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 MMR in the U.S. increased from 17 deaths per 100,000 live births in 1990 to 26 deaths per 100,000 live births in 2015. During the same time period, the global MMR decreased by 44%. The U.S. has also failed to meet prior national goals for maternal mortality reduction and is not on track to meet the modest Healthy People 2020 goal of reducing maternal mortality by 10% between 2007 and 2020. Although 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, improvements in data accuracy are not enough to account for the alarming rise in MMR.
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—42 deaths per 100,000 live births among black women versus 12 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 daily experiences of racial discrimination can increase the risk of negative perinatal outcomes including preterm birth and delivery of a low birth weight infant for women of color. Maternal mortality ratios also vary significantly by socioeconomic status and geography. Women living in poverty and women in certain states experience significantly higher maternal mortality ratios than the national average.
A major driver of maternal health disparities in the U.S. is the growing contribution of non-communicable diseases to maternal mortality. Access to prenatal care also appears to play a role: Women receiving no prenatal care are three to four times more likely to have a pregnancy-related death than women who receive prenatal care. Approximately 25% of all U.S. women do not receive the recommended number of prenatal visits; this number rises to 32% 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 boards have the potential to better inform state health departments and clinicians on context-specific interventions that can reduce preventable maternal mortality. As of 2010, only 23 states have a full or partial policy establishing maternal mortality review boards.
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.