Maternal Mortality: A Global Public Health Crisis

Maternal mortality, defined as the death of a woman during pregnancy, childbirth, or shortly after delivery, persists as a critical global public health concern. Even in developed nations, a significant number of women continue to succumb to preventable complications, underscoring healthcare inequities that disproportionately impact various populations. This blog provides a comprehensive analysis of maternal mortality, examining trends across countries, age groups, racial disparities, and other critical factors.

Maternal Mortality Rates by Country

Among developed nations, the United States stands out with the highest maternal mortality rate at 19 deaths per 100,000 live births. This is significantly higher than the maternal mortality rates observed in other developed countries, such as Norway and Sweden, which are as low as 2.0 and 4.0 deaths per 100,000 live births, respectively.

This stark difference suggests that the U.S. healthcare system faces systemic issues that disproportionately affect maternal health outcomes. Emerging research has identified structural racism as a significant contributing factor to the country's poor maternal mortality statistics (Bisson et al., 2022). Specifically, Black women in the U.S. experience maternal mortality at a rate three to four times higher than their White counterparts (Howell, 2018). This disparity cannot be fully explained by individual risk factors, such as pre-existing health conditions or socioeconomic status, pointing to the critical role of systemic discrimination and social drivers of health.

Note. The data is from The U.S. Lags Behind in Fight Against Maternal Mortality by Felix Richter, 2024, Statista.

Global Maternal Mortality Trends (2000-2020)

Globally, maternal mortality has declined over the past two decades, but progress has stagnated in recent years. The graph below illustrates the global decline in MMR from 2000 to 2020, showing a drop from 342 deaths per 100,000 live births in 2000 to 211 deaths per 100,000 live births in 2020. While this represents significant progress, the decline has slowed in recent years, underscoring the need for renewed global efforts to address this pressing public health challenge.

Note. The data is from Fragile States Index. Available at: https://fragilestatesindex.org/data/.

 

Maternal Mortality in the United States: A Deep Dive

The United States has experienced fluctuating maternal mortality rates over the past few years. In 2022, the maternal mortality rate stood at 22.3 deaths per 100,000 live births, which marked a significant decrease from the 2021 rate of 32.9 deaths per 100,000 live births. However, the U.S. still lags behind other developed countries in maternal health outcomes, with notable racial and ethnic disparities across various demographics.

Trends and Key Factors

The year 2022 saw a notable decline in maternal deaths following a sharp rise in 2021, which was largely attributed to the COVID-19 pandemic. Nevertheless, the rate in 2022 remains high compared to historical figures and international standards. For instance, Black women in the U.S. continue to experience disproportionately higher maternal mortality rates, with a staggering 49.5 deaths per 100,000 live births in 2022. In contrast, White women had a rate of 19.0, and Hispanic women, 16.9 deaths per 100,000 births.

Understanding the Disparities

Several factors contribute to the high maternal mortality rate in the U.S., particularly among Black and Hispanic women:

• Healthcare Access: Women from minority groups often face barriers in accessing prenatal and postnatal care. This includes geographic challenges, financial constraints, and systemic inequities in the healthcare system.
• Underlying Health Conditions: Chronic conditions such as hypertension, diabetes, and heart disease, which are more prevalent among Black women, also contribute significantly to maternal deaths.
• Social Determinants of Health: Broader social and economic factors, including housing, education, and employment opportunities, play a critical role in maternal health outcomes.

To provide further context, the graph below illustrates the maternal mortality rates in the United States from 2018 – 2022:

Note. The data is from The National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.htm

Understanding the Global Causes of Maternal Death (2003-2009)

Maternal deaths remain a significant global issue, with most deaths caused by direct obstetric conditions. From 2003 to 2009, haemorrhage was the leading cause of maternal deaths worldwide, accounting for 27.1% of deaths. Hypertensive disorders contributed 14%, followed by sepsis at 10.7%, and abortion-related complications at 7.9%. Additionally, indirect causes, such as pre-existing medical conditions and HIV, made up 27.5% of deaths.

Causes of Maternal Death

• Haemorrhage: 27.1%
• Hypertensive disorders: 14%
• Sepsis: 10.7%
• Abortion: 7.9%
• Embolism: 3.2%
• Other direct causes: 9.6%
• Indirect causes: 27.5%

The chart below provides a visual illustration:

 

Note. The data is from Global Causes of Maternal Death:  A WHO Systematic Analysis https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70227-X/fulltext

Progress in Reducing Maternal Mortality by Region

Certain regions have made substantial progress in reducing maternal mortality. Southern Asia achieved a 67% reduction in maternal deaths between 2000 and 2020, while sub-Saharan Africa saw a 33% reduction.

 

Note. The data are from Fragile States Index. Available https://fragilestatesindex.org/data/

 GDP per Capita vs Maternal Mortality

Maternal mortality is closely tied to a country’s economic development. Countries with higher GDP per capita tend to have lower maternal mortality rates, as wealthier nations invest more in healthcare infrastructure and maternal care services.

The graph below shows a clear correlation between a country’s wealth and its maternal health outcomes, highlighting the importance of economic factors in reducing maternal deaths.

Maternal mortality remains a complex global challenge, affecting both developed and developing nations. While progress has been achieved, disparities persist, particularly in the United States, where racial inequities and limited healthcare access continue to contribute to preventable maternal deaths. Addressing these systemic issues and investing in maternal health are critical to reducing maternal mortality worldwide.

 Note.The data is from Maternal mortality ratio (per 100,000 live births), World Bank. [https://genderdata.worldbank.org/en/indicator/sh-sta-mmrt]

References

Bisson, C., Dautel, S., Patel, E., & Rana, S. (2022, June 1). Maternal mortality in the United States: The pervasive effects of racism. Elsevier BV, 3(6), 361-364. https://doi.org/10.1016/j.medj.2022.05.008

Fragile States Index. Available at: https://fragilestatesindex.org/data/

Howell, E A. (2018, June 1). Reducing Disparities in Severe Maternal Morbidity and Mortality. Lippincott Williams & Wilkins, 61(2), 387-399. https://doi.org/10.1097/grf.0000000000000349

Richter, F. (2024, June 24). The U.S. lags behind in fight against maternal mortality. Statista Daily Data. https://www.statista.com/chart/23541/maternal-mortality-developed-countries/

Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A. B., Daniels, J., ... & Alkema, L. (2014). Global causes of maternal death: a WHO systematic analysis. The Lancet global health, 2(6), e323-e333.