The United States has a maternal mortality rate roughly four to five times higher than many peer nations, with approximately 22 deaths per 100,000 live births in 2022. In half of comparable high-income countries, fewer than five women die per 100,000 births. France holds steady at about eight, and even the United Kingdom, which has seen its own rate climb, sits around 13. The gap is not explained by any single factor but by a web of systemic, medical, and social failures that compound one another.
Perhaps the most striking fact: more than 80% of pregnancy-related deaths in the U.S. are preventable.
A Racial Crisis Within the Crisis
The national average masks enormous disparities. In 2023, the maternal mortality rate for Black women was 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 during or after pregnancy.
This gap persists across income and education levels, which points to something beyond individual health. Research consistently ties the disparity to structural racism in healthcare: Black women are more likely to have their symptoms dismissed, more likely to deliver in hospitals with higher complication rates, and more likely to live in areas with fewer obstetric resources. The disparity isn’t a footnote in the maternal mortality story. It is central to why the U.S. rate is so far out of line with other wealthy countries.
Deaths Don’t Just Happen in the Delivery Room
Many people picture maternal death as something that occurs during childbirth, but the timeline is much wider. CDC data from 2011 to 2015 shows that only about a third of pregnancy-related deaths happen at delivery or in the week after. Another third occur during pregnancy itself, before labor even begins. And the final third happen between one week and one year postpartum, long after the hospital stay ends.
That last group is especially important, because it represents a period when many women in the U.S. lose access to care. Medicaid covers about 40% of all births nationwide, but until recently, coverage in most states ended just 60 days after delivery. A woman could develop dangerously high blood pressure or a worsening infection at three months postpartum and have no insurance to get it treated.
Gaps in Insurance and Postpartum Care
The 60-day Medicaid cutoff has been one of the most concrete policy failures driving maternal deaths. Recognizing this, more than half of all states and the District of Columbia have now expanded postpartum Medicaid coverage to a full 12 months, giving an estimated 418,000 additional people access to continued care. This is a significant shift, but it’s recent and still incomplete. The remaining states have not adopted the expansion, leaving many new mothers uncovered during a medically vulnerable period.
Even when insurance is available, the care itself may not be. Over 35% of U.S. counties are classified as maternity care deserts, meaning they have no birthing facility and no obstetric clinician. That’s 1,104 counties affecting more than 2.3 million women of reproductive age and roughly 150,000 births in 2022 alone. Women in these areas face long drives to prenatal appointments, delayed emergency care during complications, and sometimes no local option for delivery at all. Countries with lower maternal mortality rates tend to have more distributed networks of midwives and maternity clinics that keep care close to where people live.
Mental Health and Violence
When people discuss maternal mortality, the conversation often centers on medical emergencies like hemorrhage or preeclampsia. But mental health conditions and violence account for a substantial share of deaths. Over an 18-year study period, 11% of deaths among pregnant and recently pregnant people were due to homicide and suicide combined. Of those, 39% were suicides.
These deaths are often invisible in the traditional maternal health framework. A woman who dies by suicide at eight months postpartum may not be counted the same way as one who hemorrhages during delivery, yet both are pregnancy-related deaths. Screening for depression, anxiety, and intimate partner violence during and after pregnancy remains inconsistent across the U.S., and access to mental health treatment, particularly for women on Medicaid, is limited in many regions.
Chronic Health Conditions Are Rising
American women enter pregnancy with higher rates of chronic conditions than their counterparts in other high-income countries. Obesity, diabetes, hypertension, and heart disease are all more prevalent in the U.S. population, and each one raises the risk of complications during pregnancy and delivery. The U.S. also has higher rates of unmanaged chronic illness, partly because many women lack consistent primary care before they become pregnant.
In countries with universal healthcare, women are more likely to have conditions like high blood pressure identified and treated well before a first pregnancy. In the U.S., pregnancy is sometimes the first time a woman sees a doctor in years, meaning dangerous conditions go undetected until they become emergencies.
A Fragmented System Without a Safety Net
Other high-income countries approach maternity care as a coordinated system. Most provide universal prenatal coverage, guaranteed postpartum home visits, and a midwifery workforce that handles low-risk pregnancies while freeing specialists to manage high-risk ones. The U.S. has none of these as standard. Care is split across private insurers, Medicaid, and the uninsured. There is no national standard for how many postpartum visits a woman should receive or when. Handoffs between the hospital and outpatient providers are inconsistent, and many women simply fall out of the system after delivery.
The fragmentation means that warning signs get missed repeatedly. A woman might report headaches to her OB at a six-week checkup, not return for months because she lost coverage, and then show up at an emergency room with a stroke. Each individual provider did their job. The system as a whole failed. When state Maternal Mortality Review Committees examine these deaths case by case, they consistently find that the vast majority were preventable with better coordination, faster response to warning signs, and continued access to care. The problem is not that medicine lacks the tools to keep these women alive. It’s that the American healthcare system is not structured to use them.