U.S. Maternal Mortality: What’s Going Wrong and What Could Fix It

In a nation with some of the world’s most advanced medical technology, an alarming reality persists: the United States has one of the highest maternal mortality rates among developed countries. At 18.6 deaths per 100,000 live births in 2023 (down from 22.3 in 2022), the U.S. rate still dramatically exceeds peer nations like the UK (6.5) and Canada (7.2), where mothers are significantly less likely to die from pregnancy-related causes.

Even more troubling? Over 80 percent of these deaths are preventable, according to CDC data.

The Scope of the Crisis

The numbers tell a devastating story. The U.S. maternal mortality rate is 4-6 times higher than other wealthy nations, positioning America as the country with the highest maternal mortality rate among high-income countries. American Indian and Alaska Native women face mortality rates 3.8 times higher than white women (106.3 vs 27.6 deaths per 100,000 live births), while Black women die at nearly 3 times the rate of white women (76.9 vs 27.6 deaths per 100,000 live births) during pregnancy or postpartum.

Maternal deaths increased 27% from 2018 to 2022, with a significant spike during the COVID-19 pandemic. The sharpest increase occurred in 2021, likely reflecting the pandemic’s impact on healthcare access and quality.

Dr. Wanda Barfield, CDC Director of the Division of Reproductive Health, emphasizes: “84% of pregnancy-related deaths are preventable. We have the tools to save lives; we need to implement them equitably.”

Why Are American Mothers Dying?

Research identifies several preventable leading causes of maternal death. Mental health conditions account for 23.3% of maternal deaths, followed by hemorrhage (12.8%), cardiac and coronary conditions (12.6%), infection (8.9%), and preeclampsia and eclampsia (7.4%).

The timing of these deaths reveals another critical aspect of the crisis: while 30% occur during pregnancy and 17% during childbirth or within a day after, the majority (53%) happen in the days and weeks following delivery—a period when maternal care often diminishes significantly. This postpartum vulnerability highlights a dangerous gap in the continuity of care.

Geographic and Access Disparities

The maternal health crisis isn’t uniform across America. State-by-state disparities are stark and often shocking. California has the nation’s lowest maternal mortality rate (15.7 per 100,000), while Mississippi’s rate (53.1) is more than three times higher. If all states matched California’s outcomes, nearly 2,700 maternal deaths could be prevented annually.

Access to care remains a critical issue, with 50% of U.S. counties classified as “maternity care deserts”—areas with no hospital offering obstetric care and no obstetric providers. This lack of access correlates with 33% higher severe maternal morbidity rates in rural versus urban areas.

The political landscape further complicates the picture. Mothers in states with abortion bans are nearly twice as likely to die during pregnancy, childbirth, or postpartum compared to those in supportive states. Maternal mortality fell 21% in abortion-supportive states post-Dobbs decision, while it rose 56% in Texas in the first full year of the state’s abortion ban. Women’s risk of maternal death in Texas was 155% higher than in California, highlighting how policy decisions directly impact maternal outcomes.

What’s Working: Models of Success

The good news is that we have proven solutions. When implemented, these interventions save lives.

The California Model

The California Maternal Quality Care Collaborative (CMQCC) reduced maternal mortality by 55% between 2006 and 2013 through targeted interventions. Hemorrhage prevention bundles reduced severe bleeding by 20% and blood transfusions by 19% in California hospitals. Preeclampsia protocols decreased eclampsia by 40% in participating hospitals through timely administration of antihypertensives and magnesium sulfate.

This success story demonstrates that with coordinated effort, dramatic improvements are possible. California maintains the lowest maternal mortality rate in the nation, providing a blueprint other states could follow.

Remote Monitoring Programs

Innovation in post-discharge care shows promising results. Remote blood pressure monitoring detected 30% more hypertensive disorders and reduced readmissions by 25% in a Johns Hopkins pilot study. Structured patient education reduced delays in seeking care for warning signs by 35%.

These approaches address the critical postpartum period when more than half of maternal deaths occur, offering a safety net during a vulnerable time.

Policy Improvements

Extending Medicaid postpartum coverage from 60 days to 12 months increased care retention from 21% to 74% in Ohio, significantly improving chronic condition management. This policy change acknowledges that pregnancy-related health needs don’t end after two months and provides crucial continuity of care during the high-risk postpartum period.

The Role of Self-Advocacy and Education

Empowering expectant mothers with knowledge about warning signs is a crucial part of prevention. Structured education about symptoms requiring immediate medical attention—severe headache, vision changes, breathing difficulty, excessive bleeding—helps women recognize when to seek urgent care.

Research also shows that implicit bias contributes significantly to disparities; Black women’s pain is undertreated 40% more often than white women’s in obstetric settings. This reality makes self-advocacy skills particularly important for women of color navigating a system where their concerns may be dismissed or minimized.

How Beginning.com Supports Maternal Health

Beginning.com’s comprehensive pregnancy and postpartum courses are designed to bridge critical knowledge gaps that contribute to preventable maternal deaths. Our evidence-based modules cover recognizing early warning signs of preeclampsia and when to seek immediate care, understanding normal versus abnormal bleeding after childbirth, identifying postpartum mental health red flags, and building self-advocacy skills for medical settings.

Our approach combines educational content with practical tools that empower women to participate actively in their care. Through our app, expectant and new mothers can access guided meditations specifically designed to reduce pregnancy and postpartum stress, expert-led masterclasses on pregnancy complications and warning signs, and personalized content that adapts to individual risk factors and concerns.

Moving Forward: A Multi-Faceted Approach

Addressing America’s maternal mortality crisis requires action on multiple fronts. System-wide implementation of proven protocols like those in California represents one essential component. The Alliance for Innovation on Maternal Health (AIM) bundles implemented in 46 states reduced severe maternal morbidity by 20% between 2015-2020, showing the scalability of California’s approach.

Expanded postpartum care beyond the traditional six-week checkup acknowledges the extended risk period when most maternal deaths occur. Enhanced maternal health education starting in pregnancy and continuing through postpartum helps women recognize danger signs and seek timely care.

Addressing implicit bias in medical settings that leads to disparate treatment requires systemic changes in healthcare education and practice. Finally, expanding access to maternity care in underserved areas would help close the geographic gaps that endanger women in rural and underresourced communities.

The economic case for these interventions is compelling. U.S. maternal morbidity costs $2.5 billion annually in excess healthcare costs and lost productivity. In contrast, interventions like hemorrhage bundles yield $1.70 in savings for every $1.00 invested.

While the U.S. maternal mortality crisis is deeply concerning, the path forward is clear. By implementing proven protocols, expanding access to care, addressing disparities, and empowering women with knowledge, we can dramatically reduce preventable deaths.

At Beginning.com, we’re committed to being part of the solution by providing accessible, evidence-based education that helps women recognize warning signs and advocate for their care. Because no woman should lose her life bringing new life into the world—especially when we have the knowledge and tools to prevent it.

Are you pregnant or planning to become pregnant? Download the Beginning app today for personalized support throughout your maternal health journey, including evidence-based education on pregnancy and postpartum warning signs.