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Am J Perinatol 2025; 42(09): 1109-1118
DOI: 10.1055/a-2404-8035
Review Article

The Ongoing U.S. Struggle with Maternal Mortality

James A. O'Brien
1   Emeritus of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Adam K. Lewkowitz
2   Department of Obstetrics and Gynecology – Maternal Fetal Medicine, Brown University, Providence, Rhode Island
,
Elliot K. Main
3   Department of Obstetrics and Gynecology – Maternal Fetal Medicine, Stanford University School of Medicine, Stanford, California
,
Eli Y. Adashi
4   Department of Medical Science, Brown University, Providence, Rhode Island
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Funding None.
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Abstract

Despite significant efforts over the past two decades, the maternal mortality rate (MMR) in the United States remains at least double that of most other high-income countries (HICs). In addition, substantial racial disparities exist with MMRs among Black and American Indian/Alaska Native women two to three times higher than White, Hispanic, and Asian/Pacific Islander counterparts. Of the three surveillance systems currently in place, Maternal Mortality Review Committees (MMRCs) are widely considered to provide the highest quality data. MMRCs in combination with Perinatal Quality Collaboratives and other successful initiatives provide the best hope of reversing these concerning trends. The state of maternal health in the United States is at a critical juncture. To reach the ultimate goal of rendering the United States as one of the “safest countries in the world to give birth” will require greater coordination and consolidation of national efforts across the entire prenatal, perinatal, and postpartum continuum. The authors make suggestions to create a robust federal infrastructure to finally provide equitable high-quality maternal care and bring U.S. maternal mortality into alignment with other HICs.

Key Points

  • U.S. MMRs are double that of other HICs.

  • Black MMRs are two to three times higher than White MMRs.

  • “Maternity care deserts” show a marked increase in maternal mortality.

  • Listed strategies have shown success in reversing these trends.

Keywords

maternal mortality - maternal morbidity - health equity - international comparators

Authors' Contributions

J.A.O'B.: conceptualization, writing—original draft. A.K.L.: conceptualization, writing—review and substantive revision. E.K.M.: conceptualization, writing, and substantive revision. E.Y.A.: conceptualization, writing—review and substantive revision.




Publication History

Received: 21 August 2024

Accepted: 26 August 2024

Article published online:
10 October 2024

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