Maternal Mortality in the United States

Introduction

Despite having the incredibly high quality of life characteristic of most Western nations, the United States has high rates of maternal mortality compared to its peer nations. US maternal mortality rates increased every year from 2018–2021 for all ethnic groups, with a particularly high increase in that of Black women (Abbasi, 2023). Crucially, different reports estimate that 50 to 80% of maternal deaths are preventable (Tanne, 2024; Troiano, 2018). Considering the fact that women’s health developments have consistently lagged behind those in other areas of medicine, that over 86% of women will give birth before 44, and the persistence of this trend over the past several years, it is imperative to consider the causes of this mortality (Livingston, 2018).  Moreover, disparities in maternal outcomes transcend racial boundaries—rural communities often lack access to obstetric care, and low-income women consistently struggle to attend appointments. What distinguishes the United States’ birth systems from those of its peer nations? What are the medical and systemic causes of maternal mortality? What can be done to prevent these deaths? For the women who have been failed by our medical system, these are the questions that must be answered to prevent sustained harm. Thus, this article will explore maternal mortality through five lenses: 1) US mortality rates in the international context, 2) leading medical causes of maternal mortality, 3) health system issues, 4) social determinants of health, and 5) potential solutions. 

US Maternal Mortality Rates in an International Context

Maternal mortality is defined by the Centers for Disease Control as “the death of a woman while pregnant or within 42 days of termination of pregnancy,” excluding incidental and accidental deaths (Detailed Evaluation of Changes in Data Collection Methods, 2019). The 2021 US maternal mortality rate was 32.9 per 100,000 live births, which is more than ten times the estimated rates for other high-income nations like Australia and Spain. The latter two countries have rates between 2-3 deaths per 100,000 live births (Abbasi, 2023). Maternal mortality rates decreased by 44% in developed nations worldwide between 1990 and 2013, but in the United States, they more than doubled (Troiano, 2018). While US maternal deaths spiked during the COVID-19 pandemic (Siliezar, 2025), it seems that this was a worsening of an existing trend rather than an unprecedented issue. Thus, while the impact of COVID on maternal health should absolutely be considered, it is crucial to consider the structural and medical causes of such mortality independent of the pandemic. 

Interestingly, research shows that this difference is not necessarily a function of income. White US women living in the top 1% and 5% highest-income counties had worse outcomes than average citizens of comparable nations. In the top 1% of highest-income US counties, there were approximately 10.05 maternal deaths per 100,000 births, while Canada had an average of 6 deaths per 100,000 births and France had 5.10 deaths per 100,000 births (Emanuel, 2020). This suggests that other factors, such as racial and geographic disparities, may be exacerbated in the United States. It is also worth considering how US obstetric care systems differ from those of its peers.

The majority of maternal deaths in the US occur during the postpartum period, which is defined as the day of the initial birth through the following year (Gunja et al., 2024). The nation also relies heavily on private, employer-sponsored insurance systems supplemented by Medicaid, resulting in substantial healthcare costs that may impact appointment adherence (International Health Care System Profiles, n.d.). On the other hand, peer nations like Canada and Sweden function on a universal healthcare system, and better adherence to recommended postpartum and prenatal care may lead to more favorable birth outcomes (Fredriksson, 2024; About Canada's health care system, n.d.). 

Causes

Leading causes of maternal mortality in the US include cardiomyopathy, hemorrhage, and chronic medical conditions (Collier & Moline, 2019). Cardiomyopathy deals with the weakening of the heart muscle, and the hormonal changes involved in pregnancy can trigger Peripartum Cardiomyopathy (PPCM). PPCM causes the heart to weaken during the late stages of pregnancy and up to five months following childbirth (Peripartum Cardiomyopathy, 2024). Hemorrhage refers to severe internal or external bleeding, and when severe blood loss leaves organs unable to function, it can result in death (Hemorrhage, 2024). Causes of hemorrhage during pregnancy include placental abruption, uterine atony, ectopic pregnancy, and more (Postpartum Hemorrhage, n.d.). 

A 2018 report from nine states found that nearly 50% of all pregnancy-related deaths were caused by hemorrhage, coronary conditions, cardiomyopathy, or infection. In non-Hispanic Black women, the most common causes included preeclampsia, eclampsia, and embolism. Non-Hispanic white women had mental health conditions as the leading cause of death (Collier & Molina, 2019). In terms of chronic health conditions, obesity in pregnancy has also been associated with maternal mortality in a Washington State cohort between 2004 and 2013, suggesting that the obesity epidemic may be contributing to adverse outcomes (Lisonkova et al., 2017). 

The impact of cardiovascular disease and cardiomyopathy cannot be underestimated; during a 2011–2013 reporting period, these factors accounted for more than 25% of all maternal deaths. Previously prevalent causes, like venous thromboembolism and hypertension, seem to have decreased in relevance. Among non-Hispanic Black women, cardiovascular disease and cardiomyopathy contributed to 46.8% of pregnancy-related deaths between 2011 and 2013, compared to 40.9% among non-Hispanic white women and 25.5% among women of other races (Lisonkova et al., 2017).

Health Systems Issues

US obstetric care is less reliant on midwife care, has fragmented insurance coverage, higher rates of C-sections, and larger regions of maternity care deserts.

A 2025 study reported that 36% of all US counties qualify as maternity care deserts, meaning that they have “no hospitals offering obstetric services or birth centers and no obstetricians, gynecologists, or certified nurse midwives” (Adashi, O’Mahony, & Cohen, 2025). These deserts tend to overlap with rural areas, which experience higher rates of maternal mortality (Spencer, 2023). The potential causes for this disparity are intuitive — if a woman lives in a region without maternal care, the likelihood that she will consistently seek care is much lower. This disparity also falls along racial lines; approximately 1 in 4 Native American babies and 1 in 6 Black babies are born in maternity care deserts (Jeffers, 2023).  Insurance coverage has a similar effect; by creating another barrier, it becomes less likely that care is dependable. 

It is known that cesarean delivery (CD) has higher risks of adverse outcomes compared to vaginal birth. These risks include placenta abnormalities and uterine rupture (Kongwattanakul et. al., 2020). A 2024 study found that in a low-resource setting, women who underwent CD were more than five times more likely to die than those who delivered vaginally. Leading causes of death following CD included postpartum hemorrhage, eclampsia, and infection (Riches et. al., 2024). It is surprising, then, that in 2023, over 30% of US births were through CD (Berg, 2025), and that women of color are the most susceptible to unnecessary CD (Dun et al., 2025). Hospitals with sufficient nurse staffing experience lower rates of CD, and profit motivation within healthcare may also motivate the rise in this type of delivery (Why a Low C-Section Rate Matters for Expecting Mothers, 2025). 

Social Determinants of Health

Beyond racial disparities, many structural issues contribute to maternal mortality rates in the United States, including nutritional disparities and poverty.

Dr. Monica McLemore, a professor at the University of Washington School of Nursing, describes that women are coming to pregnancy older, more obese, and with more preexisting chronic health conditions. She notes that access to healthy foods, clean water, and insurance to manage preexisting conditions are not exclusively healthcare issues— rather, they are policy and structural ones (Abbasi, 2023). When lawmakers fail to mitigate nutritional issues in food deserts, allow water contamination crises to fester, and restrict low-income populations’ access to primary care, half of the healthcare battle has been lost before a patient even takes a pregnancy test.

Moreover, the United States is one of the only high-income countries that does not legally require paid parental leave of at least 14 weeks. This leave is essential for women to manage the physical and psychological demands of motherhood (Tanne, 2024). Mental health outcomes do account for a portion of maternal mortality, particularly among white women (Collier & Molina, 2019). 

The private healthcare insurance system decreases access to healthcare due to financial barriers, but the root of this issue is poverty. 12.6% of US citizens live below the poverty line. These women are less likely to receive prenatal care, preventing screening for conditions like hypertension, diabetes, anemia, Rh disease, and syphilis (Nagahawatte & Goldenberg, 2008). These women do not just experience the greatest socially-developed healthcare issues; rather, even when these issues are incurred, financial strain means they cannot even be identified. 

Potential Solutions

As identified by an article in the 2019 publication of NeoReviews, the potential solutions to US maternal mortality are fivefold (Collier & Molina, 2019):

1. “Integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond;

2. Addressing structural racism and the social determinants of health;

3. Implementing hospital-wide safety bundles with team training and simulation;

4. Providing patient education on early warning signs for medical complications of pregnancy; and

5. Regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams.”

Understanding the complex relationships between social determinants of health is crucial (Singh & Lee, 2020). Examples include taking a policy-level approach to healthcare systems, including enhancing guaranteed maternal leave, modifying insurance systems to increase access to postpartum care, and passing policies to alleviate nutritional gaps in food deserts. While healthcare providers and scientists cannot independently achieve this, avenues to change include political lobbying and grassroots advocacy.

Medically, this means ensuring providers are more thoroughly educated on the impact of cardiovascular disease and nutritional deficits on pregnancy so they are able to best advise their patients. Unlike policy-level changes, this change would occur at an educational level. 

Finally, the National Perinatal Task Force is working to establish Perinatal Safe Spots in “maternotoxic zones,” or regions in which pregnancy is unsafe for mothers. Perinatal Safe Spots are places where mothers receive prenatal care to gain knowledge about pregnancy and agency in their childbirth process. Establishing more safe locations in areas with particularly high mortality rates ensures that women are educated about how to reduce risks. 

Pregnancy in the United States is a highly politicized issue, with politicians, healthcare providers, and the general public alike questioning the level of autonomy women have over their pregnancies, who is considered fit to parent, and whose suffering during and after pregnancy is legitimized. These debates are not exclusively ideological– they directly influence clinical decision-making, access to timely care, and symptom dismissal, all of which drive preventable maternal mortalities. While the prevalence of maternal mortality in the United States is devastating, it should not be treated as an unavoidable reality. Rather, through conscious and critical assessment and intervention, we are capable of building solutions.  Implementing changes at the educational, policy, and hospital levels can create a medical system that structurally protects its most vulnerable patients, strengthening not only the American healthcare system, but also the broader movements towards reproductive and health justice.

Edited by Jay Nathan '27

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COVER PHOTO: https://www.yalemedicine.org/news/maternal-mortality-on-the-rise