Introduction

The U.S. has the highest maternal mortality rate of any wealthy country. In 2023, there were 18.6 maternal deaths for every 100,000 live births in the U.S. That’s almost twice the average maternal mortality rate for countries with comparable economies. And it’s nearly the same as the U.S. rate two decades ago (18.8). 

This lack of progress makes the U.S. an outlier. Between 2000 and 2023, global maternal mortality rates dropped, on average, by 40%. But in the U.S., the rate spent decades climbing. By the end of 2019, it hit 20.1 deaths per 100,000 live births. In 2021, the strain of COVID-19 on an already underperforming health system pushed that number to 32.9.  

Though it has fallen since, 18.6 is still unacceptably high. Some wealthy nations have almost entirely eliminated preventable maternal deaths. The U.S. can—and must—do better. 

Preventing maternal deaths

80% of U.S. pregnancy-related deaths are preventable.

In the U.S., the lives of most women who die during pregnancy or within the following year could have been saved. But economic, legal, and social barriers keep them from getting the care they need. These include: 

• Lack of care options. More than 2.2 million women of childbearing age live in counties where no maternity care is available. Some states have restricted the ability of doulas and midwives to provide care. Birth centers have also been targeted by harsh regulations. 
• Lack of insurance coverage. Both Medicaid and private insurance may not cover essential care. 
• Mistreatment. 1 in 6 women report mistreatment during maternity care. For women of color, the number is nearly 1 in 4. 
• Providers’ implicit bias. Marginalized groups are at increased risk of mistreatment and neglect. They also face disproportionate barriers to care.
• Elimination of public health programs. Funding cuts have gutted programs and initiatives responsible for monitoring maternal health and reducing maternal mortality. 

Disparities in maternal health

Women of color are bearing the brunt of this crisis.

Maternal mortality rates are not the same for everyone. In the U.S., Black and Indigenous women are much more likely to die giving birth than women of other races. For Black women, the maternal mortality rate in 2023 was 50.3—nearly 3.5 times the maternal mortality rate for white women (14.5). While overall maternal deaths dropped from 2022 to 2023, Black maternal deaths actually increased.  

These disparities reflect underlying economic and social inequalities. Racial differences in insurance coverage and income are important barriers to care. But finances alone don’t explain the gap: High income Black women are as likely to die in their first year of motherhood as the poorest white women. Racism in health settings is a clear factor. As is chronic stress, which leads to worse health outcomes for both mother and child.   Today, programs designed to address systemic racism in health care are being gutted. Research on health disparities has been halted. Data has been stripped from government sites. And diversity and equity initiatives have been dismantled across the federal government and beyond.  

State abortion bans & restrictions

State abortion bans and restrictions are making the crisis worse.

Since the overturn of Roe v. Wade in 2022, half the U.S. states have banned or severely restricted abortion. These bans and restrictions are undermining access to reproductive care of all kinds. This includes early pregnancy care, miscarriage management, and treatment for dangerous pregnancy complications.  

Doctors are leaving states with abortion bans, worsening shortages. Those who stay are being pushed to deprioritize maternal health in favor of the fetus. In serious pregnancy complications, abortion is necessary and life-saving. But many doctors now fear losing their license or facing criminal charges for providing it.  

Increasingly, people in need of such life-saving care are unable to access it. State bans and restrictions have already caused the deaths of multiple women, including three in Texas and two in Georgia, who were delayed or denied emergency care.  

Abortion bans are also driving delays in prenatal care. Pregnant people may wait to see a doctor until after their first trimester, fearing that a miscarriage–misconstrued as an abortion—could result in criminal charges. A 2024 report also found that providers in abortion ban states are sometimes encouraging patients to delay care for the same reason   These impacts are falling disproportionately on Black and Indigenous women, who are more likely to live in states with abortion bans. They are also less likely to have the resources necessary to travel out of state.

Ending the crisis

We can end the U.S. maternal health crisis.

The U.S. health care system is failing pregnant people and mothers. But there are policies that can change this. These include:

• Protecting Extended Postpartum Medicaid Coverage. In 2021, Medicaid covered 41% of U.S. births. But states are only required to provide Medicaid coverage for 60 days after delivery. To date, 49 states and Washington DC have voluntarily extended coverage to a full year postpartum. With current extreme threats to Medicaid funding, protecting this extended coverage is critical. This should be extended to a full year postpartum.  
• Expanding Access to Midwifery and Doula Care. Access to midwives and doulas is proven to improve maternal health outcomes. Removing legal barriers  will increase their availability.

• Strengthening rights to informed consent and refusal. When people seek health care during pregnancy and birth, they should not be coerced or subjected to unwanted testing, treatment, or interventions without their consent.