Maternal mortality refers to the death of a woman during pregnancy or within 42 days following the end of the pregnancy, from any cause related to or aggravated by the pregnancy or its management. While the clinical definition excludes accidental causes, data collection often includes deaths from injury or violence to capture the full scope of risk. The maternal death rate is a recognized indicator of a nation’s health system quality. In high-income countries like the United States, rates have been rising, contrasting sharply with the general global decline.
Identifying the Leading Cause of Maternal Death
The leading cause of maternal death is not a single medical complication, but a category of non-obstetric causes related to injury and mental health crises. Data indicates that deaths from homicide, suicide, and accidental overdose collectively surpass any individual traditional medical cause of death. This trend shifts the focus from purely clinical intervention to broader public health and safety concerns affecting pregnant and postpartum people.
This non-obstetric category, including violence, self-harm, and accidental poisoning (drug overdose), accounts for a substantial percentage of all maternal deaths—sometimes over one-third of all mortality during pregnancy and the immediate postpartum period. Homicides are often a greater contributor than suicides, with firearms involved in a majority of these violent deaths.
Pregnancy may increase the risk of these external events, particularly violence. A pregnant or recently pregnant person is at a higher risk for intimate partner violence, which can lead to homicide. The psychological, social, and economic stress associated with pregnancy and new parenthood can also exacerbate underlying mental health conditions, increasing the risk of suicide and accidental overdose.
Addressing these non-clinical factors requires universal screening for mental health disorders, substance use, and intimate partner violence during prenatal and postpartum visits. Interventions must extend beyond the hospital, involving community resources, mental health services, and violence prevention programs. The prominence of deaths from injury and mental health issues signals a complex societal problem impacting maternal well-being.
Other Major Clinical Complications
Beyond non-obstetric causes, several traditional medical complications remain major contributors to maternal death. Cardiovascular conditions are the most common specific clinical cause. These include cardiomyopathy, a weakening of the heart muscle, and other heart issues stressed by the physiological demands of pregnancy. As more individuals enter pregnancy with pre-existing heart disease, obesity, or diabetes, the risk posed by cardiovascular events continues to grow.
Severe obstetric hemorrhage, or excessive bleeding, is another significant threat that can occur during or shortly after childbirth. This complication requires rapid recognition and intervention, as large blood loss can quickly lead to shock and death. Hemorrhage is often considered one of the most preventable causes of maternal death when standardized protocols for blood loss management are effectively implemented.
Hypertensive disorders of pregnancy, such as preeclampsia and eclampsia, are also high-ranking causes of mortality. Preeclampsia involves the sudden onset of high blood pressure and organ damage, usually after 20 weeks of gestation, which can progress to seizures (eclampsia) or stroke. Management necessitates careful monitoring and sometimes immediate delivery to prevent poor outcomes.
Pulmonary and amniotic fluid embolisms represent less common but often rapidly fatal complications. A pulmonary embolism occurs when a blood clot travels to the lungs, blocking blood flow. An amniotic fluid embolism is a rare, sudden allergic-like reaction that happens when amniotic fluid enters the mother’s bloodstream. These events require immediate, specialized intervention, highlighting the need for high-level care readiness.
Addressing Systemic and Societal Risk Factors
Clinical complications occur within a context of systemic factors that elevate risk for certain populations, resulting in profound racial and ethnic disparities. Black women in the United States experience maternal mortality rates three to four times higher than those of white women. This disparity persists regardless of income or education, suggesting that structural racism and implicit bias within the healthcare system play a significant role.
Access to quality prenatal and postpartum care is another pervasive risk factor, especially in rural or underserved areas where maternity wards have closed. Lack of consistent access means that pre-existing chronic conditions, such as hypertension, diabetes, and obesity, are often poorly managed before and during pregnancy. These chronic illnesses increase the likelihood of developing severe complications like preeclampsia or cardiovascular issues.
The period following childbirth, the “fourth trimester,” is especially vulnerable, as nearly two-thirds of pregnancy-related deaths occur after delivery. Many delayed deaths are attributable to conditions like cardiomyopathy or untreated mental health issues that emerge or worsen in the weeks after birth. The lack of comprehensive postpartum support and follow-up care contributes to preventable mortality during this extended recovery period.
Strategies for Improving Maternal Health Outcomes
To reduce maternal mortality, a multi-faceted approach focusing on prevention and intervention across the entire maternity care continuum is necessary. One fundamental strategy involves empowering patients through education to recognize and report potential warning signs of complications. Providing clear information on symptoms encourages timely communication with providers, preventing a crisis from escalating.
Improvements within the healthcare system center on standardizing care and enhancing readiness for emergencies. This includes the widespread adoption of “safety bundles,” which are structured sets of evidence-based practices designed to manage specific complications like hemorrhage and severe hypertension. State-based Maternal Mortality Review Committees also play a significant part by investigating every death to identify systemic failures and inform targeted prevention efforts.
Policy changes are important to ensure continuous access to necessary care throughout the postpartum period. Expanding Medicaid or other insurance coverage to last for a full year after birth, rather than the traditional 60 days, ensures access to follow-up care for chronic conditions and emerging mental health issues. Addressing persistent racial and ethnic disparities through system-wide anti-bias training and culturally competent care models is an ongoing public health priority.