What Is the Pregnancy Risk Assessment Monitoring System, and Why Is It at Risk?

The United States has far higher maternal and infant mortality rates compared to other high-income nations, and stark geographic and racial/ethnic disparities. Timely, high-quality data on the factors contributing to poor and inequitable maternal-infant outcomes is critical for developing and evaluating interventions to address this longstanding public health crisis.

One key source of such data — the Pregnancy Risk Assessment Monitoring System (PRAMS) — is under threat. PRAMS, which is led by the Centers for Disease Control and Prevention (CDC) in collaboration with state and city health departments, plays a crucial role in the health of U.S. mothers and babies. By collecting information directly from mothers on maternal health, health behaviors, and experiences before, during, and after pregnancy, PRAMS helps public health experts and policymakers understand what is and isn’t working when it comes to pregnancy and infant care.

PRAMS has been credited with improving maternal health efforts and helping to reduce infant deaths in the U.S., which went from 10 per 1,000 live births in 1987, when the program began, to 5.5 per 1,000 by 2022. However, the shutdown of the PRAMS data collection system in January 2025, and staff reductions at the CDC in April 2025, have led to uncertainty about future funding and data access. Without PRAMS, policymakers and health systems are losing critical data for addressing health disparities and improving maternal and infant health outcomes nationwide.

How does PRAMS support efforts to improve maternal and infant health?

PRAMS has been foundational in supporting the field of maternal-child health research in the U.S., generating hundreds of published studies and successful public health initiatives, including breastfeeding initiatives in both Tennessee and Michigan and a folic acid education campaign in Vermont. PRAMS data have also been integral to the development of programs to improve maternal health. Examples include Asabike Health Start, which provides in-home support to Native American mothers in Michigan, and a pilot program for dental care outreach to pregnant Medicaid enrollees in Connecticut.

States also use PRAMS data extensively when designing policies. In Maine, it informed changes to Medicaid policy, including reimbursement for smoking cessation treatment and extended postpartum coverage, along with public awareness campaigns on shaken-baby syndrome and lead paint risks. In New Jersey, a PRAMS analysis on the root causes of infant mortality among Black families led the state’s Department of Health commissioner to channel $4.7 million to community-based case management programs. Nearly 50,000 women have received case management services as a result, and 25,000 have been referred to home visiting and Healthy Start programs. This funding was also used to hire 79 doulas, 30 maternal-child community health workers (CHWs), and 13 CHW supervisors.

What kind of data does PRAMS collect?

The national Pregnancy Risk Assessment Monitoring System tracks maternal health, health behaviors, and experiences before, during, and after pregnancy. Led by the CDC in collaboration with state and city health departments, PRAMS has collected survey information from thousands of mothers across the country every year since its launch in 1987. Topics include prenatal care, pregnancy experiences, birth outcomes, and health behaviors. Surveys may be conducted by mail, online, or via telephone. This information helps researchers and policymakers understand the factors that affect maternal and infant health and identify trends, disparities, and emerging issues of concern.

PRAMS data are representative of all births in participating jurisdictions, which in 2024 included 46 states, the District of Columbia, New York City, Puerto Rico, and the Northern Mariana Islands. This allows for comparisons of maternal and infant outcomes by insurance type, income, immigration status, and other important characteristics. PRAMS survey methods and questions are standardized by the CDC, meaning indicators can be tracked consistently across jurisdictions and over time.

PRAMS also allows customized questions to be added each year that can be tailored to track local priorities, such as understanding who is taking parental leave, using telehealth or virtual prenatal care, attending postpartum follow up, and seeking mental health care. When new public health crises unfold, PRAMS is nimble enough to capture data to support rapid-response efforts. Examples include modules on the Zika virus in 2016–2017, opioid use in 2019, and COVID-19 in 2020.

Aren’t there other maternal and infant health data sources?

While PRAMS is a unique and valuable resource for understanding maternal and infant health, it’s not the only source of information available. Other national and state programs also collect data about pregnancy, births, and health outcomes, like vital records and hospital data.

However, these data sources have limitations: they may not capture the same level of detail as PRAMS when it comes to social factors, health behaviors, and experiences during pregnancy. PRAMS is also unique because it asks people directly about their experiences, allowing for a deeper understanding of the factors that influence health outcomes.

Why is PRAMS at risk?

System shutdown. In January 2025, for the first time in three decades, the software system used to collect PRAMS data was abruptly shut down by the CDC. States were in the middle of surveying mothers who gave birth in 2024. The fate of the data they had collected, their ability to reach moms they had yet to survey, and the overall future of PRAMS was unclear for months. In August 2025, the CDC indicated that while states could not contact any more people who gave birth in 2024, the data that states had already collected will be processed and returned to them, though the timeline remains unclear.

Elimination of key CDC staff. As part of large-scale workforce reductions initiated by the U.S. Department of Health and Human Services, the majority of staff at the CDC’s Division of Reproductive Health were let go in April 2025, including the entire team responsible for PRAMS. Layoffs have created a vacuum in expertise on maternal and child health epidemiology, survey data collection, and statistical weighting.

Uncertain funding. CDC grants that fund states’ implementation of PRAMS expire April 30, 2026, and future funding is in doubt. This uncertainty has led some states with fewer resources — many with high maternal and infant mortality rates — to cease operations. Better-resourced states, meanwhile, might choose to opt out of PRAMS entirely and establish their own approach to maternal and infant health surveillance, as California has long done. If this becomes a broader trend, cross-state comparisons and national-level analysis could be seriously compromised.

Portal access issues. The PRAMS online portal used by researchers has been down for months, leaving those with ongoing or planned projects without access to the data. Absent a coordinated process for accessing historical PRAMS data across states, researchers would have to enter into separate data-use agreements with over 45 jurisdictions — a prohibitive task for many researchers and state health departments.

What happens if PRAMS is discontinued?

Disruptions to PRAMS have already led to gaps in data collection for U.S. births in 2024 and 2025. Inconsistent data collection will undermine the comparison of maternal health indicators over time and our ability to track trends and progress.

In the long run, if PRAMS were to be discontinued, federal and state public health officials, policymakers, researchers, and advocates will lose a representative, multistate data source that has long been essential for efforts to improve maternal and infant health. Without this information, the U.S. will be less able to direct public resources toward the most effective interventions and hold public officials accountable for meeting maternal and infant health outcome goals.