No One Signed the Death Certificate

Last week, we walked you through how the administration starved Title X without ever passing a law to end it. No floor vote. No press conference. Just a slow shutoff of money Congress had already approved, and a redefinition of the program until what was left no longer resembled what Title X used to be.

This week: same playbook, different target.

There is a way to kill a federal program without admitting you killed it. You don't pass a bill. You don't hold a vote. You don't issue a statement. You send everyone home on "administrative leave," you leave the office lights on, you keep the paperwork moving through the system — and a year later, when someone finally asks what happened to the data, you say it will be released "at a later time."

That is what is happening to PRAMS. And it is the same method as Title X. We're going to start calling it by its name: action through omission.

What PRAMS is — in plain language

PRAMS stands for the Pregnancy Risk Assessment Monitoring System. The acronym is bureaucratic. The thing itself is not.

For thirty-eight years, the CDC has worked with 46 states and territories to send a survey to new mothers in the months after they gave birth, asking what actually happened to them. Did you want to be pregnant? Did your provider listen to you? Were you screened for depression after delivery? Did anyone hurt you during the pregnancy? Were you able to get birth control? Did you have insurance? Did you breastfeed — and if not, why?

Hospital records can't tell you any of that. Hospital records tell you what was billed. Death certificates can't tell you any of that. Death certificates tell you who died. PRAMS was the only federal source that asked the woman herself — the only place where a Black mother in Mississippi and a white mother in Vermont were being asked the same questions about what their pregnancies were actually like.

If you have heard a statistic about American maternal health in the last twenty years — about racial disparities, about postpartum depression, about unintended pregnancy, about who gets prenatal care and who doesn't — there is roughly a 100% chance PRAMS is somewhere underneath it. It is the empirical floor under every clinical guideline, every state Medicaid postpartum coverage decision, every Maternal Mortality Review Committee finding, every disparities-reduction policy we have built since the 1980s.

As of May 2026, it has effectively stopped existing. Nobody ever announced it stopped.

The timeline of a program being quietly killed

Here is what happened, step by step.

April 1, 2025. The entire CDC PRAMS team was placed on administrative leave through a Reduction in Force notice. Jennifer Bombard, the senior epidemiologist who had coordinated state PRAMS implementation for years, sent a note to state coordinators that afternoon to say the team — including her — was gone. About two-thirds of the broader Division of Reproductive Health (roughly 110 out of 165 people) were eliminated in the same action. Thirteen months later, none of them have been rehired.

The 2023 data was already finished. CDC had cleaned the 2023 dataset and prepared it for release in March 2025. It has never been released. There is no published timeline for when it will be. The 2024 cohort has not been processed. The 2025 cohort was never properly collected — in Mississippi, mothers who gave birth in February and March 2025 were no longer eligible to be surveyed by October, because the survey window had closed and no one was there to send it.

November 21, 2025. CDC published a Federal Register notice asking the Office of Management and Budget for a routine three-year extension of PRAMS. March 9, 2026. That request was revised — to cut 1,495 hours of annual data-collection burden. 1,395 of those hours were the telephone callbacks that protect the survey against non-response bias. The paperwork is still being filed. The bureaucratic shell is still being maintained. There is just no team to do the work the paperwork authorizes.

April 30, 2026. The federal grants funding the 46 state PRAMS sites expired. State coordinators describe ad hoc bridge extensions and inconsistent answers from federal officials.

Asked by Mississippi Today when PRAMS data would be released, HHS said: "HHS is committed to optimizing maternal and infant health outcomes and will share PRAMS data at a later time."

That is the entire answer. "At a later time."

This is what action through omission looks like. They did not end PRAMS. They just stopped doing PRAMS. They did not refuse Congress's money — Congress appropriated PRAMS in the Consolidated Appropriations Act of 2026 (P.L. 119-75), signed February 3. They did not repeal the program. They sent the people home and let the inboxes pile up.

The pattern is the point

This is not a story about one survey. PRAMS is one room in a building being quietly emptied.

The same April 1, 2025 RIF notice also eliminated:

• The team that maintains the U.S. Medical Eligibility Criteria for Contraceptive Use — the guidelines ob-gyns, in ACOG president Stella Dantas's words, "turn to every day."
• The six-person team running national Assisted Reproductive Technology surveillance — the only federal source for IVF outcomes.
• The staff supporting ERASE MM, the CDC's $118 million investment in state Maternal Mortality Review Committees.

Two of the three branches of the Division of Reproductive Health were structurally eliminated in a single day.

Across 2025 and 2026, the same method was used to gut the CDC Office of Health Equity, the HHS Office of Minority Health, the CMS Office of Minority Health, and the equivalents at FDA and HRSA. NIH terminated 1,392 grants worth roughly $1.7 billion. The National Institute on Minority Health and Health Disparities lost 29.6% of its active funding — the largest proportional cut of any institute, per Liu et al. in JAMA, May 2025.

The Black Maternal Health Momnibus Act was reintroduced in March 2026 as the "Momnibus Act." The word "Black" appears once in the entire text. The CDC's "Racism and Health" portal is offline. An HHS list of nearly 200 banned words for federal grant applications — surfaced in Head Start court filings on December 5, 2025 — includes "Black," "women," "disability," "tribal," "racism," and "trauma."

You cannot count what you have agreed not to name. You cannot fund what you have agreed not to study. You cannot reduce a disparity you have agreed does not exist.

This is the architecture. Title X was the first piece we showed you. PRAMS is the second. Next week we'll show you the third: the medication shortages — heparin, methylergonovine, oxytocin, magnesium sulfate, RhoGAM, mifepristone — that are not being managed because the people who manage them are also gone.

Same playbook every time. Congress kept the money. The administration killed the program. No bill. No vote. Just the RIF notice, the unanswered letter, the redefined mission, and the calendar.

What this means for you

1. If you provide obstetric or primary care

   Your chart is the record now. The Title V Block Grant measures your state files against, the postpartum Medicaid expansions your state is designing, the clinical guidelines your specialty writes — all of them have depended on PRAMS-style data. When the federal instrument goes dark, the burden of evidence falls on your documentation. Document severity. Document timing. Document barriers to care. Document outcomes through one year postpartum. The chart is the witness now.

2. If you are a patient — or you love one

   The clinical guidelines your doctor follows for preeclampsia, gestational diabetes, postpartum depression, contraceptive counseling, breastfeeding support — they were calibrated on a generation of PRAMS data. Those guidelines don't change overnight. But the next generation of guidelines, the ones built for your daughter, need continued surveillance. That surveillance is now in fragments.

3. If you are a researcher

   Download what is public now. Mirror the PRAMStat dashboards through the Wayback Machine. Use RestoredCDC.org. Pull the 2016–2022 MCH Indicators files before they vanish. Pull CDC WONDER mortality data for women 15–44 by state and race. The PRAMS Automated Research File portal has been functionally degraded for months — existing data users report intermittent access; new requests are blocked. Treat PRAMS as a discontinued time series after 2022.

4. If you have access to anyone in Congress

   The fight is not "appropriate PRAMS." Congress already did. The fight is that HHS is ignoring an appropriation that became law on February 3, 2026, and is refusing to staff the program Congress paid for. The Impoundment Control Act of 1974 and the Administrative Procedure Act are the legal architecture. Use them.

The quiet work

Here is the harder thing.

The government has, in this domain, abandoned itself. HHS will not enforce the appropriations Congress passed. The CDC will not release the data it has already cleaned. The agencies whose job it was to protect the health of women in this country have been told, in budget and in language, that this is no longer their job.

If our response to that is to keep writing letters and waiting for answers that come back as "at a later time" — we have agreed to lose.

The administration's method is action through omission. It is governance by what is not done: the data not released, the grant not awarded, the team not rehired, the word not spoken. The strength of the method is that it is invisible. There is nothing to protest, because officially, nothing happened.

The answer, then, has to be social, distributed, and at least as subversive as the method we are responding to. Prosecutors choose whether to investigate a miscarriage. Clinicians choose what to chart and how. Hospital systems choose what to collect and what to share. State health departments choose how to use what discretion they still have. Researchers choose what to mirror, what to back up, what to keep alive on independent servers. Newsrooms choose what to keep covering after the press release cycle has ended. Communities choose what to remember when the federal record forgets.

These are not federal questions anymore. They are local ones. Every single one of them is a choice. And every one of those choices is a place where someone can protect women — or fail to.

The asking is done. We asked. The answer came back: "at a later time."

Now is the part where we stop being satisfied with that. Now is the quiet work of resistance.