Episode 3 – Why Are American Mothers Still Dying?

In this episode

• How maternal mortality is measured
• Why interpretations of the trend differ
• Racial and geographic disparities
• Prevention and opportunities to improve care

US maternal mortality has been rising and remains substantially higher than in other high-income countries. Key data points:

Understanding the Numbers

Overall rates: The age-standardized pregnancy-related death rate was 33.0 per 100,000 live births during 2018–2022, increasing 27.7% from 25.3 in 2018, peaking in 2021, and declining to 32.6 in 2022. [1] The NCHS reported 1,205 maternal deaths in 2021 (32.9 per 100,000) compared with 754 in 2019 (20.1 per 100,000). [2] An estimated two-thirds of US pregnancy-related deaths are preventable. [3]

Interpreting the Trend

However, interpretation of trends is complicated by measurement artifacts. A recent analysis found that when excluding deaths coded as “cause unspecified” (a proxy to remove effects of the pregnancy checkbox on death certificates), maternal mortality remained relatively stable between 6.75 and 10.24 per 100,000 from 2000 to 2019, then spiked to 18.86 in 2021 before returning to 10.23 in 2022. [4]

Racial and ethnic disparities

Racial and ethnic disparities are stark and persistent:

• Non-Hispanic Black women: ~2.8–3.8× higher mortality than non-Hispanic White women across all time periods [1][4-5]
• American Indian/Alaska Native women: 3.8× higher than non-Hispanic White women during 2018–2022, with the largest increases over time [1][6]
• These disparities persist across age groups and education levels — Black and AI/AN women with college education have higher mortality than other groups without a high school diploma [5]

Geographic Differences

Geographic variation: Rates vary more than 3-fold by state. Alabama (59.7) and Mississippi (58.2 per 100,000) had the highest rates, while California (18.5) and Minnesota (19.1) had the lowest during 2018–2022. If all states matched the lowest rate, an estimated 2,679 deaths could have been prevented. [1] The South had the greatest regional increases. [4]

References

1. Pregnancy-Related Deaths in the US, 2018-2022.JAMA Network Open. 2025. Chen Y, Shiels MS, Uribe-Leitz T, et al.
2. Management of Pregnancy (2023).Department of Veterans Affairs. 2023. Colleen C. Blosser MSN RN, Michael Bybel DO FAAFP, Alicia Christy MD MHSCR, et al.
3. Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Circulation. 2021. Mehta LS, Sharma G, Creanga AA, et al.
4. Trends in Maternal, Fetal, and Infant Mortality in the US, 2000-2023. JAMA Pediatrics. 2025. Park RY, Bilinski A, Parks RM, Flaxman S.
5. Racial/Ethnic Disparities in Pregnancy-Related Deaths – United States, 2007-2016. MMWR. Morbidity and Mortality Weekly Report. 2019. Petersen EE, Davis NL, Goodman D, et al.
6. Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States. The Journal of the American Medical Association. 2023. Fleszar LG, Bryant AS, Johnson CO, et al.