A thirty-eight-year-old federal data system has been quietly liquidated.
The Pregnancy Risk Assessment Monitoring System (PRAMS) is the CDC-coordinated, state-administered surveillance instrument that has, since 1987, sent a survey to new mothers in 46 jurisdictions covering 81 percent of U.S. live births, asking what actually happened during their pregnancies. CDC credits PRAMS with helping drive the U.S. infant mortality rate from 10 per 1,000 live births in 1987 to 5.5 per 1,000 by 2022.
What changed
The team was not formally dismissed; the program was not formally ended. The federal grants funding state-level data collection expired April 30, 2026. The CDC published OMB extension paperwork in November 2025 and a "Revision" reclassification in March 2026 — moving the paperwork forward while no one operates the program. HHS told Mississippi Today the agency would share PRAMS data "at a later time."
PRAMS captured three things no other federal data source can.
Pregnancy intention
Roughly 40 percent of U.S. pregnancies are reported as unintended at conception. PRAMS is the only federal source asking that question at population scale. Death certificates do not capture intention. Hospital records do not capture intention. PRAMS asked the woman.
Race-stratified data on lived experience
Vital records capture race at birth and death. They do not capture what happened in pregnancy. PRAMS asked Black, white, Asian, AI/AN, Hispanic, and multiracial mothers the same questions about prenatal care access, provider treatment, mental health screening, and postpartum follow-up. The instrument was the empirical baseline for every disparities-reduction policy of the last twenty years.
Lived experience
Intimate partner violence (with the 2016 expansion to include "my ex-husband or ex-partner" as a perpetrator category). Postpartum depression screening. Contraceptive access at pregnancy. Postpartum care discontinuity. Substance use. COVID-19 experiences. The disability module (2019–2020). The opioid callback survey (2019–2020). Social determinants of health added 2022.
The pattern, named
PRAMS did not fall alone. The same April 1 RIF eliminated the MEC contraceptive guidelines team, the ART/IVF surveillance team, and the ERASE MM-supporting infrastructure. Two of three branches of CDC's Division of Reproductive Health were structurally eliminated. NIH terminated 1,392 grants worth approximately $1.7 billion by April 2026, with NIMHD losing 29.6 percent of its previously active funding — the largest proportional cut of any NIH institute (Liu et al., JAMA, May 2025). The Black Maternal Health Momnibus Act was retitled the "Momnibus Act" with "Black" appearing once across the text. A six-page HHS list of nearly 200 banned words includes "Black," "women," "disability," "tribal," and "trauma."
The methodological pivot to all-cause mortality and hospital utilization.
When the gold-standard instrument is suppressed, the surveillance frame must shift. Labora's methodological pivot is to all-cause mortality among women ages 15–44 plus hospital utilization proxies. The pivot is externally validated.
The six-layer proxy stack
- Layer 1. All-cause mortality, women 15–44, by state and race (CDC WONDER UCD).
- Layer 2. Cause-specific spikes in non-O-coded categories — cardiovascular, septicemia, suicide, unintentional injury, substance-related (CDC WONDER MCD).
- Layer 3. Maternal ICU admission rate from NVSS natality (NCHS Data Brief 485 baseline: 1.4–6.5 per 1,000).
- Layer 4. NICU admission rate as sentinel — rose 13% from 2016 to 2023 (NCHS Data Brief 525).
- Layer 5. Hospital utilization via HCUP NIS/KID, Medicaid TAF, with state-level overlay (CMQCC, Ohio, North Carolina independent surveys).
- Layer 6. The money trail — CMS spending dashboards, Form 990 Schedule H community benefit filings. Pre-mortality maternal events generate intense hospital spending; divergence from declining O-code mortality is the flag.
The deliverable
A quarterly state-level scorecard with six columns. A state where O-coded maternal mortality is declining while the other five columns are rising is a state where deaths are being miscoded or undercaptured. That divergence is the Labora finding.
The build
Pilot release Q3 2026 for California, New York, Mississippi, Texas, Ohio. Scaled to all 50 states by year-end. Methodology paper with Eugene Declercq (Boston University), Marie Thoma (Maryland), Jamie Daw (Columbia) as candidate co-authors. Publishable in Health Affairs Scholar or AJPH Forum.