October 03, 2022

US Maternal Mortality is Still High

By Phyllis Leppert

The August 2021 Campion Fund blog pointed out the high rates of maternal mortality in the United States. This rate was based on 2019 statistical data, which was the most up to date data available at that time. We called these statistics a scandal. Unfortunately, the most currently available 2020 data demonstrates that maternal mortality was worse. It was 23.8 deaths/100,000 live births as opposed to 20.1 deaths/100,000 live births reported in 2019. The rates for blacks were even more concerning. That rate was 55.3 per 100,000 live births. This is a very worrisome increase from the 44.0 rate in 2019. The US has the highest maternal mortality rate of all the developed countries.  Why is this?

The Centers for Disease Control (CDC) has just published a report showing that 80% of pregnancy related deaths were deemed preventable according to the findings of Maternal Mortality Review Committees from 36 states that partnered with the CDC in 2020 as part of the Maternal Mortality Review Information Application (MMRIA pronounced “Maria”) *. Maternal Mortality Review Committees (MMRC) were established in 2018 by the US congress to comprehensively review all deaths that occur within one year of a pregnancy (the long accepted medical and public health definition in the US of a maternal death).  Members of these public health committees are representatives of public health professionals, obstetricians and gynecologists, maternal-fetal medicine specialists, nursing, midwifery, forensic pathologists, mental and behavior health specialists, patient advocacy groups and community-based organizations. Their mandates are to review all cases of pregnancy associated deaths in their jurisdiction, to determine the preventability of the deaths, and to determine what strategies are needed to address underlying issues within the health care and community environments. In evaluating whether a death was preventable members of the committees discussed in depth each case and assigned one of three categories: 1. No chance of prevention 2. Some chance of prevention 3. Good chance of prevention.

The report discussed the findings regarding a total of 1018 deaths among the 36 state MMRCs and found that the committees had determined 80% of the maternal deaths were preventable – assigned to either some chance of prevention or good chance of prevention. Fifty-three percent of the 1018 deaths occurred during 7-365 days postpartum. Thirty-four percent of the deaths were among black women, while 46.6 percent where among non-Hispanic whites. Remember that the subgroup rates are calculated as the rate of deaths among that group/births. Thus, even though the percentage of deaths of blacks among all deaths is a lower percentage that whites, the black death rate as calculated by the number of black deaths/100,000 black live births was scandalously high. However, all subgroup rates as well as the total maternal mortality rates in the United States were very high compared to other developed countries. The take home message is that the United States is not doing well at providing maternity care to our population. All of us must communicate this fact to our neighbors and our elected officials.

The CDC report also presents data that is very thought provoking. Eighty-one-point eight percent of the maternal deaths were among women who lived in urban areas. The MMRCs evaluated the highest cause of death among black women was cardiovascular and coronary conditions. Among non-Hispanic whites the highest cause of death was attributed to mental health disease, including suicide. Among Asian women the highest cause was hemorrhage.

These CDC findings were reported by national news media. Unfortunately, they did not have much impact on the public as the current news is fraught with war, national disasters and national politics. Thus, it is vital that individuals with interests in and concerns about reproductive health must help inform others of this serious problem facing the United States health care system. Maternal and newborn health has long been considered to be an important parameter in evaluation of the health of any nation and these maternal mortality statistics serve as a warning that we need to pay attention and take serious steps to change these rates. The good news is that now 39 states and one territory have an MMRC. A program called ERASE MM, an acronym for Enhancing Reviews and Surveillance to Eliminate Maternal Mortality, has been established to promote MMRCs and to assist states that do not have review committees in getting necessary resources and support to build the political and social will to establish MMRCs and to raise awareness among the public and elected officials of the role of MMRCs in elimination of pregnancy related deaths.  ERASE MM is a first step for the United States in solving our shockingly high maternal mortality.  The first step in problem solving is to always to identify and understand the problem. We must of course do more.  Action is needed at all levels to eliminate this public health issue.  

The Campion Fund focus currently is the fundamental science of pregnancy and birth which is why we are drawing attention to the grave and embarrassing problem of US Maternal Mortality. Public health preventive measures, public awareness and education as well as increased professional education are necessary to eliminate the preventable deaths. Fundamental scientific research must find the cause of and solutions for the elimination of nonpreventable deaths. The US is a rich country with extremely innovative individuals. We have the capacity to do more to prevent pregnancy related deaths. We only need the will to improve US maternal mortality.

  *Fourteen states not included in the report are: Idaho, Iowa, Kentucky, Maine, Maryland, Michigan, Montana, Nevada, North Dakota, Rhode Island, South Carolina, South Dakota, Utah and Vermont.


Callahan T, Zaharatos J, St Pierre A, Merkt PT, Goodman D. Enhancing Reviews and Surveillance to Eliminate Maternal Mortality. J Womens Health (Larchmt). 2021 Aug;30(8):1068-1073. doi: 10.1089/jwh.2021.0357. PMID: 34410869.

Trost T, Beauregard, J. Chandra G, Njie F, Berry J, Harvey A, Goodman DA. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019. CDC National Center for Chronic Disease Prevention and Health Promotion. Division of Reproductive Health. Sept. 19, 2022.