80% Preventable. 100% Unacceptable: U.S. Maternal Mortality
In the wealthiest country on earth, in the year 2026, giving birth remains a leading cause of death for women, and if she is Black, the risk is more than triple. We know the problem, time to take evidence-based solutions to scale.
Where We Stand: The Latest Data
In 2024, 649 women died from maternal causes in the United States, a rate of 17.9 deaths per 100,000 live births. That number was statistically unchanged from 2023's rate of 18.6. The U.S. remains the only high-income country with a maternal mortality rate that has trended upward over the last three decades, and the World Health Organization has flagged us alongside Venezuela, Belize, and the Dominican Republic as one of only seven nations where pregnancy has gotten more dangerous since 2000.
State-level data tell an even more troubling story. Aggregated CDC data from 2019 to 2023 shows the bottom of the rankings is concentrated in the South:
Tennessee: 42.1 deaths per 100,000 live births
Louisiana: 40.7
Mississippi: 39.7
Alabama, Arkansas, Georgia, and Indiana all clustered in the high 30s to mid-40s
Compare that to California (10.1) and Minnesota (14.1), and you see something important. Maternal mortality is not a uniform American problem. It is a geographic, racial, and political one.
A Crisis Hiding Inside the Crisis
The national average masks a chasm. In 2024:
Black (non-Hispanic) women: 44.8 deaths per 100,000 live births
White (non-Hispanic) women: 14.2
Hispanic women: 12.1
Asian women: 18.1
Black women in America are dying from pregnancy at more than three times the rate of white women. That ratio has barely budged in twenty years. When researchers control for income, education, and even insurance status, the gap stubbornly remains. A Black woman with a graduate degree and private insurance still has worse outcomes than a white woman who finished only high school. Education will not save her. Money will not save her. The pattern points somewhere else.
Same City, Different Country: Washington, D.C.
If you want to understand how dramatic these disparities are, look no further than the nation's capital, eight square miles where a maternal health emergency and one of the most resourced healthcare ecosystems in the world coexist.
In Washington, D.C., Black women account for approximately 90% of all pregnancy-related deaths, despite being roughly 45% of the population. Wards 7 and 8, predominantly Black, lower-income neighborhoods east of the Anacostia River, account for 70% of pregnancy-associated deaths. The maternal mortality rate in those wards has been estimated at around 30 per 100,000 live births, while Wards 2 and 3, wealthier and predominantly white, have reported zero pregnancy-associated deaths in the same period.
It is the same city. The same hospitals on paper. The same Medicaid program. And yet for nearly a decade, Wards 7 and 8 had no labor and delivery facility at all. Cedar Hill Regional Hospital only opened in 2025. Mothers were driving across town or into Maryland to give birth.
The same pattern repeats elsewhere:
In Georgia, Black mothers are roughly three times more likely to die from pregnancy-related causes than white mothers, with rural Black women facing the worst outcomes.
In Louisiana, the maternal mortality rate is approximately four times higher for Black mothers than for white mothers, and 59% of Black maternal deaths are preventable, compared with 9% of white maternal deaths.
In Mississippi, Black women are nearly three times more likely to die from pregnancy-related causes than white women, and the state ranks among the nation's worst overall.
In Arkansas, Black women face a maternal mortality rate roughly three times that of white women, and the state has one of the highest neonatal mortality rates in the country.
In California, where overall outcomes are among the best in the nation, Black women still account for 21% of pregnancy-related deaths while making up only 5% of the pregnant population.
When the same systems produce wildly different outcomes for women based solely on their race and zip code, the issue is not biological. The issue is structural.
What Actually Drives This
Let us name the drivers, because vague language has been part of the problem.
Access. More than 35% of U.S. counties are "maternity care deserts" with no hospital, birth center, or OB-GYN. Rural hospital closures have accelerated. Black and Indigenous women are disproportionately concentrated in these gaps.
Socioeconomic factors. Poverty, housing instability, food insecurity, lack of paid leave, transportation barriers, and chronic stress all elevate maternal risk, and these conditions are not randomly distributed. They are the residue of decades of policy choices.
Racism in clinical care. Black women report having their pain dismissed, their symptoms ignored, and their concerns minimized. The Serena Williams story, a world-class athlete who nearly died because providers initially dismissed her self-reported pulmonary embolism symptoms, is not an anomaly. It is a pattern documented in study after study, including by the National Academies of Sciences.
Structural racism. Redlining, environmental injustice, the absence of grocery stores, school underfunding, mass incarceration of Black men, the chronic physiological "weathering" effect of lived racism, all of it lands in the body of a pregnant woman before she ever walks into a clinic.
Chronic disease burden driven upstream. Hypertension, cardiovascular disease, and diabetes are leading causes of maternal death. They are also conditions disproportionately produced by the structural factors above.
Postpartum cliffs. More than half of pregnancy-related deaths occur after delivery, many between 42 days and one year postpartum, a period when many women historically lost coverage.
According to the CDC, more than 80% of pregnancy-related deaths in the U.S. are preventable. Let that sink in.
We Spend Too Much Time Naming the Problem
The maternal health field has spent too many years cataloging this crisis. We have produced excellent reports. We have built dashboards. We have hosted symposiums. We have raised awareness. Awareness was never the bottleneck. Implementation is.
It is time to spend less energy describing the burning building and more energy putting out the fire.
What Actually Works
The good news is that we know what works. Communities and clinicians have been building the evidence base for years.
Doulas. A Cochrane systematic review of continuous labor support found women with continuous one-on-one support, including from doulas, were less likely to have cesarean births, more likely to have spontaneous vaginal births, and reported higher satisfaction with their birth experience (Bohren et al., Cochrane Database of Systematic Reviews, 2017). A 2022 ASPE evidence review summarizing a meta-analysis of 27 studies and a 2025 systematic review in JAMA Network Open further documented associations with reduced cesarean rates, improved breastfeeding initiation, and lower maternal anxiety. States including Oregon, Minnesota, New Jersey, New York, and California now reimburse doula services through Medicaid. This needs to be national.
Community health workers and home visiting. A 2018 randomized controlled trial of doula home visiting (Hans et al., Maternal and Child Health Journal) and a substantial body of research on the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program show improvements in prenatal care utilization, breastfeeding rates, and child development outcomes. Systematic reviews of community health worker interventions (Kim et al., American Journal of Public Health, 2016) have documented improvements in maternal and child health outcomes, particularly for low-income and minority populations.
A workforce that better reflects the community it serves. Research consistently shows racial concordance between patients and providers is associated with greater patient trust, better communication, higher patient ratings of care, and improved adherence (Alsan et al., American Economic Review, 2019; Cooper et al., Annals of Internal Medicine, 2003). A sustained pipeline investment is needed: HBCU medical school funding, midwifery training programs in underserved communities, and scholarship and loan-forgiveness programs tied to service in maternity deserts.
Midwifery integration. A 2018 study by Vedam and colleagues in PLOS ONE found that states with greater integration of midwives into maternity care had significantly better outcomes, including lower rates of preterm birth, low birth weight, and neonatal death. A Cochrane review (Sandall et al., 2016) of midwife-led continuity models found reductions in preterm birth and fetal loss before 24 weeks compared with other models of care.
Community-based organizations as the front door. Groups like Mamatoto Village in D.C., SisterSong, the Birth Equity Collaborative, and others have spent years building trust where institutions have failed. Evaluations of community-based perinatal support models, including studies of Mamatoto Village published in the Journal of Perinatal Education (2020) and analyses by the Commonwealth Fund, document improvements in prenatal care engagement, breastfeeding, and patient-reported quality of care for Black women. These groups should be funded as core infrastructure, not as one-off pilot grants.
Hospital quality collaboratives. The California Maternal Quality Care Collaborative (CMQCC), founded in 2006, helped drop California's maternal mortality rate by 55% from 2006 to 2013 through standardized hemorrhage and hypertension protocols, simulation drills, and shared data. Peer-reviewed evaluations published in the American Journal of Obstetrics and Gynecology (Main et al., 2017; Shields et al., 2017) documented significant reductions in severe maternal morbidity following toolkit implementation. This model is replicable.
Extending postpartum Medicaid coverage to 12 months. Forty-eight states have now adopted this option. Research from the Commonwealth Fund and a 2022 Health Affairs study (Eliason) found that Medicaid expansion and extended postpartum coverage are associated with lower maternal mortality, with maternal death rates 18% to 49% higher in non-expansion states compared with expansion states. Every state should adopt the 12-month extension.
Engaging community stakeholders early and meaningfully, not as advisory window dressing, but as co-designers of programs and policies, with budget authority. Frameworks like the National Birth Equity Collaborative's community-led design model and the National Academies' 2024 consensus report on advancing maternal health equity reinforce that interventions designed with affected communities outperform those designed for them.
Then Came OBBBA, and the ACA Cliff
We were beginning to see signs of progress. Then federal policy moved hard in the other direction.
The One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, includes the largest cut to Medicaid in the program's history, roughly $990 billion to $1 trillion over ten years. The Congressional Budget Office estimates approximately 11.8 million people will lose health coverage by 2034 as a result.
Why this matters for maternal health:
Medicaid pays for approximately 42% of all U.S. births, 50% of births in rural communities, and 60% of births to women of color.
While pregnancy Medicaid itself is technically protected, OBBBA imposes new work requirements, more frequent eligibility reviews, and provider tax restrictions that will destabilize the broader Medicaid system that pregnant and postpartum women depend on. Hospitals, particularly rural ones, are projected to close at accelerating rates.
States facing federal funding cuts may scale back optional benefits like the 12-month postpartum Medicaid extension, doula coverage, home visiting programs, and maternal mental health services, exactly the interventions proven to reduce mortality.
Restrictions on Medicaid funding for clinics that also provide abortion care, which sweep in nearly 200 Planned Parenthood centers, eliminate primary reproductive care for over a million women, including prenatal care, contraception, and cancer screenings.
Layered on top, the ACA enhanced premium tax credits expired on January 1, 2026. Congress did not extend them. As a result:
Approximately 7.3 million people will lose subsidized marketplace coverage, and roughly 4.8 million will become uninsured.
Average annual marketplace premium payments are projected to more than double, a 114% increase.
Women, particularly self-employed women, gig workers, women between jobs, and women of childbearing age not yet on Medicare, will be hit hard.
In short, at the exact moment we have the evidence and the tools to bend the maternal mortality curve, the federal government has chosen to widen the gap. The mothers most likely to die, Black women, rural women, low-income women, are the mothers about to lose coverage.
Call to Action: What Each Sector Should Do Now
The federal government should at minimum:
Restore enhanced ACA premium tax credits.
Mandate 12-month postpartum Medicaid coverage in all states, not just allow it.
Fully fund the Black Maternal Health Momnibus Act provisions, including investments in social determinants of health, perinatal workforce diversification, and community-based organizations.
Maintain robust CDC maternal mortality surveillance, MMRC funding, and ERASE MM, regardless of administration.
Require Medicaid reimbursement for doulas, midwives, and community health workers nationwide.
States should:
Adopt 12-month postpartum coverage if they have not, and protect it if they have.
Reimburse doulas at sustainable rates. Current rates in many states are too low to sustain a workforce.
Replicate California's CMQCC model, a statewide quality collaborative that uses real-time data, shared protocols, and simulation to drive measurable improvement. Texas, New York, Illinois, and Oregon have similar collaboratives showing promise.
Strengthen Maternal Mortality Review Committees and act on their recommendations, not just publish them.
Invest in the workforce: licensure pathways for midwives, scholarships for providers serving in maternity deserts, implicit bias training tied to outcomes, not just attendance.
Look at New Jersey's Nurture NJ, Oregon's doula expansion, and California's Momnibus Act and Strong Start and Beyond initiative as models worth borrowing.
Academic medical centers should:
Partner with, not over, community-based organizations.
Invest in pipelines from HBCUs, Tribal colleges, and Hispanic-serving institutions into clinical maternal care.
Publish race-stratified outcomes data and tie executive accountability to closing the gap.
Treat racism as a clinical risk factor and train every clinician to address it.
Health systems and payers should:
Hold themselves accountable to disparity-reduction targets, not just averages.
Pay for what works: doulas, midwives, community health workers, behavioral health integration, and postpartum home visits.
Stop closing labor and delivery units in underserved communities without a viable replacement plan.
Community stakeholders, philanthropy, and the private sector should:
Fund Black-led, community-based maternal health organizations as long-term core infrastructure, not as 18-month pilot grants.
Invest in housing, transportation, and food security as maternal health interventions, because they are.
Support paid family leave, doula employment, and lactation support as standard benefits.
A Final Word
Maternal mortality is not an inevitability. It is not a mystery. It is not a tragic accident. It is the predictable downstream consequence of policy choices, investment choices, and design choices- choices that can be made differently.
Every mother who dies in this country in 2026 dies in a healthcare system we built. We can build a better one.
The data is clear. The solutions exist. The will is what is missing.
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Sources include the CDC's National Center for Health Statistics, the Commonwealth Fund, KFF, the March of Dimes, the National Health Law Program, the National Academy for State Health Policy, the Congressional Budget Office, the Urban Institute, the Cochrane Database of Systematic Reviews, JAMA Network Open, the American Journal of Obstetrics and Gynecology, PLOS ONE, Health Affairs, the American Economic Review, the Annals of Internal Medicine, and reporting from The Washington Informer, DCist, and WTOP.