US maternal mortality rates see a sharp increase

For the study, researchers analyzed data from CDC's Wide-Ranging Online Data for Epidemiologic Research. All pregnancy-related deaths among women ages 15 to 54 years between 2018 and 2022 were included.

Overall, there were 6,283 pregnancy-related deaths, including 1,891 late maternal deaths, between 2018 and 2022. Late maternal deaths refer to deaths that occur between 42 days and one year after pregnancy. In the United States, the maternal mortality rate increased from 25.3 deaths per 100,000 live births in 2018 to 32.6 deaths per 100,000 live births in 2022 — an increase of 27.7%.  

Cardiovascular disease was the leading cause of pregnancy-related deaths, as well as late maternal deaths. Other causes of maternal mortality were cancer, mental and behavioral disorders, and drug- and alcohol-induced deaths.

The researchers also found significant racial, ethnic, and regional disparities for maternal mortality.

For example, Native American and Alaska Native women had maternal mortality rates that were 3.8 times higher than white women. Black women also had maternal mortality rates that were 2.8 times higher than white women. Hispanic and Asian women had the lowest maternal mortality rates.

Maternal mortality rates were also highest in Southeastern states, including Alabama and Mississippi. The states with the lowest maternal mortality rates were California and Minnesota.

"Our study illustrates why we can't take our eyes off maternal health," said Rose Molina, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and one of the study's authors. "[Women need] access to high-quality care from the moment of conception to a full year after birth."

Funding and staff cuts could put maternal health further at risk

In the study, the researchers said that maternal mortality is "an urgent public health priority" in the United States. However, recent cuts to funding and staff may make it harder to collect data on maternal health and improve disparities and health outcomes.

For example, almost all of CDC's Division of Reproductive Health, as well as its entire Pregnancy Risk Assessment Monitoring System (PRAMS) team, recently received reduction-in-force notices as part of widespread layoffs at HHS. These employees are on administrative leave until June 2, when they will have to leave CDC. 

According to Isaac Michael, a mathematical statistician on the PRAMS team, his team had just finished analyzing 2023 maternal health data and were about to start on 2024 data when they received the layoff notices.

"We had just gotten caught up, and we were just about to start shifting gears towards making the system more efficient ... and then everything got shut down," Michael said. "We're going to lose information on cigarettes, on postpartum depression, on healthcare, on mortality rates, on COVID experiences."

PRAMS is "considered the gold standard in survey data," Michael added. "… Our team is not redundant. Our data is not duplicated."

Aside from maintaining PRAMS data, Michael and his team also collaborated with local health departments to assess maternal health trends and find ways to address disparities while also improving maternal and infant health outcomes.

"Losing access to PRAMS surveillance data would be devastating to clinicians, researchers, and patients," said Sindhu Srinivas, president of the Society for Maternal-Fetal Medicine. "This data is critical because it allows us to monitor and understand emerging issues that impact maternal and child health outcomes."

David Hackney, a maternal-fetal medicine doctor at Case Western Reserve University, agreed, saying that if PRAMS "stops existing, that's a tremendous loss, precisely when we have some of the highest maternal mortality in the world, [and] some of the highest rates of preterm birth and infant mortality, too."

Aside from the staffing cuts, there have also been cuts to federal funding for maternal health initiatives. Compared to other medical specialties, ob/gyn research tends to rely more heavily on federal funding than sources like private industry, medical device, and pharmaceutical companies.

"Some of these NIH initiatives to improve maternal mortality were started and funded in the first Trump administration, and they're still going on. However, NIH has cut off funding for some of these maternal health research centers around the country, so it's very confusing," said Marian Jarlenski, a professor of health policy at the University of Pittsburgh. "This study that we're talking about today shows why this is not a political issue, and it's really important that we all be focusing on how we can reduce maternal mortality and working together on it."

Advisory Board's maternal health resources

To help you address issues related to maternity care, Advisory Board offers a library of resources on women's health, which includes:

Trends in women's health

We have several resources on the top drivers of change in the maternal and reproductive health market, as well as the outlook for the women's health service line.

These ready-to-use-slides can also help you understand the trends impacting maternal and reproductive care and how they will impact cross-industry stakeholders.

How to improve women's health

To learn more about ways to improve women's health in the United States, this report outlines six key factors to take into consideration, including the roles of various healthcare stakeholders and the importance of cross-industry collaboration.

For resources related specifically to maternity care, this research brief explains how Enhanced Recovery After Surgery protocol for C-sections can reduce patient length of stay for obstetrics, which can help with capacity constraints. In this white paper, we offer key tactics for launching a successful midwifery program and explain how to overcome common implementation challenges.

This expert commentary also outlines ways healthcare stakeholders can reduce maternity care deserts and improve pregnancy outcomes. Some examples include expanding outreach with mobile units/satellite clinics and using digital health to close gaps in maternity care. In addition, this insight details on how health plans are taking steps to drive better outcomes for pregnant people.