Maternal Mortality Crisis: 287,000 Annual Deaths and Growing Disparities

What Are the Leading Causes of Maternal Death Worldwide?

The WHO's 2023 report on Trends in Maternal Mortality estimated that approximately 287,000 women died from pregnancy-related complications in 2020, translating to roughly 800 women dying every day. Obstetric hemorrhage, primarily postpartum hemorrhage, remains the single largest cause, responsible for approximately 27% of maternal deaths globally. Hemorrhage can be caused by uterine atony (failure of the uterus to contract after delivery), retained placenta, uterine rupture, or coagulopathy. Most hemorrhage deaths are preventable with timely administration of uterotonics (oxytocin), active management of the third stage of labor, and access to blood transfusion and surgical intervention.

Hypertensive disorders of pregnancy, including preeclampsia and eclampsia, account for approximately 14% of maternal deaths. These conditions involve dangerously elevated blood pressure and organ dysfunction, with eclampsia (seizures) carrying a high mortality rate when untreated. Magnesium sulfate for seizure prevention and timely delivery remain the definitive treatments. Sepsis and infections contribute approximately 11% of deaths, often related to unhygienic delivery conditions, prolonged labor, or cesarean section complications in resource-limited settings. Complications of unsafe abortion account for approximately 8% of maternal deaths, concentrated in countries with restrictive abortion laws and limited access to safe services.

The vast majority of maternal deaths, estimated at 95%, occur in low- and middle-income countries, particularly in sub-Saharan Africa and South Asia. Sub-Saharan Africa alone accounts for approximately 70% of global maternal deaths, with a regional maternal mortality ratio of 545 per 100,000 live births compared to 13 per 100,000 in Europe. These deaths are driven by inadequate access to skilled birth attendants, emergency obstetric care, blood transfusion services, and essential medications. The Sustainable Development Goal (SDG) target of reducing the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030 remains far off track.

Why Is Maternal Mortality So High in the United States?

The United States reported a maternal mortality rate of 22.3 per 100,000 live births in 2022, according to the National Center for Health Statistics, the highest among peer high-income nations and more than triple the rates in countries like the United Kingdom, Canada, and Germany. The leading causes of pregnancy-related death in the US include cardiovascular conditions (including cardiomyopathy), hemorrhage, infection, preeclampsia/eclampsia, and mental health conditions including substance use disorders and suicide. Notably, cardiovascular conditions have surpassed hemorrhage as the leading cause of pregnancy-related death in the US, reflecting the high prevalence of chronic conditions among American women of reproductive age.

Racial and ethnic disparities in maternal mortality are stark and persistent. Black women in the United States die from pregnancy-related causes at approximately 2.6 to 3 times the rate of white women, a disparity that persists even after controlling for education, income, and insurance status. Research has demonstrated that structural racism, including differential access to quality healthcare, implicit provider bias, chronic stress from discrimination (known as weathering), and residential segregation affecting proximity to well-resourced hospitals, all contribute to this disparity. Indigenous and Alaska Native women also face elevated maternal mortality rates approximately 2 to 3 times higher than white women.

The fragmented US healthcare system contributes significantly to maternal mortality. An estimated 36% of maternal deaths occur between one week and one year postpartum, a period when many women lose insurance coverage, particularly in states that have not expanded Medicaid. Historically, pregnancy-related Medicaid coverage expired 60 days postpartum, leaving new mothers without access to care during a vulnerable period. The American Rescue Plan Act of 2021 gave states the option to extend postpartum Medicaid coverage to 12 months, and as of 2025, over 40 states have adopted this extension, a critical policy intervention for reducing postpartum deaths.

What Interventions Can Reduce Maternal Deaths?

The Alliance for Innovation on Maternal Health (AIM) has developed standardized patient safety bundles that have demonstrated measurable reductions in maternal morbidity and mortality. The obstetric hemorrhage bundle, implemented in participating hospitals across the United States, includes protocols for quantitative blood loss measurement, hemorrhage risk assessment on admission, massive transfusion protocols, and unit-level hemorrhage drills. States that have widely adopted hemorrhage bundles have reported reductions in severe maternal morbidity from hemorrhage. Similarly, the severe hypertension bundle establishes protocols for rapid treatment of acute hypertension within 30-60 minutes, standardized use of magnesium sulfate, and timely delivery when indicated.

Maternal Mortality Review Committees (MMRCs) now operate in nearly all US states, systematically reviewing every pregnancy-related death to identify contributing factors and recommend systemic improvements. A landmark CDC report found that approximately 80% of pregnancy-related deaths in the United States are preventable. MMRCs have identified common contributing factors including lack of patient and provider knowledge of warning signs, delayed or missed diagnoses, lack of coordination among providers, and social determinants of health including unstable housing, substance use, and intimate partner violence.

Globally, the most effective intervention for reducing maternal mortality is ensuring access to skilled birth attendance and emergency obstetric care. The WHO recommends that every birth be attended by a skilled health professional (doctor, nurse, or midwife) and that comprehensive emergency obstetric care, including cesarean section capability and blood transfusion, be available within two hours of every community. Increasing the coverage of skilled birth attendance from 80% to universal access in high-burden countries could avert an estimated 113,000 maternal deaths annually. Community health worker programs, mobile health technologies for remote monitoring, and task-shifting strategies are helping expand access in resource-limited settings.