In a powerful, data-rich study that peels back the layers of maternal mortality in the United States, researchers from the National Cancer Institute, Harvard Medical School, Boston Children’s Hospital, the Technical University of Munich, and Beth Israel Deaconess Medical Center have exposed a sobering truth: between 2018 and 2022, 2,679 pregnancy-related deaths could have been prevented.
This finding is more than just a statistic—it’s a national wake-up call. The study, recently published in JAMA Network Open, reveals how profoundly broken America’s maternal health systems are, and just how dangerous it can be to become pregnant in the wealthiest country on Earth.
America’s Maternal Mortality Crisis: The Numbers Behind the Tragedy
The United States stands alone in a grim category: it has the highest maternal mortality rate among high-income nations. While nations like the Netherlands, Norway, and even neighboring Canada have made strides in lowering their pregnancy-related deaths, the U.S. seems to be moving in the opposite direction.
Between 2018 and 2022, researchers tracked 18,475,989 live births and 6,283 pregnancy-related deaths among women aged 15 to 54. Alarmingly, of these, 1,891 deaths occurred in the late postpartum period—after 42 days but within one year of giving birth.
The age-standardized pregnancy-related mortality rate increased by nearly 28% over the study period, rising from 25.3 deaths per 100,000 live births in 2018 to 32.6 in 2022. And these are not just numbers on a page—they represent mothers, daughters, sisters, and partners lost too soon, leaving behind shattered families and unanswered questions.
If America Were California: A Glimpse at What Could Have Been
One of the most shocking insights from the study is the disparity between states. Mortality rates varied more than threefold across the country. For example:
- Alabama had the highest crude pregnancy-related mortality rate at 59.7 deaths per 100,000 live births.
- Mississippi closely followed with 58.2.
- California, meanwhile, had the lowest rate at 18.5, with Minnesota next at 19.1.
If the national average had matched California’s, a total of 2,679 maternal deaths could have been avoided. These numbers underscore a painful truth: place of residence in the United States can be a matter of life or death for pregnant individuals.
Geographic and Racial Disparities: A Deepening Divide
The tragedy of maternal mortality in America is not evenly distributed. Where you live and the color of your skin still play a devastating role in health outcomes.
- Rural counties saw rates 1.7 times higher than large metropolitan areas.
- American Indian and Alaska Native women had the highest mortality rate at 106.3 deaths per 100,000 live births.
- Non-Hispanic Black women followed with 76.9 deaths per 100,000, nearly three times higher than their white counterparts.
- Non-Hispanic white women had a rate of 27.6, while Latino or Hispanic women had 25.9, and non-Hispanic Asian women had the lowest at 21.8.
These stark differences reflect deep-seated systemic issues—ranging from structural racism and unequal access to care to socioeconomic disparities and gaps in culturally competent healthcare delivery.
Maternal Age and Postpartum Peril: When Death Doesn’t Stop at Delivery
Another troubling trend is the rise in maternal deaths beyond the immediate postpartum period. Late maternal deaths (occurring 43 to 365 days after delivery) surged, with rates increasing from 7.3 to 11.1 per 100,000 live births from 2018 to 2022.
Women aged 25 to 39 years—often considered prime maternal age—experienced a 36.8% increase in pregnancy-related mortality, further dismantling the assumption that youth alone protects against complications.
The study breaks down causes of late maternal death, which paint a complex picture of health vulnerabilities that persist or worsen after childbirth:
- Cardiovascular disorders led the list, accounting for 4.7 deaths per 100,000.
- Cancer followed at 2.0, then endocrine disorders (1.6), drug- and alcohol-related causes (1.1), and mental and behavioral health disorders (1.0).
Notably, substance use and mental health issues contributed to over 21% of late maternal deaths—highlighting how gaps in postpartum mental healthcare and addiction support can become fatal.
The Patchwork of U.S. Data: Why We Still Struggle to Count the Dead
One of the more insidious challenges exposed by the study is the fragmented nature of data collection in the U.S., which makes it incredibly difficult to understand and address maternal mortality.
Different tracking systems—like the National Vital Statistics System, the Pregnancy-Related Mortality Surveillance System, and state-based Maternal Mortality Review Committees—often report different estimates. Until as recently as 2018, not all states had even implemented the updated 2003 death certificate revision, skewing the accuracy of national data.
And even now, most systems do not standardize by age, nor do they routinely include late maternal deaths. With women choosing to have children later in life, and overall birth rates declining, age-adjusted and complete tracking is not just helpful—it’s essential for meaningful intervention.
How Did We Get Here? Systemic Failures in Maternal Health
So how does a nation that leads the world in medical technology and spending fall so short in protecting mothers?
The study and its implications point to several root causes:
- Fragmented health systems that don’t integrate prenatal, delivery, and postpartum care.
- Underinvestment in rural healthcare infrastructure and maternal health programs.
- Bias and discrimination in healthcare, particularly against women of color.
- Gaps in postpartum care, especially mental health services and cardiovascular follow-up.
- Inconsistent implementation of maternal death review and reporting protocols across states.
The U.S. spends more per capita on healthcare than any other country, yet mothers are dying at rates that should be unthinkable.
The Path Forward: Solutions Are Within Reach
Despite the grim statistics, the takeaway from the study is not hopelessness—it’s possibility. More than 80% of these deaths are preventable, according to state Maternal Mortality Review Committees. This means the solutions exist—we just need the collective will to implement them.
Here’s what a better path could look like:
- Universal adoption of standardized, age-adjusted maternal mortality tracking, including late deaths.
- Expanded Medicaid coverage for postpartum care beyond the current 60-day limit, which many women fall off before getting needed care.
- Investment in rural healthcare and maternal-fetal medicine specialists.
- Targeted interventions for high-risk populations, including culturally competent care and community-based support systems.
- Mental health and substance abuse integration into postpartum care.
- National benchmarks, modeled after top-performing states like California, to guide improvement across all states.
Conclusion: Lives That Could—and Should—Have Been Saved
The stories behind the 6,283 maternal deaths are not just tragic—they’re infuriating. They speak to a healthcare system that too often forgets its mothers. They reflect how systemic inequities can literally become lethal. And they remind us that in the richest country in the world, no one should die from pregnancy when so many of these deaths are avoidable.
This landmark study does more than just count the dead. It exposes the failings. It lights the way toward solutions. And it calls on all of us—from policymakers to healthcare providers to ordinary citizens—to act.
Because every one of those 2,679 preventable deaths wasn’t just a number.
It was a person.
A life.
And we can—and must—do better.
Reference: Yingxi Chen et al, Pregnancy-Related Deaths in the US, 2018-2022, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.4325