Why Maternal Mortality Still Falls Unequally in the U.S.

Bottom line: Maternal deaths in the United States remain uneven. Black women and some American Indian and Alaska Native (AI/AN) women continue to face a much higher risk of dying during pregnancy or within a year after giving birth compared with White women. Many of these deaths happen after delivery, often from heart conditions or mental health causes. Policy changes such as 12-month postpartum Medicaid coverage aim to improve care, but coverage alone does not guarantee access.

The latest numbers: Persistent gaps by race and age

According to the Centers for Disease Control and Prevention (CDC), the U.S. maternal mortality rate remains higher than in other high-income countries. Recent CDC data show that Black women are about two to three times more likely to die from pregnancy-related causes than White women. AI/AN women also face significantly elevated risk.

These disparities appear across education and income levels. In other words, the gap is not explained by individual choices or income alone. Age also matters: people 35 and older face higher overall risk, but racial disparities persist within age groups.

Public health researchers and federal agencies describe these differences as preventable and closely tied to access to care, chronic disease burden, and structural inequities—not race itself as a biological cause.

What counts as a maternal death?

Clear definitions matter.

Maternal mortality typically refers to deaths during pregnancy or within 42 days after the end of pregnancy from causes related to or worsened by the pregnancy.
Pregnancy-related deaths include deaths during pregnancy and up to one year postpartum that are linked to pregnancy or its management.

The CDC emphasizes that many deaths occur well after delivery, often weeks or months later. That extended time frame is important because postpartum health risks are frequently overlooked.

There are also data limitations. Maternal death reporting relies in part on death certificates, which may misclassify causes or pregnancy status. Final national data often lag by a year or more, and provisional numbers can change after review.

Leading causes: Heart conditions and mental health

CDC analyses show that cardiovascular conditions—including cardiomyopathy, severe hypertension, and other heart diseases—are among the leading causes of pregnancy-related death. Other major causes include:

Severe bleeding (hemorrhage)
Infection
Blood clots
Mental health conditions, including substance use and suicide

A peer-reviewed analysis published in JAMA examining racial and ethnic disparities in maternal mortality found that cardiovascular causes accounted for a substantial share of deaths, particularly among Black women. The study was observational, meaning it identified patterns and associations but could not prove specific causes of disparities. Still, it reinforces the role of chronic disease and access to care in shaping outcomes.

Importantly, mental health conditions are a leading cause of death in the postpartum year. That includes suicide and overdose. Screening for depression and substance use, along with access to treatment, is a critical part of maternal care.

Why disparities persist

Experts point to several overlapping drivers:

1. Chronic disease before pregnancy

Conditions such as hypertension, diabetes, obesity, and heart disease increase the risk of complications. These conditions are more common—and often less well controlled—in communities with limited access to preventive care.

2. Gaps in postpartum care

Many pregnancy-related deaths occur after hospital discharge. Historically, Medicaid coverage for pregnancy ended 60 days postpartum in many states, leaving some low-income parents uninsured during a high-risk period.

3. Access and workforce shortages

Rural areas and some urban neighborhoods face shortages of obstetric providers and cardiologists. Even with insurance, patients may struggle to find timely appointments.

4. Structural inequities

Longstanding differences in housing, transportation, environmental exposures, and healthcare access contribute to higher chronic disease rates and stress. Research suggests that experiences of discrimination in healthcare settings may also affect care quality and follow-up.

These are system-level issues. Race itself does not cause maternal death. Rather, inequities in care and health conditions increase risk.

Geography matters

Maternal mortality rates vary widely by state. Differences reflect a mix of population health, Medicaid policy, provider availability, and hospital resources. The CDC and other federal agencies note that state-level review committees often identify preventable factors in a large share of pregnancy-related deaths.

What extended Medicaid postpartum coverage does—and does not do

In recent years, most states have adopted a federal option allowing Medicaid coverage to continue for 12 months after childbirth. Tracking by KFF shows that the large majority of states have implemented this extension.

This policy aims to:

Maintain insurance during the high-risk postpartum year
Improve follow-up for hypertension and diabetes
Expand access to mental health and substance use treatment
Reduce coverage gaps that interrupt care

Federal initiatives through Medicaid and the Centers for Medicare & Medicaid Services (CMS) also focus on maternal and infant health quality improvement, including better blood pressure control and coordinated care.

However, insurance coverage does not automatically ensure access. Patients may still face provider shortages, transportation barriers, or long wait times. Researchers are still studying whether the coverage extension will translate into measurable reductions in maternal mortality rates nationwide.

What this means for families

Pregnancy-related complications can develop weeks or months after delivery. Families should know urgent warning signs and seek care promptly. These include:

Severe headache or vision changes
Chest pain or shortness of breath
Heavy vaginal bleeding
Swelling of the face or hands with high blood pressure
Persistent sadness, hopelessness, or thoughts of self-harm

Postpartum follow-up is important even if delivery seemed uncomplicated. Blood pressure checks, mental health screening, and chronic disease management should continue beyond the traditional six-week visit.

For families with low income, checking Medicaid eligibility after childbirth is critical. In most states, coverage now lasts a full year postpartum. Local health departments, Medicaid offices, or Healthcare.gov can help clarify options.

What remains uncertain

Maternal mortality data take time to finalize, and reporting systems continue to improve. While policy changes are expanding coverage, it will take several years of data to determine their full impact on mortality rates and disparities.

What is clear from CDC and peer-reviewed research is that many pregnancy-related deaths are considered preventable. Addressing chronic disease, improving postpartum follow-up, expanding mental health care, and strengthening healthcare access are central to narrowing the gap.

The takeaway: Maternal mortality in the U.S. is not evenly distributed. Black and some Indigenous women continue to face significantly higher risk. Many deaths occur after delivery and are linked to chronic conditions and access gaps. Extended Medicaid coverage may help improve continuity of care, but reducing disparities will require sustained improvements in healthcare access, quality, and social conditions that shape health long before pregnancy begins.

Sources

This article is for general informational purposes only and is not medical advice. Research findings can be early, limited, or subject to change as new evidence emerges. For personal guidance, diagnosis, or treatment, consult a licensed clinician. For current outbreak or public health guidance, follow your local health department, the CDC, or another relevant public health authority.