Local Action to Global Replication: How Sub-national Data Efforts Support SDG Achievement
In 2018, the Local Data Action Solutions Initiative (LDA-SI) launched a microgrant program aimed at developing sub-national solutions for Sustainable Development Goal (SDG) monitoring. In this synthesis report, learn about the shared experiences and contextual differences of SDG localization in Aruba, Brazil, Colombia, England, India, and the United States.
Written by Sandra Ruckstuhl. Editing by Jessica Espey. Design by Micha Dugan, Ryan Swaney, and Jay Neuner.
Local Sustainable Development Goal (SDG) data efforts have a primary objective: to make the global agenda locally relevant and actionable. With 84 percent of the world’s current population living in urban areas, cities have been named as critical to achieving the SDGs1. Realizing that their engagement is imperative to global success, municipalities, metropolitan regions, and provinces the world over are setting cutting-edge examples for local initiatives that successfully promote sustainability at all levels. Though global policies often focus on national leadership, some of the most significant change-makers can be found at the local level. Momentum is building for more sub-national action in support of the SDGs. Those who have led the charge provide a diverse pool of examples from which others can learn and derive their own strategies.
Five grantees in five different countries, supported by the Sustainable Development Solutions Network’s Local Data Action Solutions Initiative in 2018, developed unique local SDG data solutions and documented their methodologies for others to use. This brief summarizes seven areas of impact demonstrated by the grantees’ efforts, proving the utility and value of local SDG action.
Local Data Action Solutions Initiative
When the SDGs were launched in September 2015, SDSN began collaborating with cities and other sub-national partners to promote strategies for achieving these goals locally. As efforts were kicked off in pilot cities in the US, it quickly became evident that the SDG indicators provided a common language for sustainable development planning and programming among stakeholders. Specifically, four major points of interest emerged: indicator selection, how to utilize third-party data, how to link local and national reporting systems, and how to build data visualization platforms.
The Local Data Action Solutions Initiative (LDA-SI) was kicked off in 2017 as a crossover project between SDSN’s U.S.A. Sustainable Cities Initiative (USA-SCI) and Thematic Research Network on Data and Statistics (TReNDS). It aims to create a library of case studies documenting technical knowledge of how stakeholders worldwide have promoted SDG achievement through sub-national data and monitoring systems. The archive aims to promote sound, replicable data methods that facilitate good practice in local action and support the “leave no one behind” principle of Agenda 2030, the UN resolution that encompasses the SDGs. Each case relates to one of the four major points of interest cited above.
In early 2018, LDA-SI launched a microgrant initiative aiming to seed and support the documentation of local data innovations and promote the resulting lessons from these experiences. A call for proposals was announced in January 2018 and SDSN received dozens of quality submissions. Five grantees were chosen for their demonstrated ability to support SDG implementation in their specified location and for the strength of their model to inform sub-national SDG initiatives in other parts of the world. Applicants were assessed based on six criteria: clarity of their sub-national SDG monitoring concept; applicability for local action toward SDG target achievement; and general transferability, replicability, adaptability, and affordability of the proposed methodology. The five selected organizations also had a strong interest in engaging in a global knowledge exchange to strengthen local SDG data initiatives.
Over the course of 2018 the grantees have implemented their work plans to develop sub-national SDG data solutions. Each of the five has prepared a learning brief and/or blog explaining the methodology behind their data solution, serving as a blueprint for local SDG data action that can be replicated and adapted by stakeholders in other locations.
The following work was conducted by the five grantees over the course of the program:
For Aruba, Wolfs Company built on the TEEB (The Economics of Ecosystems and Biodiversity) Framework and existing SDG analysis, creating a hybrid framework to track land and marine socioeconomic and ecological indicators that align with the SDGs and that can inform SDG efforts on the island.
For Brazil, the Metropolitan SDG Observatory (METRODS) and Movimento Nossa BH implemented a collaboration with the Metropolitan Agency of Belo Horizonte, University Newton Paiva, and other local partners to identify 50 indicators and collect and analyze indicator data, supporting the achievement of SDG 11 targets in the Belo Horizonte Metropolitan Area.
In Colombia, the Comó Vamos City Network (CVCN) and Fundación Corona developed a public online data tool to track and compare SDG indicators and goals for 19 Colombian urban agglomerations (over 35 municipalities). Read their brief here.
In India, Community Systems Foundation‘s OpenCities Institute (OCI) worked with the City of Patiala in the State of Punjab to create a proof-of-concept package for SDG localization, comprised of a model indicator framework reflecting municipal human development objectives across sectors and hosted on a prototype data dashboard. Read their brief here.
In the United States of America, the City of Los Angeles collaborated with four universities to develop a list of locally-adapted SDG targets that the Mayor’s office will consider as it prepares a city-level system for reporting on the SDGs. Read their brief here.
Insights were also gleaned from other project partners in the first and latter stages of LDA-SI, including Bristol in the United Kingdom; Baltimore, Maryland and San José, California in the U.S.A.; and additional work in Brazil. These insights are summarized in project briefings available at sdsntrends.org/local-data-action.
Facilitating Change through Local Data Efforts
The grantees’ efforts provide a wealth of examples for SDG data localization. Each grantee has prepared a “how-to” brief and/or blog explaining their own localization processes and the products of their labor. Those briefs can be accessed on the TReNDS LDA-SI website. Overall, the grantees’ experiences reveal their local SDG data efforts have impact in seven areas:
Broadening political support for the global sustainable development agenda
Supporting national SDG monitoring initiatives
Promoting action when national leadership is missing
Localizing indicators while also promoting coordination and comparison across regions and cities
Evaluating and expanding beyond official data sources
Incentivizing relative progress
Broadening Political Support for the Global Sustainability Agenda
Sub-national governments have puzzled over how the SDGs, with a global frame and nationally focused targets, are relevant to them and what their role should be in achieving them. Significant progress has been made since September 2015 and now more local stakeholders are becoming active participants in the global initiative. At the High-level Political Forum on Sustainable Development in July 2018, New York City became the first city to report its status of implementing the SDGs to the UN. New York’s well-developed model for a Voluntary Local Review (VLR) and the stature of this event elevated the platform for sub-national involvement in SDG achievement efforts worldwide. It is clear that local action is necessary to make sure that national strategies are truly inclusive and effective. The experience of the LDA-SI grantees is further evidence of how political support can be built at the local level, prompting buy-in and action among officials.
Several grantees channeled resources to educate politicians and bureaucrats in order to ensure the data solution that they were building would be relevant, usable, and sustained. In Brazil and India, for example, where national strategies do not yet exist, the SDGs are not well understood by many stakeholders including local authorities. In Brazil, the grantee team noted this was a particularly acute issue in small and peripheral cities in the Belo Horizonte Metropolitan Region where they were conducting the work. The team advised that, if the localization model was to be replicated elsewhere in Brazil, those work plans should include public education on the SDGs and training for local stakeholders. This, they argued, would ensure they would be more informed and effective partners on achievement efforts.
Grantees noted that political support was more easily built when an SDG effort was formulated around existing policies and initiatives. In Patiala, India, the SDG strategy was developed around the stated priorities of the city’s leadership, which aligned with SDGs 3, 6, 9, 11, 13, and 16. This simple connect-the-dots approach was found to reduce any skepticism and improve buy-in from local officials. In the case of Los Angeles, where the mayor has played a leadership role in promoting the SDGs, the grantee team developed a list of proposed local SDG indicators that aligned with the city’s Sustainable City pLAn. The team aimed to propose a set of targets and associated indicators that would enable a more coordinated government effort to achieve the SDGs.
Cities often face capacity limitations that constrain their ability to support a “new” initiative, such as one to achieve the SDGs, and in turn this can limit political will to put resources toward such an effort. For this reason, the grantees found that partnerships with universities and nongovernmental organizations were critical to designing and kickstarting a local SDG effort. In Belo Horizonte, professors and students from the University Newton Paiva contributed time and expertise to the SDG 11 indicator review, the data collection process, and project evaluation discussions. The university consulted local authorities throughout the project, and this engagement served as a learning opportunity for local government officials to be educated on sustainable development concepts and the value of SDG monitoring. In L.A., university students conducted the initial mapping and proposal of indicators for the city to adopt. In Colombia, nonprofit cities network CVCN has taken on the responsibility of being the institution in charge of developing indicators, managing and disseminating data, and engaging stakeholders. The organization will continue in this role as it explores options for other organizations that could coordinate local SDG efforts over the long term.
Supporting National SDG Initiatives
The grantees offer a series of examples of how local data efforts can support national progress on the SDGs. In Colombia, CVCN is leading several activities across Colombian cities, which are purposefully embedded in the Colombian national government’s SDG achievement effort by explicitly relating to national level SDG reporting structures. CVCN developed the SDG Indicator Framework for Colombian cities based on the country’s official SDG indicators, which were defined by the national government. In the State of Punjab in India, one organization–NITI Aayog–had been leading an official portion of the Voluntary National Review (VNR) process. OCI developed its initiative with Patiala with the vision that the city’s data system could be integrated into the state-level SDG reporting effort.
In Aruba, though the island’s government is mandated to report jointly to the High-level Political Forum on Sustainable Development along with the three other countries of the Kingdom of the Netherlands (Netherlands, Curaçao, Sint Maarten), there are currently no systems in place that integrate sub-national data from the four constituent countries. The grantee developed an indicator tool linking values of ecosystem services with SDG indicators so that these could be used as a common framework for reporting across the Dutch Caribbean Islands, and likewise, at the Kingdom level.
Promoting Action When National Leadership is Missing
In Brazil, the Brazilian Commission on Sustainable Development Goals has been established, but neither a national SDG strategy nor an official SDG indicator framework have been created and recent elections have made national efforts to implement Agenda 2030 uncertain. Further complicating matters is a notable data gap, as 2010 national census data is outdated, especially in the wake of the recent economic crisis. To address this, in May 2017 a group of civil society organizations, members of the public and private sectors, and universities established the Metropolitan SDG Observatory (METRODS). The organization was created to identify, disseminate and monitor SDG 11 indicators for metropolitan areas of Brazil2. Then, in an effort to pilot METROD’s SDG Indicator Framework in a metropolitan area, the team of grantees endeavored to collaborate with stakeholders in the Metropolitan Region of Belo Horizonte. When testing the framework in Belo Horizonte, the grantees aimed to model the benefits of local data and monitoring activities and provide an institutional example for a local data observatory. An official or permanent observatory has not yet been set up in Belo Horizonte, but the grantees hope that this will change in the near future and that the example will provide a basis for establishing observatories in other metropolitan areas in the country.
In the United States cities also provide a unique example of SDG leadership in the absence of a national strategy. In early 2016 the federal government launched an official website displaying U.S. national statistics that align with the SDGs (sdg.data.gov). However, the current administration has not expressed support for Agenda 2030 and the SDGs. In the absence of national leadership Los Angeles, along with several other major cities like New York and San José, is modeling local leadership in implementing a global agenda. Setting a high-bar example of city leadership, in July 2018 the City of New York presented the first VLR of the SDGs at the High-level Political Forum on Sustainable Development. Creating a framework to help mobilize national actors, SDSN has launched city indexes for the U.S.A., Italy, Spain, and India, and has supported an effort in Mexico.
Localizing Indicators While Also Promoting Coordination and Comparison Across Regions and Cities
Data and indicators provide a common language for coordinating sustainability efforts, and those that are being used to set targets and track progress are a means to coordinate efforts and activities within and between organizations. Often sub-national efforts have been launched by first examining alignments between the Inter-agency and Expert Group on SDG Indicators (IAEG-SDGs) official indicators and targets and measurement systems associated with existing sustainability plans and programs in the focus location. However, local indicators often vary from the official list. For example:
A target, and therefore a measurement, may not be relevant to a sub-national context. Bristol, U.K. (a later addition to the LDA project) used three categories for why a target was deemed irrelevant: (i) if the target focused on, or was limited to, developing or least developed countries; (ii) if the target explicitly referenced laws or policies at higher levels of government; or (iii) if the target addressed sustainable development issues that occur outside urban contexts.
Some targets name a standard that some locations do not consider relevant and so a more appropriate standard is applied. For example, for SDG Target 1.1, the international poverty line of US$1.25 may not be a suitable standard to use in more developed economies. In the case of New York City, the government determined to use a poverty standard that reflected the cost of living in the city: US$33 per day
Locally-disaggregated data aligning with the IAEG-SDG official indicators may not be available. To address this, grantees used alternative urban indicator frameworks to select SDG-aligned indicators, such as: World Council on City Data ISO 37120, the UN-Habitat City Prosperity Index and the SDSN U.S.A. SDG Index.
Measures of progress in lower density or less central neighborhoods in a sub-national area, like a metropolitan area, may be different from downtown areas. For example, in Brazil for Target 1.2 (“By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older persons”) the Belo Horizonte grantee team determined it important to find an effective measure to track service and progressive change in peripheral areas. Given the needs and the nature of the economies in these locations, the team adopted an indicator measuring the coverage of regional public transportation linkages.
Binary concepts of gender may not be appropriate in some cultural contexts, as it may exclude some identities. In L.A., the grantees proposed revising targets and removing binary language in most places. If these targets are formally adopted by the city and indicators are developed in accordance with these, the appropriate means for gender-disaggregating the data will need to be determined.
In L.A., a list of city-level SDG targets was developed to be complementary to the Sustainable City pLAn, a revision of which is to be released in 2019. In this same spirit, the L.A. team mapped alignments between the SDGs and its resilience strategy Resilient Los Angeles. Finally, the target and indicator data review that was conducted by the grantees revealed jurisdictional boundaries with implications for action, monitoring, and reporting. Therefore, the proposed list of indicators maps roles and responsibilities for stakeholders to utilize when developing coordinated action plans to achieve the city’s goals.
In Colombia, the SDG Indicator Framework for Colombian Cities was developed with the intention that it could be applied to cities across the country, thus helping to align sustainability efforts among them and between cities and the national government. The framework is adaptable; it incorporates indicators that anticipate differences among the cities with regard to resources, capacity, and the level of development. Because it allows for comparative assessment across the cities, it can foster dialogue as well as “healthy” debate about solutions.
Local data efforts also provide a means for continuing coordination of sustainability efforts from one government to the next. This was another objective of the effort in Colombia, which intends for the SDG Indicator Framework to be used by current and future political leaders as a guidance tool for structuring the cities’ required four-year development plans in the context of the 2030 Agenda. This long-term monitoring tool would also guide municipal leaders’ assessments of past performance and as they determine how best to invest future efforts and resources. Consequently, even as political terms conclude, the municipalities would have a steady tool to align their initiatives with national and international development priorities.
In Patiala, India, the grantee developed a model data dashboard as a means to help policymakers and administrators organize their data and data sources. The initiative digitized paper data archives from eight departments: Police, Municipal Corporation, Punjab Pollution Control Board, Public Works Department, Water Department, and Solid Waste Management Department. As a “living reference” of SDG-aligned indicators, the dashboard intends to provide data to enable collaborative decision-making across departments and programs in real-time, and to improve efficiency by supporting monitoring and accountability efforts for tracking sustainability outcomes.
A common indicator framework used by a group of cities can provide a means for comparison, which can motivate action. In Colombia, the grantee developed the SDG Target Framework, a set of city-level SDG indicators aligned with national targets, which will be used to assess and track SDG achievement across more than 35 Colombian cities. The creators of the indicator list hoped that it could also be used as a tool for inter-city comparison and that consequently it would foster healthy competition that would drive local achievement efforts. To enable this, CVCN is developing an Urban Dashboard for SDGs, which will store and provide visualization tools for city-level SDG data. The dashboard will be publicly accessible, allowing stakeholders to conduct comparisons and analysis of the cities’ achievements.
The L.A. grantees pointed out that localizing indicators while retaining cross-city comparison was a “balancing act.” They recognized the need to contextualize targets within the social, economic, and cultural elements of the city so as to maximize the appeal to local stakeholders, but endeavored to keep the indicators as close to the original IAEG-SDG set as possible so as to enable active comparison.
Expanding Beyond Official Data
One of the reasons that sub-national SDG data and reporting have received increased attention is because stakeholders are realizing how they serve to inform more effective sustainable development initiatives. Official national-level data, which for many countries is the primary source of SDG indicator data, can be limited in how they can be demographically disaggregated. Local official data, with scant resources allocated to them, can provide some addition texture but face limitations as well. The grantee in Patiala found a dearth of official datasets at the city level so it determined that in a second phase of the project, it should access alternative, non-official data sources such as citizen-centered data and data from nongovernmental organizations and civil society organizations.
In Colombia, CVCN found that for many indicators, official local data was unavailable or inaccessible, and if it did exist it was not up to date. To address this, when it created its SDG Indicator Framework, CVCN created two categories of importance for the indicators. Certain indicators were labeled as “mandatory” so that cities will prioritize data development for those. A second set was labeled “aspirational.” These are indicators that can be tackled in the second phase of a local SDG data initiative when organizational capacity is higher.
Additional insights from this impact area are limited due to the limited timeframe of the grantee program (approximately eight months) and the added complexity of public-private collaboration3.
Incentivizing Relative Progress
Some cities have found that their baseline achievements surpass global or national SDG targets. However, this should not indicate a lack of action is required, and that cities should simply maintain a status quo. Rather, setting higher standards for high achievers is good practice. For the proposed list of targets for L.A., when the city had surpassed the global goal the team set a more aggressive target. Take, for example, Target 3.1. In 2016, the state of California reported fewer than 7.3 maternal deaths per 100,000, when the official global goal is to reduce to fewer than 70 per 100,000 live births4. In this situation, the team examined the global baseline and the relative change to achieve the global target. For example, the current global rate of maternal mortality is 216 per 100,000 live births. Therefore, achieving 70:1000 would be a 67 percent reduction. In the case of California, a 67 percent reduction would be 5:100,000 and so the team proposed this as the appropriate target for the city.
In Colombia, national targets have been set; however, the baseline in some cities is at a level above that national target. The grantee developed the SDG Benchmark Target Framework for Colombian cities in order to aid cities in setting their own thresholds for each target. This Framework included an acceptable target range for cities to use when projecting their own achievements. For each target, this range was bound by an aspirational point of reference and a minimum level of achievement. UN targets, other international organizations’ targets, and national targets were used to define these ranges. But in cases where a national target had already been achieved by one of the cities, then the 2015 value of that achievement was used as the minimum standard for the permissible range on that target.
Local data efforts in Brazil placed particular emphasis on inclusion, as the grant team assembled a list of indicators that could be applied to peripheral areas and less developed regions of the municipality. Spatial inequality is a major challenge when designing and implementing development initiatives across the Belo Horizonte region. The grantees observed that investments tend to focus on population centers where GDP inputs are more highly concentrated. With this dilemma in mind, the team reviewed the METRODS SDG 11 Indicator Framework, which had been developed with the intention to structure SDG 11 “profiles” for all of Brazil’s metropolitan areas. However, during the pilot in Belo Horizonte, it became evident that some indicators on the original list were not applicable to marginal areas. For example, the framework listed indicators measuring public transportation without including regional public transportation linkages, which are an important indicator when assessing service coverage in smaller, peripheral cities in the metropolitan region. The team adjusted the indicators accordingly when it developed a revised framework for the Belo Horizonte Metropolitan Region.
In L.A., the grantee team proposed revisions to local that emphasized equity and inclusion in support of all sexual orientations, gender identities and expressions, and sex characteristics. The proposed revisions included changing references to “girls and boys” to read “all children,” and from “men and women” to “all people.” Additionally, when the team reviewed baseline data they found inequities among racial and ethnic groups, and therefore proposed inclusive language to ensure achievement efforts would emphasize equal outcomes. For example, when examining rates of maternal mortality (Target 3.1), the team found that African-American mothers, regardless of educational attainment or socioeconomic status, die at three to four times the average rate5. The team therefore proposed including “for every race and ethnic group” in the target statement to ensure a focus on equity. These revisions were put forward not only to reflect the city’s values but also with the intention of incentivizing other communities, corporations, and organizations to make similar adjustments to improve efforts addressing equality and promoting the notion to “leave no one behind.”
The SDGs and the data efforts that underpin them provide a rubric that facilitates a common understanding and can encourage mutual effort to achieve sustainable development. Local SDG data initiatives, when they are designed to be relevant and actionable, are integral to global progress and effective change. The LDA-SI grantees set a broad range of examples for developing local SDG data and reporting systems that can enable change and provide valuable tools for action from the grassroots up to national and global levels. Local data initiatives can improve national strategies and can provide leadership where it is not provided by country governments. They can also provide a basis for stakeholder understanding rooted in an existing policy context, thus fostering political will, providing a code for coordinated common action, and enabling comparative analysis across locations. Collectively, these cultivate a system of incentives that inspire local action. The grantees realized that refining targets and indicators ensures that they apply locally relevant standards and inclusive definitions, and that when they determine their best options for indicator data, this serves to inform more effective long-term SDG strategies.
Once targets have been set, and as sub-national programs continue, there is immense value in using these data systems to track achievements, to identify failures and successes, and to inform adjustments in local policy and investment where required. The LDA-SI grantees have demonstrated the immense effort that is required when identifying appropriate targets and indicators, locating data sources and data sets, and establishing data management systems. Now, if tools like these can be put to use and sustained over the long term, they will serve to transform the locales that they measure–and in aggregate, their countries, their continents and the world.
Blanco, Jr., Cid. 2019. “Metropolitan Localized Data in Greater Belo Horizonte, Brazil: A Participatory Guide to Better Governance.” SDSN TReNDS. https://www.sdsntrends.org/research/2019/4/15/local-data-action-brazil-belo-horizonte.
Bromaghim, Erin. 2019. “Revising National SDG Targets for the City of Los Angeles.” SDSN TReNDS. https://www.sdsntrends.org/research/2019/4/15/local-data-action-usa-los-angeles.
California Department of Public Health. 2017. “The California Pregnancy-Associated Mortality Review.” https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/PAMR/CA-PAMR-Report-1.pdf.
California Maternal Quality Care Collaborative. n.d. “CA-PAMR (Maternal Mortality Review.” https://www.cmqcc.org/research/ca-pamr-maternal-mortality-review.
City of Los Angeles. n.d. “pLAn.” http://plan.lamayor.gov.
Government of Aruba. “A Roadmap for SDG Implementation in Aruba.” 2018. http://www.sustainablesids.org/wp-content/uploads/2018/09/The-Aruba-SDG-Roadmap.pdf.
Sáenz, Luis Hernán. 2019. “Localizing the SDGs in Colombian Cities Through the Cómo Vamos City Network.” SDSN TReNDS. https://www.sdsntrends.org/research/2019/4/15/local-data-action-colombia.
Scruggs, Gregory. 2018. “‘Everything we’ve heard about global urbanization turns out to be wrong’ - researchers.” PLACE. July 10, 2018. http://place.trust.org/i/?id=0150beca-e3f5-47e0-bc74-9ccc5ef1db8a.
SDSN TReNDS. 2019. “Introducing Contracts for Data Collaboration: New Project on Legal Conditions for Data Sharing.” SDSN TReNDS Blog. January 22, 2019. https://www.sdsntrends.org/blog/2019/1/22/introducing-contracts-data-collaboration.
SDSN TReNDS and Elena Palacios. 2019. “Prioritizing Ecosystem Services in SDG Monitoring in Aruba.“ SDSN TReNDS Blog. April 15, 2019. https://www.sdsntrends.org/blog/2019/4/15/local-data-action-aruba.
Varma, Ruchi. 2019. “Valuing the SDGs for Localization in Patiala, India.” SDSN TReNDS. https://www.sdsntrends.org/research/2019/4/15/local-data-action-india-patiala.
1. Scruggs, Gregory. 2018. “‘Everything we’ve heard about global urbanization turns out to be wrong’ - researchers.” PLACE. July 10, 2018. http://place.trust.org/i/?id=0150beca-e3f5-47e0-bc74-9ccc5ef1db8a.
2. For further information about METRODS, see: “Metropolitan Planning and Governance in Brazil: how the use of SDG data can help to deliver better results in public administration”. SDSN TReNDS. 2017. In: https://www.sdsntrends.org/research/2017/9/17/metropolitan-planning-and-governance-in-brazil-how-the-use-of-sdg-data-can-help-to-deliver-better-results-in-public-administration.
3. Challenges to public-private data collaboration include agreement upon common data storage and sharing standards and a data sharing contractual framework. For more, see Contracts for Data Collaboration: https://www.sdsntrends.org/blog/2019/1/22/introducing-contracts-data-collaboration.
4. California Department of Public Health. 2017. “The California Pregnancy-Associated Mortality Review.” https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/PAMR/CA-PAMR-Report-1.pdf.
California Maternal Quality Care Collaborative. n.d. “CA-PAMR (Maternal Mortality Review.” https://www.cmqcc.org/research/ca-pamr-maternal-mortality-review.
5. California Department of Public Health. 2017. “The California Pregnancy-Associated Mortality Review.” https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/PAMR/CA-PAMR-Report-1.pdf.