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* 1. Are you doing anything in your community to address maternal mortality? If so, please describe.

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* 2. CityMatCH is particularly interested in learning about local Maternal Mortality Review Committees. Does your health department participate in a local, maternal mortality review committee? If yes, please describe.  If no, is this something your health department would be interested in pursuing?

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* 3. If your local community does not have a maternal mortality review committee, is anyone at your health department actively involved in a state maternal mortality review committee? If yes, what does this look like? If no, is this something your health department would be interested in participating in?

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* 4. As a CityMatCH member, would you be interested in learning more about maternal mortality and/or maternal mortality review committees? If yes, please describe what specific aspects of maternal mortality and/or maternal mortality review committees you would like to learn more about. What would be most beneficial to your health department?

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* 5. Please list your contact information, including your name, your location (city and state), and the name of your organization or health department.

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