Why are U.S. Maternal Mortality Rates So High?

Maternal mortality (maternal death) refers to deaths resulting from complications of pregnancy or childbirth, or within six weeks after giving birth. Maternal mortality rates (MMRs) are the number of maternal deaths per 100,000 live births.

Where does the U.S. rank in maternal mortality?

Maternal mortality is a serious health issue worldwide and highlights significant disparities in access to healthcare. Globally, 287,000 women died during pregnancy and childbirth in 2020.

Comparing the U.S. maternal mortality rate to those of other countries reveals some shocking facts:

• The US pregnancy-related death rate is 10 times that of Australia, Austria, Israel, Japan, or Spain.
• The U.S. maternal death rate has increased by 75% over the past 20 years.
• According to the Commonwealth Fund and recent data from the World Health Organization, among high-income countries, the country with the highest maternal mortality rate is the US.

According to a report from the National Center for Health Statistics, the number of women who died of maternal causes in the United States rose to 1,205 in 2021 from 861 in 2020.

The U.S. maternal mortality ratio for 2021 was 32.9 deaths per 100,000 live births, compared with 23.8 in 2020 and 20.1 in 2019.

The new data shows that most of these deaths were preventable. So, what’s going on?

What are the causes of maternal mortality in the U.S.?

Pregnant persons are dying at an alarming rate as a result of complications of high-risk pregnancies. Most of these complications are preventable or treatable. Other patients experience complications as a result of preexisting conditions that worsen during pregnancy.

Some causes of maternal mortality include:

Cardiovascular conditions

The leading cause of maternal mortality in the US is cardiovascular disease.

According to a recent Centers for Disease Control and Prevention (CDC) report, most pregnancy complications are related to cardiovascular conditions such as:

• Heart muscle disease
• Blood clots
• High blood pressure
• Stroke

Chronic diseases and risk factors

A high rate of cesarean sections, inadequate prenatal care, and increased chronic illnesses may be factors contributing to the high US maternal mortality rate. Chronic health conditions that can lead to complications in pregnancy are:

• Infections
• Diabetes
• HIV
• Seizure disorders
• Obesity
• Asthma

Other risk factors for high-risk pregnancies include:

• Maternal age group: mothers under 17 or over 35 years of age are at increased risk of a high-risk pregnancy.
• Behavioral health problems. 
• Difficulties experienced during a previous pregnancy.
• Multiple fetuses (twins or triplets).

Lack of awareness

Warning signs such as heavy bleeding, shortness of breath, chest pain, or a bad headache are red flags that may indicate serious, life-threatening complications. Gaining an understanding of the alarm signals that can be threatening to high-risk pregnancies is important — for both patients and doctors.

Tragically, women in many parts of the country don’t have access to quality reproductive health services.

Information about high-risk pregnancies, pregnancy-related complications, and risk factors — shared among healthcare providers, pregnant persons, and their loved ones — helps to protect the health outcomes for moms, moms-to-be, and their babies.

The number of women who died of maternal causes in the United States rose to 1,205 in 2021 from 861 in 2020.

Racial disparities in maternal mortality

Stark racial disparities in maternal health have persisted for years despite many advancements in medical care.

There are significant inequalities in how women of color are treated for pregnancy-related complications compared to other women. For Black women, the maternal morbidity rate is disproportionately higher than for white or Hispanic women; Black mothers are three times more likely to die in childbirth than non-Hispanic white women.

The reasons are complex. When pregnant women are more likely to have risk factors such as diabetes, high blood pressure, late or no prenatal care, or obesity because of their race or ethnicity, poverty and lack of access to healthcare increase the chance that these conditions will go untreated.

Social determinants

Social determinants of health (SDOH) are associated with adverse maternal health outcomes. SDOH include: economic stability, educational quality, health care access, neighborhood, and social community.

Lower-income communities tend to have less access to high-quality health care and education as well as higher exposure to pollutants. Health equity reforms seek to close the gap by improving access to health care.

How can the U.S. close the gap?

There are many ways the US can work to be on par with other countries. For example, the US can implement the appropriate policies that have been successful in other nations. Some of these strategies include:

• Ensuring all women have access to free or affordable primary care.
• Providing comprehensive reproductive healthcare before, during, and after pregnancy, and postpartum support.
• A maternal healthcare workforce that includes children’s health providers and midwives covered by insurance.

Some strategies seeking to reduce the US maternal mortality rate have been implemented, or are in the process of implementation.

• When the Covid-19 emergency was declared, pregnant persons on Medicaid received continuous coverage. Public health coverage was extended for one year after childbirth—up from 60 days.
• A group of states is working with the CDC on Perinatal Quality Collaboratives to improve practices and procedures in the healthcare system that will prevent maternal deaths and reduce racial disparities.

There is a role for both the private and public sectors in providing maternal interventions to guarantee equitable coverage.

What is a maternal-fetal specialist?

A maternal-fetal medicine (MFM) specialist, like Dr. Steve Rad, is an OB/GYN who has completed three additional years of specialized obstetric education and training. MFM specialists are high-risk pregnancy experts whose mission is to keep pregnant patients as healthy as possible.

A high-risk pregnancy will usually resolve successfully, culminating in the birth of a healthy infant. But to achieve that happy result, a higher level of specialized monitoring and expert healthcare, such as Dr. Rad provides, will be required.

Choose Dr. Steve Rad and the Los Angeles Fetal & Maternal Care Center

Dr. Rad, MD, FACOG, is a highly specialized and international expert in obstetrics, gynecology, maternal-fetal medicine (perinatology), and high-risk pregnancies.

Dr. Rad’s highest priority as a healthcare provider is his patients and the care they receive. Dr. Rad recently had twin baby girls born prematurely due to his wife’s high-risk pregnancy. As a result, he has first-hand experience of what a high-risk pregnancy and NICU care entails.

We are currently accepting new patients! Call us at (844) 473-6100 or schedule your consultation online.

We have offices throughout Southern California and the Los Angeles area, at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles. We also offer in-home prenatal care and have a fly-in program for out-of-town patients. All of our patients receive VIP concierge maternal-fetal care.