where care is failing, which populations are most at risk, and what interventions are working. The pause in 2025 is the first interruption in that 38-year record.
What PRAMS Actually Tracks, and Why It Is Irreplaceable
The Pregnancy Risk Assessment Monitoring System is not a passive data collection exercise. It is an active surveillance system that collects detailed, state-specific data from new mothers about their experiences before, during, and after pregnancy, including data points that are not available from any other national source.
PRAMS tracks rates of prenatal care initiation and adequacy. It tracks breastfeeding initiation and duration by population subgroup. It tracks maternal depression screening rates and results, which are the data that allow researchers and policymakers to understand how well the clinical system is identifying postpartum mental health conditions and connecting mothers to treatment. It tracks substance use during pregnancy, including tobacco, alcohol, and opioids, which are among the most significant and most preventable risk factors for adverse pregnancy outcomes. It tracks contraception use before pregnancy and the circumstances of unintended pregnancies, data that inform family planning policy and programme design. And it tracks the demographic and socioeconomic characteristics associated with adverse maternal and infant outcomes, which is the data that makes it possible to understand why disparities exist and how they can be addressed.
The CDC's PRAMS programme page describes the surveillance system's scope and methodology in detail. PRAMS is not duplicated by any other national data source. As bipartisan congressional letters to the CDC Acting Director noted, the data it collects "is the sole source of this type of information" — not available from hospital discharge records, vital statistics, insurance claims data, or any other administrative data system that continues to function during the pause. The interruption of PRAMS data collection does not merely create a gap in one data series. It creates a gap in the surveillance capacity of the United States maternal health system that will require years of resumed data collection to begin to fill.
The Context: What the US Maternal Mortality Crisis Actually Looks Like
The decision to pause PRAMS data collection happens in the context of a maternal mortality crisis that is, by any measure, one of the most severe public health failures in the developed world. The United States has among the highest maternal mortality rates of any high-income nation, a fact that has been documented, studied, and lamented for decades without producing the sustained policy response required to address it.
The KFF international comparison of health systems documents the international picture: the US maternal mortality rate — 18.6 deaths per 100,000 live births in 2023 — is more than three times the rate of similar peer nations (5.1 deaths per 100,000). From 2000 to 2023, the global maternal mortality rate fell by approximately 40%, a reduction achieved through targeted interventions driven by the surveillance systems that identified where care was failing. The United States contributed to that global progress while falling further behind domestically.
The racial dimensions of the US maternal mortality crisis are particularly acute. The CDC's data on Black maternal mortality shows that Black women die from pregnancy-related causes at rates approximately three times higher than white women — 44.8 deaths per 100,000 live births in 2024 compared to 14.2 for white women — a disparity that persists across income and education levels and that has been resistant to the interventions implemented to date. Native American and Alaska Native women face similarly elevated mortality rates. Understanding this disparity, tracking it over time, and evaluating the effectiveness of interventions designed to reduce it requires exactly the kind of surveillance data that PRAMS provides and that has now been paused.
What Else Was Erased
The pause in PRAMS data collection is not the only action the administration took in 2025 that reduced the information available to clinicians, researchers, and families about maternal health. The Commonwealth Fund's reporting on the Trump administration's first 100 days and women's health documented that the administration erased information it considered in violation of executive orders from government health websites, including data, resources, and guidance related to maternal health, reproductive care, and health equity.
The specific content that was removed from government health websites includes research summaries, clinical guidance documents, data visualisations, and resources that had been developed over years by the CDC, HRSA, and other federal health agencies. Public health officials, clinicians, researchers, and families looking for health information from government sources are finding gaps where there was previously comprehensive, evidence-based guidance.
The erasure of health information from government websites is not a neutral administrative action. Government health websites are, for many clinicians and for most members of the public, the authoritative source for evidence-based health information. When that information is removed, the authority of evidence-based medicine in the spaces where clinical decisions are made is reduced, and the vacuum it leaves is filled by sources that may be less rigorous, less reliable, and less beneficial to the people seeking guidance.
How Surveillance Gaps Become Health Crises
The relationship between maternal health surveillance and maternal health outcomes is not theoretical. It is documented in the history of public health practice and in the specific evidence of what happens when surveillance capacity is reduced.
The Global Burden of Disease Study, coordinated by IHME, has documented extensively that the countries where maternal mortality has declined most significantly are also the countries where maternal health surveillance systems are most robust. The mechanism is not complicated: surveillance identifies where deaths are occurring and what is causing them, targeted interventions are designed and implemented to address the identified causes, and the surveillance system tracks whether the interventions are working. Without the surveillance, the identification step cannot happen, the targeted interventions cannot be designed, and the evaluation of what works cannot be conducted.
The United States has already experienced the consequences of maternal health surveillance gaps in specific contexts. When COVID-19 disrupted data collection systems in 2020 and 2021, the resulting gaps in maternal health data delayed the identification of pandemic-related increases in maternal mortality and slowed the policy response. The current pause in PRAMS data collection is, in its structure, analogous: a gap in surveillance capacity that will delay the identification of emerging problems and slow the response to them.
The specific consequences of the current pause will not be fully visible for years, because surveillance data gaps produce lagged effects. As STAT News reported on the practical impact of the PRAMS shutdown: "I don't know how else to say it, this data system is needed. It's not an option. It's part of having a functional public health system." The maternal deaths that occur during the period when PRAMS is not collecting data will not be captured in the surveillance system. The trends in prenatal care access, postpartum depression screening, and breastfeeding support that would have been tracked through PRAMS will not be tracked. The emerging patterns that would have triggered targeted interventions will not be identified.
The harm is real. It is invisible while it is occurring. And it will take years to understand in its full extent.
What Researchers and Clinicians Are Doing in the Gap
In response to the federal surveillance pause, several states, research institutions, and public health organisations have moved to maintain maternal health data collection through alternative mechanisms, recognising that the absence of federal surveillance does not eliminate the need for the information.
Several states with strong independent public health research capacity, including California, Massachusetts, and New York, have committed to continuing state-level pregnancy outcome surveillance using state funding and state health department infrastructure. The California Maternal Quality Care Collaborative has maintained its own maternal mortality review process and data collection infrastructure independent of federal surveillance systems, and has committed to continuing that work during the federal pause.
The Association of Maternal and Child Health Programmes is coordinating state-level responses to the federal surveillance pause and providing guidance to state health departments on maintaining data collection capacity through state-funded mechanisms. Academic public health schools, including those affiliated with the Association of Schools and Programmes of Public Health, have mobilised advocacy and support for restoring federal public health research investment, documenting how the 2025 disruptions have halted critical research programmes that partially compensate for the federal surveillance gap.
These are meaningful responses. They are also partial and geographically uneven. The states with the capacity and the will to maintain surveillance independently are not the states where the surveillance gap creates the greatest risk. The states where maternal mortality rates are highest, where public health research infrastructure is most limited, and where the federal surveillance system was most critical are the states least equipped to fill the gap independently.
What You Can Do
Contact your elected representatives about PRAMS restoration. The CDC PRAMS programme is administered through the CDC's Division of Reproductive Health and funded through the annual appropriations process. Contact your senators and representative using the Congressional member finder specifically about restoring PRAMS data collection and protecting CDC maternal health surveillance capacity.
Follow the advocacy organisations tracking this issue. The Maternal Mental Health Leadership Alliance and the Association of Maternal and Child Health Programmes provide ongoing updates on the status of federal maternal health surveillance and advocacy resources for people who want to engage with the policy process on this issue.
Use peer-reviewed research as your primary health information source. Given the removal of health information from government websites, clinicians and families seeking evidence-based maternal health guidance should supplement government sources with peer-reviewed research. PubMed provides free access to the primary research literature on maternal health, and the Cochrane Library provides systematic reviews of the evidence on specific clinical questions.
The Decision Not to Measure
The decision to pause PRAMS data collection is not a neutral administrative action taken for operational reasons. It is a decision not to measure a problem that the available evidence indicates is getting worse, in a policy environment where the other decisions being made — the Medicaid cuts, the WIC reductions, the Title V administrative collapse, the family planning funding freeze — are likely to make it worse further still.
You cannot solve a problem you have stopped measuring. That is not merely a methodological principle. It is a description of a governance choice: the choice to not know what is happening to mothers in America, to not track which mothers are dying and why, to not build the evidence base required for the interventions that would prevent those deaths. It is the choice to govern in ignorance, dressed up as administrative compliance.
The maternal mortality crisis in the United States is real. It is ongoing. It is among the most severe in the developed world and the most racially unequal. And for the period during which PRAMS data collection is paused, the deaths that occur, the risk factors that emerge, the trends that would have informed intervention — those will not be captured in the system that is supposed to track them.
The decision not to measure is a decision not to act. And in a country where mothers are already dying at rates that the rest of the developed world does not accept, not acting has a cost that will be paid, as it always is, in lives.
