The leading reasons women die in childbirth are severe bleeding, dangerously high blood pressure, and infections. Globally, about 260,000 women died during or after pregnancy and childbirth in 2023, more than 700 every day. The vast majority of these deaths, over 80%, are considered preventable with timely medical care. Understanding what goes wrong, and when, helps explain why childbirth remains one of the most dangerous events in many women’s lives.
Severe Bleeding Is the Top Killer
Hemorrhage, or uncontrolled bleeding, is the single most common cause of maternal death worldwide. It most often happens after delivery, when the uterus fails to contract firmly enough to clamp down on the blood vessels where the placenta was attached. This failure to contract, called uterine atony, can cause life-threatening blood loss within minutes. Other causes of hemorrhage include tears in the birth canal during delivery, pieces of the placenta remaining inside the uterus, and problems with blood clotting.
What makes hemorrhage so dangerous is speed. A woman can lose a fatal amount of blood before anyone recognizes the severity, especially in settings without close postpartum monitoring. Medications that help the uterus contract are the first-line treatment and are routinely given right after the baby is born to reduce the risk. When medications aren’t available, which happens in many low-resource settings, the risk of dying from bleeding rises sharply.
High Blood Pressure and Preeclampsia
Hypertensive disorders of pregnancy are the second leading cause of maternal death globally. The most well-known is preeclampsia, a condition that develops after 20 weeks of pregnancy and involves dangerously high blood pressure along with damage to organs like the kidneys and liver. The root cause appears to be poor blood flow between the placenta and uterus, which triggers a cascade of blood vessel dysfunction throughout the body.
When preeclampsia isn’t caught or treated in time, it can progress to eclampsia (seizures), stroke, heart attack, pulmonary edema (fluid filling the lungs), or a syndrome where the liver breaks down and blood platelets plummet. The only definitive treatment is delivering the baby, which creates an agonizing tradeoff when the pregnancy is far from full term. Delayed delivery increases the risk of all these severe complications, including death for both mother and baby.
Infection After Delivery
The birth process creates open wounds inside the uterus and sometimes in the birth canal, making the postpartum body vulnerable to infection. Genital tract infections and pneumonia are the two most common sources of maternal sepsis. The bacteria most frequently responsible is E. coli, accounting for roughly 30% of infections in one large study, but a range of other bacteria can be involved.
Sepsis becomes fatal when the body’s immune response spirals out of control, causing organ failure. Pneumonia-related infections are particularly deadly: they appear more often in sepsis cases that end in death than in those that are cured. Women who experience severe hemorrhage face a compounded risk, because massive blood loss can trigger clotting problems that make infection harder to survive.
Heart Disease and Late Deaths
Cardiovascular disease is the single largest cause of indirect maternal death, responsible for over 33% of pregnancy-related deaths. Pregnancy puts enormous strain on the heart. Blood volume increases by nearly 50%, the heart pumps harder and faster, and the demands continue after delivery. For women with undiagnosed heart conditions or pregnancy-induced heart problems like peripartum cardiomyopathy (where the heart muscle weakens during or just after pregnancy), this strain can be fatal.
Many of these deaths happen weeks or months after delivery, outside the window when women are being closely monitored. Late maternal deaths, those occurring between six weeks and one year after childbirth, represent a significant and often overlooked share of total maternal mortality. Because these deaths happen long after the birth itself, they’re sometimes not connected to pregnancy at all, leaving the true toll undercounted.
When Deaths Happen
Nearly half of all postpartum maternal deaths, 48.9%, occur within the first 24 hours after childbirth. Another 24.5% happen between days two and seven, and roughly 25% between one and six weeks postpartum. This concentration of deaths in the first day underscores why immediate postpartum care matters so much. The hours after delivery, when hemorrhage and blood pressure crises are most likely, are the highest-risk window.
But the weeks that follow carry real danger too. Infections take time to develop. Blood clots can form days after delivery. Heart failure can emerge gradually. The risk doesn’t end when a woman leaves the hospital.
Racial Gaps in the United States
In the U.S., Black women die from pregnancy-related causes at 50.3 per 100,000 live births, roughly 3.5 times the rate for White women (14.5 per 100,000) and nearly four times the rate for Hispanic women (12.4 per 100,000), according to 2023 CDC data. Asian women had the lowest rate at 10.7 per 100,000.
These disparities persist across income and education levels, pointing to factors beyond individual health. Black women are more likely to deliver at hospitals with higher complication rates, more likely to have warning signs dismissed or undertreated, and more likely to have chronic conditions like hypertension that increase pregnancy risk. The gap is not explained by biology. It reflects differences in the quality of care women receive and the cumulative effects of systemic inequity on health before pregnancy even begins.
Why So Many Deaths Are Preventable
The CDC classifies more than 80% of pregnancy-related deaths as preventable, meaning there was at least some chance the outcome could have been different with reasonable changes to care. That definition covers a broad range of failures: a patient whose symptoms were dismissed, a hospital that lacked the right medication, a community without access to emergency obstetric care, a woman who couldn’t afford or reach prenatal visits.
The global picture reflects this. Between 2000 and 2023, the worldwide maternal mortality ratio dropped by about 40%. Eastern Europe cut its rate by 75%, and southern Asia by 71%, largely through expanding access to skilled birth attendants, emergency obstetric care, and basic medications like those that stop postpartum bleeding. Sub-Saharan Africa, which still carries a disproportionate share of maternal deaths, achieved a 40% reduction over the same period. COVID-19 briefly reversed progress, with global deaths spiking in 2021, but by 2022 the numbers had fallen below pre-pandemic levels.
The tools to prevent most maternal deaths already exist. Hemorrhage can be treated with medications that cost pennies. Preeclampsia can be caught with a blood pressure cuff. Infections respond to antibiotics when caught early. What kills women, in most cases, is not the absence of medical knowledge but the absence of timely access to it.