Globally, hemorrhage (severe bleeding) is the leading cause of maternal death, accounting for roughly 27% of all maternal deaths worldwide. In the United States, the picture looks different: a recent study analyzing CDC data from 2005 to 2022 found that homicide and suicide are the number one cause of death among pregnant people and those within six weeks of delivery. The answer depends on where you look, and both statistics reveal critical failures in how maternal health is protected.
The Global Picture: Hemorrhage
A WHO systematic analysis of maternal deaths from 2009 to 2020 found that hemorrhage caused 27% of all maternal deaths worldwide, making it the single largest medical cause. Indirect obstetric deaths (conditions worsened by pregnancy, like heart disease or infections) came second at 23%, and hypertensive disorders like preeclampsia ranked third at 16%.
Most fatal hemorrhage occurs after delivery, when the uterus fails to contract firmly enough to stop bleeding from the area where the placenta was attached. This condition, called uterine atony, is the primary driver. The rate of postpartum hemorrhage in the United States increased 26% between 1994 and 2006, largely because of rising rates of atony. Hemorrhage can kill within hours, which is why access to skilled birth attendants, blood transfusions, and emergency surgery determines whether it’s survivable. In high-resource settings, most cases are caught and managed. In low-resource settings, delays in reaching care make hemorrhage far more deadly.
The US Picture: Violence
When researchers reviewed 18 years of CDC data on deaths among pregnant people and those within 42 days postpartum, they found that 11% of the 20,421 deaths were caused by homicide or suicide, making violence the leading single category. Of those 2,293 violent deaths, 61% were homicides and 39% were suicides. Firearms were involved in 55% of cases.
This finding is striking because traditional maternal mortality tracking often focuses on medical causes like bleeding, blood pressure disorders, and heart conditions. Violence falls outside those categories, which means it can be undercounted in standard obstetric reporting. The data suggest that pregnancy itself may increase vulnerability to intimate partner violence, and that mental health crises during and after pregnancy are more lethal than commonly recognized.
Hypertensive Disorders and Preeclampsia
Preeclampsia and its more severe form, eclampsia, are responsible for about 16% of maternal deaths globally. In preeclampsia, the placenta doesn’t develop a healthy blood supply, and in response, it releases proteins into the mother’s bloodstream that damage blood vessel walls throughout her body. The organs hit hardest are the brain, liver, and kidneys, because they rely on a type of blood vessel lining that’s especially sensitive to these circulating toxins.
The damage triggers widespread inflammation, raises blood pressure, and impairs the body’s ability to regulate clotting. In severe cases, this cascade leads to seizures (eclampsia), stroke, liver rupture, or multi-organ failure. The combination of these toxic proteins can also cause swelling in the brain that resembles a condition seen in stroke patients. Delivery of the placenta is the only definitive treatment, which is why preeclampsia sometimes forces early delivery to save the mother’s life.
Cardiovascular Complications
Heart and blood vessel problems are a growing contributor to maternal death, particularly in the United States. Pregnancy puts enormous strain on the cardiovascular system: blood volume increases by nearly 50%, heart rate rises, and blood becomes more prone to clotting. For women with underlying heart conditions, whether diagnosed or not, this can tip them into crisis.
Blood clots are the most common cardiovascular complication during pregnancy, affecting about 2% of pregnancies. Heart failure, abnormal heart rhythms, and heart attacks also occur, though less frequently. Many of these events happen not during labor itself but in the weeks and months after delivery, when the cardiovascular system is still recovering from the demands of pregnancy.
When Deaths Happen
The risk of maternal death is not evenly spread across pregnancy and postpartum. The first two days after childbirth are by far the most dangerous, with mortality nearly 39 times higher than baseline. Risk drops substantially but remains elevated for weeks: it’s about 5 times higher during days 2 through 6, roughly 3 times higher during the second week, and about twice as high through six weeks postpartum.
In sub-Saharan Africa, which accounts for two-thirds of global maternal deaths, 48% of maternal deaths occur between 24 hours and 42 days after delivery, and another 13% happen between 42 days and one year. This extended window of vulnerability is why many experts argue that the traditional six-week postpartum cutoff for tracking maternal deaths misses a significant portion of pregnancy-related mortality.
Who Is Most at Risk
In the United States, Black women face a maternal mortality rate of 50.3 deaths per 100,000 live births, compared to 14.5 for White women, 12.4 for Hispanic women, and 10.7 for Asian women. That means Black women die at roughly 3.5 times the rate of White women. This disparity persists across income and education levels, pointing to systemic factors in healthcare access and quality rather than individual health behaviors alone.
Age is the other major risk factor. Women under 25 have a mortality rate of 12.5 per 100,000 live births. For women 25 to 39, it rises to 18.1. For women 40 and older, it jumps to 59.8, nearly five times the rate of the youngest group. Older mothers are more likely to have preexisting conditions like high blood pressure, diabetes, and heart disease that complicate pregnancy.
Most Deaths Are Preventable
The most recent data from CDC-funded Maternal Mortality Review Committees, released in August 2025, concluded that 87% of pregnancy-related deaths in the United States are preventable. That number reflects failures at every level: delayed recognition of warning signs by patients and providers, gaps in postpartum follow-up, inadequate mental health screening, lack of access to emergency obstetric care in rural areas, and systemic inequities in how seriously symptoms are taken depending on a patient’s race.
The overall U.S. maternal mortality rate stood at 17.9 deaths per 100,000 live births in 2024, not significantly changed from 18.6 in 2023. For a high-income country, that rate is unusually high, and it reflects both medical and nonmedical causes. Addressing hemorrhage, cardiovascular disease, and preeclampsia requires better clinical systems. Addressing violence and suicide requires something broader: recognizing that pregnancy is a period of heightened vulnerability that extends well beyond the delivery room.