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.
Resources
Key Papers
- Health care disparity and state-specific pregnancy-related mortality in the United States, 2005-2014
Obstetrics & Gynecology | October 2016 - Deadly delivery: The maternal health care crisis in the USA & 2011 update
Amnesty International | 2010 & 2011 - Pregnancy-related mortality in the United States, 2006-2010
Obstetrics & Gynecology | January 2015 - Reproductive injustice: Racial and gender discrimination in U.S. health care
Center for Reproductive Rights, Sister Song, National Latina Institute for Reproductive Health | 2014 - Racial/ethnic disparities in obstetric outcomes and care: Prevalence and determinants
American Journal of Obstetrics & Gynecology | April 2010 - Black-white differences in severe maternal morbidity and site of care
American Journal of Obstetrics & Gynecology | January 2016 - Shifting the frame: A report on diversity and inclusion in the American College of Nurse-Midwives
ACNM | June 2015 - Racial disparities in comorbidity and severe maternal morbidity/mortality in the United States: an analysis of temporal trends
Acta Obstetrica et Gynecologica Scandinavica | October 2017
Recent Publications
Interventions to Prevent Perinatal Depression US Preventive Services Task Force Recommendation Statement
Gestational Weight Gain and Severe Maternal Morbidity at Delivery Hospitalization
Pregnancy Outcomes in US Prisons, 2016–2017
Association of Maternal Social Relationships With Cognitive Development in Early Childhood
Low-income Texas women’s experiences accessing their desired contraceptive method at the first postpartum visit
See all maternal health in the U.S. publications>>
News
Appropriate Storage and Management of Oxytocin – a Key Commodity for Maternal Health
Interventions to Prevent Perinatal Depression US Preventive Services Task Force Recommendation Statement
Recommendations to the Indian Health Service on American Indian/Alaska Native Pregnant Women and Women of Childbearing Age with Opioid Use Disorder
When We Talk about Maternal Mortality, We Must Talk about Mental Health
Summit’s focus: High mortality rates of black mothers, infants
See all maternal health in the U.S. news>>
Documents & Reports
Report from Nine Maternal Mortality Review Committees
Designing Capacity for High Value Healthcare: The Impact of Design on Clinical Care in Childbirth
The Mothers and Babies Course: A Preventive Intervention of Perinatal Depression for Low Income Women in the United States
Taking MI from Global Policy to Implementation at the Country Level: The PAHO Experience
Shifting the Frame: A Report on Diversity and Inclusion in the American College of Nurse-mMidwives
See more maternal health in the U.S. documents & reports>>
Organizations
The Role of the MHTF
Infographic
Racial disparities and a failed global commitment: An infographic on maternal mortality in the U.S. by the MHTF
Projects
Disparities in U.S. Maternal Health
Meetings & Events
In November 2015, as a part of the Advancing Dialogue on Maternal Health Series, the MHTF hosted a panel discussion at the Woodrow Wilson Center focused on maternal health in the U.S.
What Explains the United States’ Dismal Maternal Mortality Rates?
Blog
Blog series: Inequities in Maternal Mortality in the U.S.