Globally, severe bleeding after childbirth is the leading cause of maternal death, accounting for the largest share of the roughly 75% of maternal deaths caused by major complications. In the United States, the picture looks different: infection (heavily driven by COVID-19 in recent data) and mental health conditions have overtaken hemorrhage as the top killers. Understanding this distinction matters because the causes, and how preventable they are, vary dramatically depending on where a person lives and what resources are available.
The Global Picture: Hemorrhage Leads
Worldwide, the major complications behind about 75% of all maternal deaths are severe bleeding (mostly after childbirth), infections following delivery, high blood pressure during pregnancy, complications from delivery, and unsafe abortion. Of these, severe bleeding, known clinically as postpartum hemorrhage, is the single largest contributor.
During pregnancy, blood flow to the uterus increases from about 100 mL per minute to 700 mL per minute. After delivery, the uterus is supposed to contract firmly, clamping down on blood vessels where the placenta was attached. When that contraction fails, a condition called uterine atony, bleeding can become life-threatening within minutes. Uterine atony is responsible for 70% to 80% of all postpartum hemorrhages. A blood loss of more than 1,500 mL typically produces visible clinical signs of shock.
Hypertensive disorders, primarily pre-eclampsia and eclampsia, are responsible for roughly 16% of maternal deaths globally. In 2023, that translated to approximately 42,000 deaths. Pre-eclampsia affects 3% to 8% of pregnancies and can progress to seizures, organ damage in the kidneys, liver, or brain, and placental abruption. These conditions can escalate quickly, which is why access to prenatal blood pressure monitoring is a critical factor in survival.
Leading Causes in the United States
U.S. maternal death data from 2021, compiled by CDC Maternal Mortality Review Committees, tells a strikingly different story from global trends. Infection was the top cause at 33.2% of all pregnancy-related deaths, though COVID-19 accounted for 27.7% of all deaths in that year, heavily skewing the infection category. Mental health conditions ranked second at 22.5%, followed by cardiovascular conditions at 10.4%.
Hemorrhage, the global leader, accounted for just 8.7% of U.S. pregnancy-related deaths. Hypertensive disorders contributed 3.5%. This gap reflects the availability of blood products, surgical intervention, and hospital-based monitoring in the U.S., which can catch and treat bleeding emergencies that prove fatal in lower-resource settings. The trade-off is that chronic conditions and mental health crises, which require sustained care over weeks or months, are filling the gap.
Mental Health as a Growing Threat
Suicide accounts for roughly 20% of postpartum deaths and is now recognized as a leading cause of maternal mortality in the U.S. When the postpartum window is extended to one year after delivery, 13% to 36% of maternal deaths are attributed to suicide depending on the state and how deaths are classified. A review of pregnancy-related mental health deaths across 14 states found that 11% of all pregnancy-related deaths were due to mental health conditions, and 63% of those mental health deaths were suicides. Drug-related deaths were the second leading cause in some analyses.
These numbers challenge the traditional image of maternal death as something that happens on a delivery table. The risk window extends far beyond childbirth itself.
When Maternal Deaths Happen
Most maternal deaths do not occur during delivery. Approximately 83% happen either before birth (31.3%) or in the postpartum period (51.7%). Only about 17% occur on the day of delivery. This distribution underscores why postpartum follow-up care is so important. Many of the conditions that kill new mothers, including infections, blood pressure crises, heart failure, and mental health emergencies, develop or worsen in the days, weeks, and months after leaving the hospital.
Cardiovascular Conditions and Cardiomyopathy
Cardiovascular disease affects 1% to 4% of pregnancies and contributed to more than one-third of pregnancy-related deaths in the U.S. during 2017 to 2019. Cardiomyopathy, a condition where the heart muscle weakens and struggles to pump blood effectively, caused 12.1% of pregnancy-related deaths during that period. Peripartum cardiomyopathy is the most common form linked to pregnancy and can lead to heart failure, irregular heart rhythms, and sudden cardiac death.
From 2015 to 2020, there were 480 pregnancy-related deaths from cardiomyopathy in the U.S. Black women had the highest death rate from this condition at 6.0 per 100,000 live births, compared to 0.9 for Hispanic women and 1.0 for Asian women. American Indian and Alaska Native women had the highest rate overall at 7.3 per 100,000 live births.
Racial and Ethnic Disparities
The overall U.S. pregnancy-related mortality ratio from 2007 to 2016 was 16.7 deaths per 100,000 births. That average conceals enormous disparities. Black women died at a rate of 40.8 per 100,000, which is 3.2 times the rate for white women (12.7). American Indian and Alaska Native women died at 29.7 per 100,000, or 2.3 times the white rate. These gaps persist across education levels and income brackets, pointing to systemic differences in how care is delivered, how symptoms are taken seriously, and how follow-up is structured.
More Than 80% Are Preventable
According to the CDC’s Maternal Mortality Review Committees, more than 80% of pregnancy-related deaths in the U.S. are preventable. A death qualifies as preventable if there was at least some chance it could have been avoided through reasonable changes at any level: the patient and family recognizing warning signs, providers responding appropriately, hospitals having the right protocols, or community systems ensuring access to care. That 80% figure means the vast majority of these deaths are not inevitable medical tragedies. They are failures of systems that could, in principle, be fixed.
The specific interventions vary by cause. For hemorrhage, rapid access to blood transfusions and uterine compression techniques saves lives. For mental health conditions, screening during and after pregnancy, combined with accessible treatment, could intercept crises before they become fatal. For cardiovascular conditions, identifying women at risk before pregnancy and monitoring them closely afterward makes the difference. The common thread is continuity of care that extends well beyond the delivery room.