Overview

Maternal mortality is defined as a pregnancy-related death that occurs while pregnant or within one year of the end of pregnancy from any cause related to or aggravated by the pregnancy (PMSS, n.d.).

Pregnancy-related deaths varied in timing:
- 22% of deaths occurred during pregnancy
- 25% occurred on the day of delivery or within 7 days
- 53% occurred between 7 days to 1 year after pregnancy (CDC, 2022).

Data Disclaimer

A lack of standardized methods and terminology for identifying maternal deaths in the United States has resulted in nuanced data collection and interpretation challenges (Collier & Molina, 2020).

Although these challenges continue to exist in the data collection process, current data trends still show a steady increase in U.S. maternal mortality and morbidity.

Many factors influence the U.S. maternal mortality rate. These include both clinical factors and social determinants of health. The rise of chronic health conditions has also exacerbated patient outcomes during pregnancy. Additional information on these factors will be discussed in the later sections.

A Global Perspective: How Does the U.S. Compare to Other OECD Countries?

The OECD defines healthcare expenditure as the final consumption of healthcare goods and services. This includes personal health and collective services. Since the 1970s, the United States has consistently spent the most on health expenditures (OECD, 2024).

Compared to other industrialized high-income countries, the U.S. has the highest rate of maternal mortality. Since the COVID-19 pandemic exacerbated barriers to care, transportation, employment, and mental health resources, maternal mortality has worsened since the pandemic (Simpson, 2023).

Maternal Outcomes Vary by Race

In the U.S. maternal mortality continues to disproportionately affect women of color. 2021 Data from the CDC portrays the disparities among race and maternal outcomes. The data excludes 2021 data for Asian mothers.

Compared with white women, black women were more likely to report:

• Being treated unfairly and with disrespect by providers because of their race
• Not having decision autonomy during labor and delivery
• Feeling pressured to have a cesarean section (Declercq & Zephyrin, 20220).

What Conditions Cause Maternal Mortality?

There are many underlying causes of maternal death:

• Chronic medical conditions (cardiovascular conditions, hemorrhage, etc.)
• Unintentional death from violence, overdose, and self-harm
• Existing inequities in pregnancy care (Collier & Molina, 2020).

The High Cost of Childbirth

Compared with women with private health insurance, women with Medicaid coverage were more likely to report:

• No postpartum visit
• Returning to work within two months of birth
• Less postpartum emotional and practical support at home
• Not having decision autonomy during labor and delivery
• Being treated unfairly and with disrespect by providers because of their insurance status (CommonWealth, 2020).

Similar to race, women's experience with the health care system varied by insurance coverage. As a result, patient outcomes also differ across income, location, and insurance status.

Impact on U.S. Families

Maternal death implies long-term economic and social repercussions for the families they leave behind.

• In 2019, 41.2% of mothers were the sole breadwinners for their families (Glynn, 2021)
• Increased mortality risk for children 0 to 9
• Decreased nutrition and schooling for children
• Higher rates of poverty
• Lack of household resources and management (National Research Council (US) Committee on Population, 2000)

The U.S. healthcare system needs to reconsider how to address this problem. Disparities in patient care influence outcomes across race, income, gender, & geography.

A country that spends the most on health care has the resources to create a more efficient and equitable system. Ultimately, mitigating barriers to care and expanding accessibility are key to improving health equity.