How Many Women Die in Childbirth in the US?

In 2022, roughly 22 women died for every 100,000 live births in the United States, giving the country the highest maternal mortality rate among wealthy industrialized nations by a wide margin.¹ That translates to several hundred deaths each year directly tied to pregnancy or childbirth. But the real picture is messier than a single number suggests, shaped by deep racial disparities, geographic gaps in care, and a data collection system that has struggled to count these deaths accurately for over a decade.

How the US Compares to Other Wealthy Countries

The gap between the United States and its peers is striking. A Commonwealth Fund report found that the US rate of 22 deaths per 100,000 live births in 2022 dwarfed rates in countries like Norway (effectively zero), Switzerland (about 1 per 100,000), Australia (about 4), the United Kingdom (about 6), and Canada (about 8).¹ That means an American woman faces roughly four times the risk of dying from pregnancy-related causes compared to a woman in the UK, and many multiples higher than women in Scandinavia. The US spends far more on healthcare per person than any of those countries, which makes the disparity especially hard to explain away as a simple resource problem.

This wasn’t always the case. In 1900, the US maternal mortality rate was around 850 per 100,000 births. Over the twentieth century, advances in antisepsis, blood transfusion, antibiotics, and safer surgical techniques brought that number down by roughly 99 percent.² But while other high-income countries continued to drive their rates lower through the 2000s and 2010s, the US rate plateaued and then began climbing again, a trend that has drawn increasing alarm from public health researchers.

Why Counting Maternal Deaths Is Surprisingly Complicated

One reason the US number is difficult to pin down is a well-documented problem with how deaths are recorded. In 2003, a pregnancy checkbox was added to the standard US death certificate, intended to help identify maternal deaths that might otherwise be missed. The idea was simple: if a woman died and the checkbox indicated she was pregnant or recently pregnant, the death could be flagged for review. But the checkbox’s rollout took 16 years across all states, and during that long transition, the National Center for Health Statistics stopped publishing a national maternal mortality rate entirely, from 2007 to 2018, because state-by-state data weren’t comparable.³

The checkbox also introduced a specific kind of error. A four-state validation study found that among death certificates with the pregnancy box checked, roughly a third of those whose pregnancy status could be confirmed turned out to be false positives. Of those false positives, more than 40 percent had been assigned an ICD code that would have counted them as maternal deaths in a standard calculation.⁴ Errors were especially common among women over 40 and for deaths attributed to nonspecific causes.³

This matters because the checkbox didn’t just add noise to the data. It systematically inflated the apparent rate. One analysis estimated that the checkbox’s introduction was associated with an increase of roughly 8 to 17 additional maternal deaths per 100,000 live births, depending on whether the area was urban or rural, with rural areas seeing the largest artificial bump.⁵ When researchers limited their analysis to deaths from specific, well-defined obstetric causes (which are less likely to be miscoded), the urban-rural differences and upward trends were substantially smaller. So part of the story of “rising maternal mortality” in the US is a real and alarming trend, and part of it is better (if flawed) detection.

What Women Actually Die From

The medical causes of pregnancy-related death in the US are varied, but cardiovascular conditions stand out. Cardiomyopathy and other heart-related problems, hemorrhage, and chronic medical conditions that are worsened by pregnancy are all leading killers.⁶ Eclampsia and preeclampsia, which involve dangerously high blood pressure, and obstetric embolism, where a blood clot reaches the lungs, round out the most common direct causes. Many of these conditions are treatable if caught early, which is part of why the preventability estimates are so high.

But an underappreciated category of maternal death doesn’t involve medical complications at all. Researchers distinguish between “pregnancy-related” deaths (caused by a pregnancy complication or a chain of events initiated by the pregnancy) and “pregnancy-associated” deaths (deaths that happen during or within a year of pregnancy from any cause). Under the broader definition, homicide, suicide, and drug overdose emerge as leading causes.⁷ Pregnancy-associated homicide carries a mortality burden at least as high as any of the leading specific obstetric causes, and intimate partners are the most common perpetrators.⁸ Both pregnancy-related mortality and pregnancy-associated homicide rates are higher in states with higher overall rates of violent crime.⁹

Substance use disorder has also become an increasingly important contributor. Accidental overdose and suicide among pregnant and postpartum people are closely linked to substance use disorders, and the opioid crisis has amplified this problem over the past decade.¹⁰ These deaths are easy to miss in traditional maternal mortality statistics because they don’t look like “childbirth deaths” on a death certificate, yet pregnancy and the postpartum period can intensify the conditions that lead to them.

The Racial Disparity

The single most stark feature of maternal mortality in the US is the gap between Black women and everyone else. Black women are three to four times more likely to die a pregnancy-related death than white women.¹¹ An enhanced vital records analysis from 2016–2017 found the ratio was 3.55 to 1, and the disparity was especially concentrated in a few specific conditions: eclampsia, preeclampsia, postpartum cardiomyopathy, obstetric embolism, and obstetric hemorrhage. Rates of death from eclampsia and postpartum cardiomyopathy among Black women were roughly five times those of white women, and together these four causes accounted for nearly 60 percent of the overall racial gap.¹²

This isn’t simply a story about poverty. Within every level of neighborhood deprivation, Black women still experienced two to five times higher maternal mortality than white women in the same income bracket.¹³ Poverty makes things worse for everyone. White women in the most deprived areas had roughly double the mortality risk of white women in the most affluent areas, and for Black women the risk was about 70 percent higher in the most deprived group compared with the most affluent. But the racial gap persists at every income level, pointing to structural factors that go beyond individual socioeconomic status, including chronic stress from discrimination, differences in the quality of hospitals where Black women deliver, and disparities in how symptoms are evaluated and treated by clinicians.

Age as a Risk Factor

Maternal age is one of the strongest individual predictors of dying during or after childbirth. A population-based study found that compared with women aged 25 to 29, women aged 35 to 39 had about 1.6 times the risk, women aged 40 to 44 had nearly four times the risk, and the risk climbed dramatically from there, with women aged 45 to 49 facing more than 28 times the risk.¹⁴ The average age at first birth in the US has been rising steadily for decades, and this demographic shift is one contributor to the upward trend in both mortality and severe complications. Women over 35 are more likely to have pre-existing conditions like hypertension and diabetes that interact dangerously with pregnancy.

Maternity Care Deserts

Where you live in the US substantially affects your odds. Roughly 36 percent of all US counties qualify as maternity care deserts, meaning they have no hospitals offering obstetric services, no birth centers, and no obstetricians, gynecologists, or certified nurse midwives.¹⁵ Women in these counties face longer drives to deliver, fewer prenatal visits, and less access to emergency obstetric care when something goes wrong.

The consequences are measurable. One study found that counties classified as maternity care deserts had a maternal mortality rate of about 32 per 100,000 live births, compared with roughly 24 per 100,000 in counties with full obstetric access, a gap of about 36 percent after adjustment for other factors.¹⁶ A separate analysis found that states with a high prevalence of maternity care deserts had about 34 percent greater risk of maternal mortality overall, along with higher infant mortality and low birthweight rates.¹⁷ Rural areas and communities of color are disproportionately affected. The maternal mortality rate in the most rural counties is about 1.6 times higher than in large metropolitan counties.¹⁵

More Than Four in Five Deaths Could Be Prevented

Perhaps the most sobering finding in the maternal mortality literature is how many deaths didn’t have to happen. A detailed national analysis suggests that more than four in five pregnancy-related deaths in the US are preventable.¹⁸ That means with the right care, delivered at the right time, most of these women would have survived. The preventability assessment covers the full range of contributing factors: missed or delayed diagnoses, lack of access to appropriate-level care, poor coordination between providers, and gaps in insurance coverage during the postpartum period.

One concrete policy lever that has shown results is Medicaid expansion. Because Medicaid covers a large share of births in the US, expanding eligibility has real consequences for postpartum health. Researchers found that Medicaid expansion was associated with a 17 percent reduction in hospitalizations during the first 60 days after birth, with some evidence of continued benefits up to six months postpartum.¹⁹ Many maternal deaths occur in the weeks and months after delivery, not during labor itself, so the postpartum coverage gap has long been identified as a vulnerability. Federal legislation now allows states to extend Medicaid coverage to 12 months postpartum, and most states have adopted or are adopting this extension.

Hospital-level quality improvement also plays a role. Patient safety bundles, which are organized sets of evidence-based practices packaged for easy adoption, have been implemented by perinatal quality collaboratives across the country. These bundles standardize the response to common emergencies like hemorrhage and severe hypertension, reducing the kind of variation in care that can be deadly.²⁰ When every nurse on a labor floor follows the same hemorrhage protocol, the odds of a delayed response drop.

Severe Complications That Don’t Kill

Focusing only on deaths misses a much larger group of women who come dangerously close to dying. Severe maternal morbidity, a category that includes events like emergency hysterectomy, blood transfusion of four or more units, kidney failure, and admission to the ICU, affects far more women than mortality statistics capture. From 2008 to 2021, the rate of severe maternal morbidity during delivery hospitalizations rose from about 135 per 10,000 discharges to over 200 per 10,000.²¹ That means roughly 1 in 50 delivery hospitalizations now involves a severe complication.

The increases were seen across all age groups and all racial and ethnic groups, though the steepest climbs were among Pacific Islander, American Indian, and Asian patients.²¹ Older mothers saw the greatest increase by age group, consistent with the broader pattern of rising maternal age amplifying medical risk.²² These near-miss events often leave lasting physical and psychological consequences, including chronic pain, post-traumatic stress, and long recovery times that affect a woman’s ability to care for her newborn and return to work.

Abortion Policy and Maternal Mortality

The relationship between abortion access and maternal mortality has come under intense scrutiny since the Dobbs decision in 2022. A scoping review of ten studies spanning data from 1959 through 2020 found a consistent pattern: states with more restrictive abortion policies had higher maternal mortality rates than states where abortion was accessible or protected.²³ The mechanisms behind this association likely involve multiple pathways, including delayed care for pregnancy complications when providers fear legal liability, loss of obstetric providers who leave states with restrictive laws, and the downstream effects of reduced reproductive healthcare infrastructure.

Early post-Dobbs data is harder to interpret. One analysis of 14 states with abortion bans found some evidence of a roughly 9 percent increase in pregnancy-associated deaths above what would have been expected, equivalent to an estimated 68 excess deaths, though the uncertainty was wide and the authors were careful to note that data limitations and the rarity of these events make firm conclusions difficult.²⁴ The same study found no detectable increase in maternal mortality under the narrower definition (deaths directly caused by pregnancy complications), which may reflect the short time window studied or the difference between how these categories capture different types of death. This is an area where the evidence will evolve substantially over the coming years as more data accumulates.

Where Delivery Happens Matters

Not all hospitals are equally equipped to handle obstetric emergencies. The US uses a tiered system of levels of maternal care, from basic facilities up to regional perinatal health centers staffed around the clock with maternal-fetal medicine specialists, anesthesiologists, and surgical teams. High-risk pregnancies tend to be managed at higher-level facilities, and the patient populations at each level differ substantially: hospitals without dedicated obstetric units care for more patients on public insurance, while higher-level facilities serve more women with advanced maternal age and pre-existing conditions.²⁵

Interestingly, the relationship between hospital level and outcomes is not as straightforward as “higher level equals better outcomes for everyone.” One study found that women with cardiac conditions actually had lower odds of severe morbidity when they delivered in lower-level facilities, possibly because the cases that reach a level IV center are the most complex and highest risk to begin with.²⁶ The broader point is that matching patients to the right level of care, getting high-risk women to high-resource hospitals and keeping low-risk births from being over-medicalized, is a challenge the US system has not fully solved, especially in areas where the nearest appropriate facility is hours away.

1
BMJ. US maternal mortality is far higher than that of other rich nations, study reports
2
American Journal of Obstetrics & Gynecology. Maternal mortality
3
PubMed. Value and disvalue of the pregnancy checkbox on death certificates in the United States-impact on newly released 2018 maternal mortality data
4
PubMed Central. Pregnant? Validity of the Pregnancy Checkbox on Death Certificates in Four States, and Characteristics Associated with Pregnancy Checkbox Errors
5
PubMed Central. Rural-Urban Differences in Maternal Mortality Trends in the United States, 1999-2017: Accounting for the Impact of the Pregnancy Status Checkbox
6
PubMed Central. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions
7
PubMed Central. Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence
8
PubMed. Racial Disparities in Pregnancy-associated Intimate Partner Homicide
9
PubMed Central. Violence As a Direct Cause of and Indirect Contributor to Maternal Death
10
PubMed Central. Substance Use Disorder as a Contributing Factor to Pregnancy-Associated Deaths
11
PubMed Central. Reducing Disparities in Severe Maternal Morbidity and Mortality
12
PubMed Central. Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017
13
PubMed Central. Maternal Mortality Trends and Social Inequalities in Maternal Mortality in the United States, 1969-2018
14
PubMed Central. Age-related disparities in national maternal mortality trends: A population-based study
15
PubMed Central. Maternity Care Deserts: Key Drivers of the National Maternal Health Crisis
16
PubMed Central. Association of Maternity Care Deserts With Maternal and Pregnancy-Related Mortality
17
AJPM Focus. State-Level Prevalence of Maternity Care Deserts: Association With Healthcare Access, Utilization, and Outcomes Among Medicaid Recipients
18
PubMed. Detailed Maternal Mortality Data Suggest More Than 4 in 5 Pregnancy-Related Deaths in US Are Preventable
19
PubMed Central. Medicaid Expansion Led To Reductions In Postpartum Hospitalizations
20
PubMed Central. Perinatal Quality Collaboratives and Patient Safety Bundles: Key Contributors to Improving Maternal Health Care Quality across the United States
21
JAMA Network Open. Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021
22
PubMed. Role of Maternal Age in Increasing Severe Maternal Morbidity Rates in the United States
23
PubMed Central. The relationship between state-level abortion policy and maternal mortality in the United States: a scoping review
24
PubMed Central. Abortion Bans and Maternal, Pregnancy-Related, and Pregnancy-Associated Mortality in 14 US States, 2016-2023: Estimated Impacts Amid Substantial Measurement Challenges
25
PubMed Central. Identifying individual hospital levels of maternal care using administrative data
26
PubMed. Do Hospitals with a Higher Level of Maternal Care Designation Have Better Maternal Outcomes?