Tennessee has the highest maternal mortality rate in the United States, with 42.1 deaths per 100,000 live births. That figure, based on data from 2019 to 2023, is more than double the national average of 17.9 per 100,000. It places Tennessee at the bottom of state rankings for maternal health, with several other Southern states close behind.
How Tennessee Compares to the National Average
The national maternal mortality rate in 2024 was 17.9 deaths per 100,000 live births, meaning roughly 649 women died from pregnancy-related causes that year. Tennessee’s five-year rate of 42.1 is roughly 2.3 times that national figure. The measure captures deaths related to or aggravated by pregnancy that occur within 42 days of the end of a pregnancy, excluding accidents or incidental causes.
The South consistently dominates the list of states with the worst maternal outcomes. This pattern holds across racial and ethnic groups: White women in Southern states die at higher rates than White women elsewhere, and the disparity is even steeper for Black women in those same states.
Racial Gaps Within the Numbers
Nationally, the median state maternal mortality rate for Black women is 55.4 per 100,000 live births. For White women it’s 26.3, and for Hispanic women it’s 19.1. That means Black women face roughly twice the risk of White women and nearly three times the risk of Hispanic women, no matter which state they live in.
In the South, those disparities layer on top of already elevated baseline rates. Some states outside the region also show alarming numbers for specific populations. Arizona and New Jersey, for example, have reported Black maternal mortality rates above 119 per 100,000. American Indian and Alaska Native women face similarly elevated risks across much of the country.
Why the South Performs Worse
High maternal mortality is not driven by a single cause. It reflects a web of factors that tend to cluster in the same regions, and the South has more of them stacked together than most parts of the country.
Poverty is one of the strongest predictors. Women living in the most economically deprived areas have a 120% higher risk of dying from pregnancy-related causes than those in the most affluent areas. That gap has been widening since the early 2000s. Lower educational attainment compounds the effect: women without a high school diploma face roughly twice the maternal mortality risk of college graduates. Unmarried women, who may have less social support and fewer financial resources, face about 1.9 times the risk of married women.
Rural geography adds another layer. Women in small rural towns have 80% higher maternal mortality than women in inner cities. Rural areas are more likely to lack nearby hospitals, specialists, and emergency services, all of which matter when complications arise during pregnancy or delivery.
The Role of Maternity Care Deserts
A maternity care desert is a county with no hospital or birth center offering obstetric care and no maternity care practitioners. Counties that qualify as maternity care deserts have a maternal mortality rate of 32.25 per 100,000, compared to 23.62 in counties with full access. That’s a 36% higher rate after adjusting for other factors.
The problem is getting worse. More than 400 maternity services closed between 2006 and 2020, mostly in rural areas. Nine percent of rural counties lost their hospital maternity units in just one decade, and 45% of rural counties never had maternity services to begin with. When a maternity unit closes, the obstetricians and nurse-midwives who staffed it often relocate, draining the area of expertise and making it harder for any future facility to reopen.
For women in these areas, the nearest delivery option may be an hour or more away. That distance delays care during emergencies like severe bleeding or dangerously high blood pressure, the kinds of complications where minutes matter.
Most Deaths Are Preventable
Mississippi, which consistently ranks near the bottom alongside Tennessee, reviewed 73 pregnancy-related deaths from 2019 to 2023 through its Maternal Mortality Review Committee. The committee concluded that 82% of those deaths were preventable, meaning that reasonable changes at the patient, provider, facility, or community level could have given those women at least some chance of survival.
That 82% figure is not unique to Mississippi. Maternal mortality review committees in other states have reached similar conclusions. The deaths aren’t happening because modern medicine lacks the tools to prevent them. They’re happening because of gaps in the system: delayed diagnoses, lack of nearby emergency care, loss of insurance coverage after delivery, and chronic conditions like hypertension and diabetes that go poorly managed before and during pregnancy.
Insurance Coverage After Delivery
Medicaid finances roughly 4 in 10 births in the United States, making it the single largest payer for maternity care. Historically, Medicaid coverage for pregnant women ended just 60 days after delivery, cutting off care during a period when many fatal complications, including infections, blood clots, and cardiovascular events, can still develop.
A provision in the American Rescue Plan Act of 2021 gave states the option to extend that coverage to 12 months postpartum. As of early 2026, 49 states plus Washington, D.C., have implemented the 12-month extension, with one additional state planning to do so. This is a significant shift from just a few years ago, when most states still had the 60-day cutoff. Whether this near-universal expansion translates into measurably lower mortality rates in the highest-risk states will take several more years of data to assess.