Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
In 2021, the maternal mortality rate in the United States was 32.9 deaths/100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019 (1 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ). The maternal mortality rate is higher in the United States than in European countries (eg, Germany, Netherlands, Poland, Spain, Sweden, Switzerland, United Kingdom). (See table .)
Disparities by race and ethnicity in maternal mortality are significant worldwide. In the United States, rates in 2021 were highest in non-Hispanic Black women (69.9/100,000), compared with 28/100,000 in Hispanic women and 26.6/100,000 in non-Hispanic White women (1 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ). In Brazil, maternal mortality is approximately 5 times higher in women of African descent than in White women (2 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ). In the United Kingdom, the rate is more than 5 times higher in Black women than in White women (3 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ).
Worldwide in 2013, the approximate percentage of maternal deaths occurred as follows (4 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ):
Antepartum: 25%
Intrapartum and postpartum: 28%
Late postpartum: 36%
More than 42 days but less the 1 year after delivery: 12%
Maternal death statistics include direct obstetric and indirect causes. The most common causes of maternal death worldwide are (5 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more )
Abortion, including induced abortion Induced Abortion In the United States, about half of pregnancies are unintended. About 40% of unintended pregnancies end in induced abortion; 90% of procedures are done during the 1st trimester. In the United... read more , miscarriage Spontaneous Abortion Spontaneous abortion is pregnancy loss before 20 weeks gestation. Diagnosis is by pelvic examination, measurement of beta subunit of human chorionic gonadotropin, and ultrasonography. Treatment... read more , and ectopic pregnancy Ectopic Pregnancy Ectopic pregnancy is the implantation of a pregnancy in a site other than the endometrial lining of the uterine cavity—ie, in the fallopian tube, uterine cornua, cervix, ovary, or abdominal... read more (8%)
Complications of delivery (3%)
Obstructed labor (3%)
Preexisting medical conditions (15%)
Usually, several factors contribute to maternal mortality (6 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ), including
Delay in deciding to seek care
Delay in arriving at an appropriate health care facility (often because of distance or lack of transportation)
Delay in receiving adequate care at a health care facility
Approximately 4 of 5 maternal deaths are preventable (7 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ).
Perinatal mortality rate is the death of a fetus toward the end of a pregnancy or the death of a young infant. Definitions vary, but one definition of perinatal mortality rate is the number of deaths of infants < 7 days of age and fetal deaths at ≥ 28 weeks of gestation per 1000 live births.
The United States perinatal mortality rate in 2021 was 5.5 perinatal deaths per 1000 live births (8 Maternal and perinatal mortality references Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause... read more ). The rate declined 30% from 1990 through 2011, was stable from 2011 through 2016, and declined 4% from 2017 through 2019.
Rates by race and ethnicity of the mother were
4.7 for children of non-Hispanic White women
9.5 for children of non-Hispanic Black women
4.9 for children of Hispanic women
The causes of perinatal death include causes of stillbirth Stillbirth Stillbirth is fetal death (fetal demise) at ≥ 20 weeks gestation (> 28 weeks in some definitions). Management is delivery and postpartum care. Maternal and fetal testing is done to determine... read more and neonatal death. Causes of stillbirth may be fetal, maternal, or placental (see table ).
The neonatal period is defined as the first 28 days of life. The majority of neonatal deaths (75%) occur within 7 days after birth (see World Health Organization: Newborn Mortality). In 2019, the major causes of neonatal death worldwide were preterm birth, childbirth-related complications (birth asphyxia or lack of breathing at birth), infections, and birth defects.
Maternal and perinatal mortality references
1. Hoyert DL. Maternal mortality rates in the United States, 2021. Centers for Disease Control and Prevention: National Center for Health Statistics Health, E-Stats, 2023. doi: https://dx.doi.org/10.15620/cdc:124678
2. Small M, Allen T, Brown HL: Global disparities in maternal morbidity and mortality. Semin Perinatol 41 (5): 318–322, 2017. doi: 10.1053/j.semperi.2017.04.009
3. Knight M, Bunch K, Kenyon S, Tuffnell D, Kurinczuk JJ: A national population-based cohort study to investigate inequalities in maternal mortality in the United Kingdom, 2009-17. Paediatr Perinat Epidemiol. 2020;34(4):392-398. doi:10.1111/ppe.12640
4. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS: Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 13;384 (9947):980–1004, 2014. doi: 10.1016/S0140-6736(14)60696-6
5. Say L, Chou D, Gemmill A, et al: Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health 2 (6):e323–33, 2014. doi: 10.1016/S2214-109X(14)70227-X
6. Barnes-Josiah D, Myntti C, Augustin A: The “three delays” as a framework for examining maternal mortality in Haiti. Soc Sci Med 46 (8):981–993, 1998. doi: 10.1016/s0277-9536(97)10018-1
7. Trost SL, Beauregard J, Njie F, et al: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022
8. Valenzuela CP, Gregory ECW, Martin JA: Perinatal Mortality in the United States, 2020-2021. NCHS Data Brief. 2023;(489):1-8