Maternal Health in the United States

• Resources
• The Role of the MHTF

The United States (U.S.) fares worse in preventing pregnancy-related deaths than most other developed nations. Despite participation in the Millennium Development Goals (MDGs) and spending more than any other country on hospital-based maternity care, the maternal mortality ratio (MMR) in the U.S. remains at about 17 deaths per 100,000 live births. Between 2000 and 2017, the global MMR decreased by 38%. The U.S. has also failed to meet prior national goals for maternal mortality reduction and did not meet the modest Healthy People 2020 goal of reducing maternal mortality by 10% between 2007 and 2020. Differences in reporting related to a new classification of maternal deaths in the updated International Classification of Disease (ICD-10) can partly explain the growing number of recorded maternal deaths as prior uncertainty about maternal death classification may have contributed to underreporting. Unfortunately, improvements in data accuracy are not enough to account for the alarming rise in the MMR, and underlying social factors are believed to be partially responsible.

The most notable disparity in mortality rates in the U.S. is defined by race: Black women die at a rate that ranges from three to four times the rate of their white counterparts—41 deaths per 100,000 live births among black women versus 13 deaths per 100,000 live births among white women as of 2010; this difference in risk has remained unchanged for the past six decades. American Indian and Alaskan Native women also fare worse than white women with approximately twice as many pregnancy-related deaths per 100,000 live births. Women of color tend to have poorer access to high quality reproductive health information and services than white women, are discriminated against in the healthcare system and experience higher rates of disrespect and abuse. Furthermore, there is evidence suggesting that the stress associated with situational experiences of racial discrimination can increase the risk of negative perinatal outcomes including preterm birth and infant death for Black women. Maternal mortality ratios also vary significantly by socioeconomic status and geography. Women living in poverty and women in certain states experience significantly higher MMRs than the national average.

One potential driver of maternal health disparities in the U.S. is non-communicable disease. Access to prenatal care also appears to play a role: women receiving no prenatal care are five times more likely to have a pregnancy-related death than women who receive prenatal care. Nearly 25% of all U.S. women start care late in pregnancy or do not receive the recommended number of prenatal visits; this number rises to 34% among African Americans and to 41% among American Indian or Alaska Native women.

Not all states gather information on race, ethnicity, income and health insurance status because there are no national standards for data collection and reporting of maternal mortality statistics. Such data are critical for recognizing and understanding disparities, and without them there has been insufficient accountability for maternal mortality. Maternal mortality review committees (MMRCs) have the potential to better inform state health departments and clinicians on context-specific interventions that can reduce preventable maternal mortality. Although at least 40 states currently have MMRCs, additional progress is necessary to further reduce the prevalence of preventable maternal deaths in the U.S. through this avenue.

Efforts at the local, state, and national levels to address maternal mortality are ongoing and civil society advocates such as Black Mamas Matter are calling for attention and action to address the unjust differences in preventable maternal mortality in the United States.