Maternal mortality: An explainer and research roundup

This piece on maternal mortality was updated on September 19, 2022, to reflect new data from the CDC.

Each year, at least 700 women die in the United States because of pregnancy or delivery complications. Four in five of those deaths are preventable, according to the latest data from the Centers for Disease Control and Prevention.

These deaths are defined as maternal mortalityor pregnancy-related deaths. The maternal mortality data are typically reported as rates, which is the number of maternal deaths per 100,000 live births.

Worldwide, the maternal mortality rate was estimated at 211 in 2017. The World Health Organization’s goal is to reduce that rate to 70 by 2030.

The U.S. maternal mortality rate is 23.8, according to the latest data from the Centers for Disease Control and Prevention. That’s considered “very low” globally, yet it is far higher than many other wealthy nations including Sweden, Italy, Austria and Japan.

To be sure, the U.S. maternal mortality rates dropped steadily throughout the 20th century, from over 800 deaths per 100,000 live birthsin 1900 to 6.6 per 100,000 in 1987. The decline was attributed to several factors, including better disease monitoring, access to health care, better nutrition and advances in medicine.

But since then, the rate has been steadily increasing. By 2018, the maternal mortality rate was at 17.3 per 100,000, then at 20.1 in 2019 and 23.8 in 2020, according to the CDC. Factors contributing to the increase include disparities in access to care, increasing maternal age and increase in chronic conditions such as diabetes and obesity, studies show.

In June, the White House released a Blueprint for Addressing the Maternal Health Crisis, with a vision that the U.S. “will be considered the best country in the world to have a baby” in the future. Among the first steps is improving and expanding Medicaid coverage, better data collection, diversifying the perinatal workforce and providing better economic and social support for people before, during and after pregnancy.

Disparities in maternal mortality

There are stark and persisting racial disparities in maternal mortality in the U.S. Black people are more than three times as likely as white women to die from pregnancy-related causes, according to the CDC. American Indian and Alaska Native people are more than twice as likely.

Between 2018 and 2020, the maternal mortality rate for Black people was 55.3, compared with 19.1 among white people and 18.2 among Hispanic people, according to the latest CDC data.

In comparison, the maternal mortality rate was 41.4 among Black people, compared with 13.7 for white people between 2016 and 2018. The rates were 26.5 for American Indian or Alaska Native people, 14.1 among Asian or Pacific Islanders and 11.2 for Hispanic people, according to the CDC.

While factors such as access to care and health insurance coverage play a role in pregnancy outcomes, research also points to disparities in social determinants of health such as income, age and housing. Many of these disparities are related to systemic and structural racism.

“It’s important to be clear that it’s racism, not race,” says Dr. Rachel Hardeman, Blue Cross Endowed Professor of Health and Racial Equity at the University of Minnesota School of Public Health, and the founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota. “It’s about systems and structures that historically have been built to not ensure that Black people and Black working people thrive.”

And until structural racism and related factors such as implicit bias in health care are addressed, “we will continue to see the disparities,” says Dr. Veronica Gillispie-Bell, associate professor at Ochsner Clinical School and head of Women’s Services at Ochsner Medical Center in Kenner, Louisiana.

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.