The United States has the highest maternal mortality rate of any high-income country, and it’s not particularly close. The average across OECD nations is 10.3 deaths per 100,000 live births. The U.S. rate is roughly two to three times that, depending on the year measured. What makes this especially striking is that the majority of these deaths are preventable. A CDC analysis of data from 36 states found that 84% of pregnancy-related deaths could have been avoided.
There’s no single explanation. The crisis is driven by a combination of racial inequities, gaps in insurance coverage, a shortage of maternity care providers in large parts of the country, rising rates of chronic health conditions, and a health system that largely stops paying attention to new mothers far too early. Here’s how each of those factors contributes.
How the U.S. Compares to Other Wealthy Nations
Among the 38 OECD countries, the average maternal mortality ratio was 10.3 per 100,000 live births in 2023. Nations like Norway, the Netherlands, and Japan consistently report rates in the low single digits. The U.S. has hovered between 20 and 32 deaths per 100,000 in recent years, placing it in a category with countries that spend far less on healthcare per person. This gap has actually widened over the past two decades, even as most peer nations saw their rates decline.
The comparison is even more jarring when you look at spending. The U.S. devotes more money per capita to healthcare than any other country, yet delivers worse outcomes for mothers on nearly every metric. Other wealthy nations generally provide universal coverage, more midwifery-led care, longer postpartum follow-up, and standardized protocols for managing complications like hemorrhage and high blood pressure during pregnancy.
Racial Disparities Are Massive
The national average obscures enormous differences by race. In 2023, the maternal mortality rate for Black women was 50.3 per 100,000 live births, compared to 14.5 for White women, 12.4 for Hispanic women, and 10.7 for Asian women. That means Black women die at roughly 3.5 times the rate of White women.
This disparity persists even when researchers control for income and education. A college-educated Black woman still faces higher risks than a White woman without a high school diploma. The gap reflects something deeper than individual health profiles: chronic stress from racism (sometimes called “weathering”), implicit bias in clinical settings where Black women’s pain and symptoms are more likely to be dismissed, and less access to high-quality hospitals. Studies have documented that Black women are more likely to deliver at hospitals with higher complication rates, even in the same city where better-resourced facilities exist nearby.
One-Third of U.S. Counties Have No Maternity Care
Over 35% of all U.S. counties are classified as maternity care deserts, meaning they lack a single birthing facility or obstetric clinician. Nearly two-thirds of these deserts are in rural areas, but the problem isn’t exclusively rural. About 1 in 10 people giving birth live in counties without full access to maternity care.
When the nearest hospital with a labor and delivery unit is an hour or more away, complications that would be routine to manage in a well-staffed facility become emergencies. Longer travel times are associated with higher rates of unplanned out-of-hospital births, more preterm deliveries, and worse outcomes when something goes wrong. Rural hospital closures have accelerated over the past decade, driven by financial pressures and workforce shortages, and each closure pushes more pregnant people further from care.
Deaths Happen Long After Delivery
One of the most underappreciated aspects of this crisis is timing. Only about a third of pregnancy-related deaths occur during pregnancy itself. Another 36% happen during delivery or in the first week afterward. The remaining third, a full 33%, happen between one week and one year postpartum.
That late postpartum window is when many people fall through the cracks. Historically, Medicaid coverage (which pays for more than 40% of U.S. births) ended just 60 days after delivery. A new mother dealing with postpartum depression, a worsening heart condition, or dangerously high blood pressure could lose her insurance right when she needed it most. The good news is that 49 states and Washington, D.C. have now adopted a 12-month postpartum Medicaid extension. Whether that translates to fewer deaths will depend on whether people actually use the coverage and whether the care available to them is adequate.
Chronic Health Conditions Raise the Baseline Risk
Americans enter pregnancy sicker than their counterparts in other wealthy nations. Rates of obesity, hypertension, diabetes, and heart disease are all higher in the U.S., and each of these conditions significantly increases the risk of pregnancy complications. Cardiovascular conditions are now the leading medical cause of pregnancy-related death.
Advanced maternal age plays a role too. The share of births to people over 35 has been climbing steadily, and mortality rates rise sharply with age. But aging alone doesn’t explain the U.S. problem. Women in their 30s and 40s give birth at similar rates in countries like Australia and France without comparable mortality. The difference is that chronic conditions are more prevalent here, less well-managed before pregnancy, and often worsened by fragmented care during and after it.
Mental Health and Violence
Maternal mortality isn’t limited to medical complications like hemorrhage or infection. Over an 18-year study period, 11% of deaths among pregnant and recently pregnant people were attributed to homicide and suicide. Homicide accounted for 61% of those deaths, and suicide accounted for 39%. Combined, they represent the leading cause of death among this population when all causes are included.
Substance use disorders, particularly involving opioids, also contribute significantly. Overdose deaths during pregnancy and the postpartum period have risen alongside the broader overdose crisis. Many of these deaths are preventable with screening, treatment for addiction, and mental health support, but those services remain difficult to access for many pregnant and postpartum people, especially in states with limited behavioral health infrastructure.
State-by-State Differences Are Stark
Where you live matters enormously. Between 2018 and 2022, California had a maternal mortality rate of 10.5 per 100,000 live births. Tennessee’s rate over the same period was 41.1, nearly four times higher. That kind of variation within a single country reflects real differences in policy, healthcare infrastructure, and public health investment.
California is often cited as a success story. The state implemented a coordinated quality improvement initiative in the 2010s that standardized how hospitals respond to hemorrhage, high blood pressure emergencies, and other common complications. It invested in data review, rapid-response protocols, and simulation training. The result was a dramatic drop in preventable deaths even as the national rate was climbing. States with worse outcomes tend to have fewer providers, less Medicaid coverage historically, higher rates of chronic disease, greater racial disparities, and fewer quality-improvement programs in their hospitals.
Why So Many Deaths Are Preventable
State and city maternal mortality review committees have examined thousands of individual deaths. Across 42 states and cities, reviewers determined that between 45% and 100% of pregnancy-related deaths were preventable, depending on the jurisdiction. The CDC’s own estimate, based on 2017 to 2019 data, puts the figure at 84%.
Preventable doesn’t mean simple. It means that with better systems, these deaths could have been avoided. Common contributing factors identified in reviews include delayed or missed diagnoses, poor coordination between providers, lack of follow-up after discharge, patients not recognizing warning signs, and gaps in insurance coverage that led to skipped appointments or unfilled prescriptions. In many cases, multiple failures had to line up for a death to occur, which also means there were multiple points where an intervention could have changed the outcome.
The problem, in other words, isn’t that medicine doesn’t know how to keep pregnant people alive. It’s that the U.S. health system fails to consistently apply what it already knows, and it fails certain populations far more than others.