View source for Maternal death

{{Short description|Aspect of human reproduction and medicine}}
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| caption         = A mother dies and is taken by angels as her new child is taken away, a grave from 1863 in Striesener Friedhof in Dresden.
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'''Maternal death''' or '''maternal mortality''' is defined in slightly different ways by several different health organizations. The [[World Health Organization]] (WHO) defines maternal death as the death of a pregnant mother due to [[Complications of pregnancy|complications]] related to [[pregnancy]], underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy.<ref name="www.who.int">{{Cite web|title=Indicator Metadata Registry Details|url=https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4622|access-date=2021-11-08|website=www.who.int|language=en}}</ref> The [[Centers for Disease Control and Prevention|CDC]] definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy.<ref name="CDC-2020">{{cite web|title=Pregnancy Mortality Surveillance System - Pregnancy - Reproductive Health|date=25 November 2020|url=https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html|publisher=CDC}}</ref><ref>{{Cite web|date=2019-02-26|title=Pregnancy-Related Deaths {{!}} CDC|url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm|access-date=2021-11-08|website=www.cdc.gov|language=en-us}}</ref> Pregnancy associated death, as defined by the [[American College of Obstetricians and Gynecologists]] (ACOG), are all deaths occurring within one year of a pregnancy resolution.<ref name="Atrash-1992">{{cite journal | vauthors = Atrash HK, Rowley D, Hogue CJ | title = Maternal and perinatal mortality | journal = Current Opinion in Obstetrics & Gynecology | volume = 4 | issue = 1 | pages = 61–71 | date = February 1992 | pmid = 1543832 | doi = 10.1097/00001703-199202000-00009 | s2cid = 32268911 }}</ref> Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

There are two main measures used when talking about the rates of maternal mortality in a community or country. These are the [[maternal mortality ratio]] and maternal mortality rate, both abbreviated as "MMR".<ref>{{cite web | url = https://www.pop.org/content/definitions-maternal-mortality | title = Maternal Mortality Ratio vs Maternal Mortality Rate | archive-url = https://web.archive.org/web/20170202083826/https://www.pop.org/content/definitions-maternal-mortality| archive-date=2017-02-02 | work = Population Research Institute }}</ref> By 2017, the world maternal mortality rate had declined 44% since 1990; however, every day 808 women die from pregnancy or childbirth related causes.<ref name="unfpa.org23">{{cite web|title=Maternal health|url=http://www.unfpa.org/maternal-health|access-date=2017-01-29|publisher=United Nations Population Fund}}</ref> According to the [[United Nations Population Fund]] (UNFPA) 2017 report, about every 2 minutes a woman dies because of complications due to child birth or pregnancy. For every woman who dies, there are about 20 to 30 women who experience injury, infection, or other birth or pregnancy related complication.<ref name="unfpa.org23"/>

UNFPA estimated that 303,000 women died of pregnancy or childbirth related causes in 2015.<ref name="unfpa.org23"/><ref name="Ozimek-2018">{{cite journal | vauthors = Ozimek JA, Kilpatrick SJ | title = Maternal Mortality in the Twenty-First Century | language = English | journal = Obstetrics and Gynecology Clinics of North America | volume = 45 | issue = 2 | pages = 175–186 | date = June 2018 | pmid = 29747724 | doi = 10.1016/j.ogc.2018.01.004 | s2cid = 13683555 }}</ref> The WHO divides causes of maternal deaths into two categories: '''''direct obstetric deaths''''' and '''''indirect obstetric deaths.''''' Direct obstetric deaths are causes of death due to complications of pregnancy, [[birth]] or termination. For example, these could range from [[Postpartum bleeding|severe bleeding]] to [[Obstructed labour#Prognosis|obstructed labor]], for which there are highly effective interventions.<ref name="GDB20132">{{cite journal|vauthors=((GBD 2013 Mortality Causes of Death Collaborators))|date=January 2015|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013|journal=Lancet|volume=385|issue=9963|pages=117–71|doi=10.1016/S0140-6736(14)61682-2|pmc=4340604|pmid=25530442}}</ref><ref name="www.who.int"/> Indirect obstetric deaths are caused by pregnancy interfering or worsening an existing condition, like a heart problem.<ref name="www.who.int"/>

As women have gained access to [[family planning]] and skilled [[birth attendant]] with backup emergency obstetric care, the global maternal mortality ratio has fallen from 385 maternal deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015.<ref name="unfpa.org23"/><ref name="Ozimek-2018"/> Many countries halved their maternal death rates in the last 10 years.<ref name="unfpa.org23"/> Although attempts have been made to reduce maternal mortality, there is much room for improvement, particularly in low-resource regions. Over 85% of maternal deaths are in low-resource communities in [[Africa]] and [[Asia]].<ref name="unfpa.org23"/>  In higher resource regions, there are still significant areas with room for growth, particularly as they relate to racial and ethnic disparities and inequities in maternal mortality and morbidity rates.<ref name="Atrash-1992" /><ref name="Ozimek-2018"/>

Overall, maternal mortality is an important marker of the health of the country and reflects on its health infrastructure.<ref name="Atrash-1992" /> Lowering the amount of maternal death is an important goal of many health organizations world-wide.

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==Causes==

=== Direct obstetric deaths ===

==== Overview ====
Direct obstetric deaths are due to complications of pregnancy, birth, termination or complications arising from their management.<ref name="www.who.int"/>

The causes of maternal death vary by region and level of access. According to a study published in the ''[[The Lancet|Lancet]]'' which covered the period from 1990 to 2013, the most common causes of maternal death world-wide are [[postpartum bleeding]] (15%), complications from unsafe [[abortion]] (15%), [[hypertensive disorders of pregnancy]] (10%), [[postpartum infections]] (8%), and [[Obstructed labour|obstructed labor]] (6%).<ref name="GDB20132"/> Other causes include [[Embolism|blood clots]] (3%) and pre-existing conditions (28%).<ref name="WHO Fact Sheet 201423">{{cite web|title=Maternal mortality: Fact sheet N°348|url=https://www.who.int/mediacentre/factsheets/fs348/en/|access-date=20 June 2014|website=World Health Organization|publisher=WHO}}</ref>

==== Descriptions by condition ====
[[Postpartum bleeding]] happens when there is uncontrollable bleeding from the uterus, cervix or vaginal wall after birth. This can happen when the uterus does not contract correctly after birth, there is left over placenta in the uterus, or there are cuts in the cervix or vagina from birth.<ref>{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/overview-of-postpartum-hemorrhage|access-date=2021-11-12|website=www.uptodate.com}}</ref>

[[Hypertensive disorders of pregnancy]] happen when the body does not regulate blood pressure correctly. In pregnancy, this is due to changes at the level of the blood vessels, likely because of the [[placenta]].<ref>{{cite journal | vauthors = Eiland E, Nzerue C, Faulkner M | title = Preeclampsia 2012 | journal = Journal of Pregnancy | volume = 2012 | article-number = 586578 | date = 2012 | pmid = 22848831 | pmc = 3403177 | doi = 10.1155/2012/586578 | doi-access = free }}</ref> This includes medical conditions like [[gestational hypertension]] and [[pre-eclampsia]].

[[Postpartum infections]] are infections of the uterus or other parts of the reproductive tract after the resolution of a pregnancy. They are usually bacterial and cause fever, increased pain, and foul-smelling discharge.<ref>{{Cite web|title=CDC Reports Infection as a Major Cause of Maternal Death|url=https://www.sepsis.org/news/cdc-reports-infection-as-a-major-cause-of-maternal-death/|access-date=2021-11-13|website=Sepsis Alliance|language=en-US}}</ref>

[[Obstructed labor]] happens when the baby does not properly move into the pelvis and out of the body during labor. The most common cause of obstructed labor is when the baby's head is too big or angled at a way that does not allow it to pass through the pelvis and birth canal.<ref>{{cite journal | vauthors = Philpott RH | title = Obstructed labour | journal = Clinics in Obstetrics and Gynaecology | volume = 9 | issue = 3 | pages = 625–640 | date = December 1982 | pmid = 7172577 | doi = 10.1016/S0306-3356(21)00535-5 }}</ref>

[[Thrombus|Blood clots]] can occur in different vessels in the body, including vessels in the arms, legs, and lungs. They can cause problems in the lung, as well as travel to the heart or brain, leading to complications.<ref>{{Cite web|title=Blood Clots: Risks, Symptoms, Treatments, Prevention|url=https://my.clevelandclinic.org/health/diseases/17675-blood-clots|access-date=2021-11-13|website=Cleveland Clinic}}</ref>

==== Unsafe abortion ====
{{Main|Unsafe abortion}}
When [[abortion]] is legal and accessible, it is widely regarded as safer for the mother than carrying a pregnancy to term and delivery. In fact, a study published in the journal [[Obstetrics & Gynecology (journal)|Obstetrics & Gynecology]] reported that in the United States, carrying a pregnancy to term and delivering a baby comes with 14 times increased risk of death for the mother as compared to a legal abortion.<ref name="Raymond-2012">{{cite journal | vauthors = Raymond EG, Grimes DA | title = The comparative safety of legal induced abortion and childbirth in the United States | language = en-US | journal = Obstetrics and Gynecology | volume = 119 | issue = 2 Pt 1 | pages = 215–219 | date = February 2012 | pmid = 22270271 | doi = 10.1097/AOG.0b013e31823fe923 | s2cid = 25534071 }}</ref> However, in many regions of the world, abortion is not legal and can be unsafe for the mother.<ref name="Raymond-2012" /><ref name="Berer-2017">{{cite journal | vauthors = Berer M | title = Abortion Law and Policy Around the World: In Search of Decriminalization | journal = Health and Human Rights | volume = 19 | issue = 1 | pages = 13–27 | date = June 2017 | pmid = 28630538 | pmc = 5473035 }}</ref><ref>{{Cite web|title=Legality and Safety|url=https://www.guttmacher.org/global/abortion/legality-and-safety|access-date=2021-11-13|website=Guttmacher Institute|language=en}}</ref> Maternal deaths caused by improperly performed procedures are preventable and contribute 13% to the maternal mortality rate worldwide. This number is increased to 25% in countries where other causes of maternal mortality are low, such as in Eastern European and South American countries. This makes unsafe abortion practices the leading cause of maternal death worldwide.<ref name="Dixon-Mueller-2007">{{cite journal | vauthors = Dixon-Mueller R, Germain A | title = Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator | journal = American Journal of Public Health | volume = 97 | issue = 1 | pages = 45–51 | date = January 2007 | pmid = 16571693 | pmc = 1716248 | doi = 10.2105/AJPH.2005.068056 }}</ref>

Unsafe [[abortion]] is another major cause of maternal death worldwide. In regions where abortion is legal and accessible, abortion is safe and does not contribute greatly to overall rates of maternal death.<ref name="Ozimek-2018"/><ref name="Berer-2017" /><ref name="Raymond-2012" /> However, in regions where abortions are not legal, available, or regulated, unsafe abortion practices can cause significant rates of maternal death.<ref>{{Cite web|title=Preventing unsafe abortion|url=https://www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion|access-date=2021-11-13|website=www.who.int|language=en}}</ref>  According to the World Health Organization in 2009, every eight minutes a woman died from complications arising from unsafe abortions.<ref>{{Cite web|title=WHO {{!}} Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2003|url=https://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241596121/en/|access-date=2021-11-13|website=WHO}}</ref>

Unsafe abortion practices are defined by the WHO as procedures that are performed by someone without the appropriate training and/or ones that are performed in an environment that is not considered safe or clean.<ref name="Dixon-Mueller-2007" /><ref>World Health Organization, Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2000, 4th ed.</ref> Using this definition, the WHO estimates that out of the 45 million abortions that are performed each year globally, 19 million of these are considered unsafe, and 97% of these unsafe abortions occur in developing countries.<ref name="Dixon-Mueller-2007" />  Complications include hemorrhage, infection, sepsis and [[genital trauma]].<ref name="Haddad-2009">{{cite journal|vauthors=Haddad LB, Nour NM|year=2009|title=Unsafe abortion: unnecessary maternal mortality|journal=Reviews in Obstetrics & Gynecology|volume=2|issue=2|pages=122–6|pmc=2709326|pmid=19609407}}</ref>

==== Rates ====
[[File:Maternal Mortality in India - History inforgraphic.jpg|thumb|600x600px|Infographic - History of Maternal Mortality in India]]

There are four primary types of data sources that are used to collect abortion-related maternal mortality rates: confidential enquiries, registration data, verbal autopsy, and facility-based data sources. A verbal autopsy is a systematic tool that is used to collect information on the cause of death from laypeople and not medical professionals.<ref name="Gerdts-2015">{{cite journal|vauthors=Gerdts C, Tunçalp O, Johnston H, Ganatra B|date=September 2015|title=Measuring abortion-related mortality: challenges and opportunities|journal=Reproductive Health|language=En|volume=12|issue=1|article-number=87|doi=10.1186/s12978-015-0064-1|pmc=4572614|pmid=26377189 |doi-access=free }}</ref>

Confidential enquires for maternal deaths do not occur very often on a national level in most countries. Registration systems are usually considered the "gold-standard" method for mortality measurements. However, they have been shown to miss anywhere between 30 and 50% of all maternal deaths.<ref name="Gerdts-2015" /> Another concern for registration systems is that 75% of all global births occur in countries where vital registration systems do not exist, meaning that many maternal deaths occurring during these pregnancies and deliveries may not be properly record through these methods. There are also issues with using verbal autopsies and other forms of survey in recording maternal death rates. For example, the family's willingness to participate after the loss of a loved one, misclassification of the cause of death, and under-reporting all present obstacles to the proper reporting of maternal mortality causes. Finally, a potential issue with facility-based data collection on maternal mortality is the likelihood that women who experience abortion-related complications to seek care in medical facilities. This is due to fear of social repercussions or legal activity in countries where unsafe abortion is common since it is more likely to be legally restrictive and/or more highly stigmatizing.<ref name="Gerdts-2015" /> Another concern for issues related to errors in proper reporting for accurate understanding of maternal mortality is the fact that global estimates of maternal deaths related to a specific cause present those related to abortion as a proportion of the total mortality rate. Therefore, any change, whether positive or negative, in the abortion-related mortality rate is only compared relative to other causes, and this does not allow for proper implications of whether abortions are becoming more safe or less safe with respect to the overall mortality of women.<ref name="Gerdts-2015" />

==== Prevention ====
The prevention and reduction of maternity death is one of the [[United Nations]]' [[Sustainable Development Goals]], specifically [[Sustainable Development Goal 3|Goal 3]], "Good health and well being".  Promoting effective [[Birth control|contraceptive]] use and information distributed to a wider population, with access to high-quality care, can make steps towards reducing the number of unsafe abortions. For nations that allow contraceptives, programs should be instituted to allow the easier accessibility of these medications.<ref name="Haddad-2009" /> However, this alone will not eliminate the demand for safe services, awareness on safe abortion services, health education on prenatal check ups and proper implementation of diets during pregnancy and lactation also contributes to its prevention.<ref name="pmid110209312">{{cite journal|vauthors=Bongaarts J, Westoff CF|date=September 2000|title=The potential role of contraception in reducing abortion|journal=Studies in Family Planning|volume=31|issue=3|pages=193–202|doi=10.1111/j.1728-4465.2000.00193.x|pmid=11020931|s2cid=14424881}}</ref>

=== Indirect obstetric deaths ===
Indirect obstetric deaths are caused by preexisting health problem worsened by pregnancy or newly developed health problem unrelated to pregnancy .<ref>{{cite journal|vauthors=Khlat M, Ronsmans C|date=February 2000|title=Deaths attributable to childbearing in Matlab, Bangladesh: indirect causes of maternal mortality questioned|journal=American Journal of Epidemiology|volume=151|issue=3|pages=300–6|doi=10.1093/oxfordjournals.aje.a010206|pmid=10670555|doi-access=free}}</ref><ref name="www.who.int" /> Fatalities during but unrelated to a pregnancy are termed ''accidental'', ''incidental'', or non-obstetrical maternal deaths.

Indirect causes include [[malaria]], [[anemia]],<ref>The most common causes of anemia/anaemia are poor nutrition, iron, and other micronutrient deficiencies, which are in addition to malaria, hookworm, and schistosomiasis (2005 WHO report p45).</ref> [[HIV/AIDS]], and [[cardiovascular disease]], all of which may complicate pregnancy or be aggravated by it.<ref>{{cite journal | vauthors = Nair M, Nelson-Piercy C, Knight M | title = Indirect maternal deaths: UK and global perspectives | journal = Obstetric Medicine | volume = 10 | issue = 1 | pages = 10–15 | date = March 2017 | pmid = 28491125 | pmc = 5405948 | doi = 10.1177/1753495X16689444 }}</ref> Risk factors associated with increased maternal death include the age of the mother, obesity before becoming pregnant, other pre-existing chronic medical conditions, and [[Caesarean section|cesarean delivery]].<ref name="Molina-2017">{{cite journal | vauthors = Molina RL, Pace LE | title = A Renewed Focus on Maternal Health in the United States | journal = The New England Journal of Medicine | volume = 377 | issue = 18 | pages = 1705–1707 | date = November 2017 | pmid = 29091560 | doi = 10.1056/NEJMp1709473 }}</ref><ref name="ACOG_SMFM_20162">{{cite journal | vauthors = Kilpatrick SK, Ecker JL | title = Severe maternal morbidity: screening and review | journal = American Journal of Obstetrics and Gynecology | volume = 215 | issue = 3 | pages = B17–B22 | date = September 2016 | pmid = 27560600 | doi = 10.1016/j.ajog.2016.07.050 | doi-access = free }} Cited in CDC 2017 report.</ref>

=== Risk factors ===
According to a 2004 [[WHO]] publication, sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers,<ref name="World Health Organisation">{{cite web|title=Maternal mortality|url=https://www.who.int/mediacentre/factsheets/fs348/en/|publisher=World Health Organisation}}</ref> especially adolescents aged 15 years or younger.<ref name="Conde-Agudelo A 20042">{{cite journal|vauthors=Conde-Agudelo A, Belizán JM, Lammers C|date=February 2005|title=Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study|journal=American Journal of Obstetrics and Gynecology|volume=192|issue=2|pages=342–9|doi=10.1016/j.ajog.2004.10.593|pmid=15695970}}</ref> Adolescents have higher risks for postpartum hemorrhage, [[endometritis]], [[operative vaginal delivery]], [[episiotomy]], low [[birth weight]], [[preterm delivery]], and small-for-gestational-age infants, all of which can lead to maternal death.<ref name="Conde-Agudelo A 20042" /> The leading cause of death for girls at the age of 15 in [[Developing country|developing countries]] is complication through pregnancy and childbirth. They have more pregnancies, on average, than women in developed countries, and it has been shown that 1 in 180 15-year-old girls in developing countries who become pregnant will die due to complications during pregnancy or childbirth. This is compared to women in developed countries, where the likelihood is 1 in 4900 live births.<ref name="World Health Organisation"/> However, in the United States, as many women of older age continue to have children, the maternal mortality rate has risen in some states, especially among women over 40 years old.<ref name="Molina-2017" />

Women in low-income countries face a lifetime risk of maternal death—defined as the probability that a 15-year-old girl will die from maternal causes—of 1 in 66, versus 1 in 7 933 in high-income countries.<ref>{{cite web |title=Maternal mortality |publisher=World Health Organization |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |access-date=6 August 2025}}</ref>

Structural support and family support influences maternal outcomes.<ref>{{cite journal | vauthors = Upadhyay P, Liabsuetrakul T, Shrestha AB, Pradhan N | title = Influence of family members on utilization of maternal health care services among teen and adult pregnant women in Kathmandu, Nepal: a cross sectional study | journal = Reproductive Health | volume = 11 | issue = 1 | article-number = 92 | date = December 2014 | pmid = 25539759 | pmc = 4290463 | doi = 10.1186/1742-4755-11-92 | doi-access = free }}</ref> Furthermore, social disadvantage and [[social isolation]] adversely affects maternal health which can lead to increases in maternal death.<ref>{{cite journal | vauthors = Morgan KJ, Eastwood JG | title = Social determinants of maternal self-rated health in South Western Sydney, Australia | journal = BMC Research Notes | volume = 7 | issue = 1 | article-number = 51 | date = January 2014 | pmid = 24447371 | pmc = 3899616 | doi = 10.1186/1756-0500-7-51 | doi-access = free }}</ref> Additionally, lack of access to [[Birth attendant|skilled medical care during childbirth]], the travel distance to the nearest clinic to receive proper care,  number of prior births, barriers to accessing [[Prenatal care|prenatal]] medical care and poor infrastructure all increase maternal deaths.<ref name="World Health Organisation"/>

=== Causes of maternal death in the US ===
Pregnancy-related deaths between 2011 and 2014 in the United States have been shown to have major contributions from non-communicable diseases and conditions, and the following are some of the more common causes related to maternal death:<ref name="CDC-2020"/> [[cardiovascular disease]]s (15.2%.), non-cardiovascular diseases (14.7%), [[infection]] or [[sepsis]] (12.8%), [[Bleeding|hemorrhage]] (11.5%), [[cardiomyopathy]] (10.3%), [[pulmonary embolism]] (9.1%), [[Stroke|cerebrovascular accidents]] (7.4%), [[Hypertensive disease of pregnancy|hypertensive disorders of pregnancy]] (6.8%), [[amniotic fluid embolism]] (5.5%), and [[anesthesia]] complications (0.3%).

In June 2022, the U.S. Supreme Court overturned Roe v. Wade (Dobbs v. Jackson Women's Health Organization), removing federal abortion protections.<ref>{{cite web |title=Supreme Court overturns Roe v. Wade |publisher=NPR |date=24 June 2022 |url=https://www.npr.org/2022/06/24/1102305878/supreme-court-abortion-roe-v-wade-decision-overturn |access-date=6 August 2025}}</ref> By 2020, maternal mortality rates were 62 % higher in abortion-restriction states than in abortion-access states (28.8 vs. 17.8 per 100 000 births).<ref>{{cite web |title=US maternal health divide: limited services, worse outcomes |publisher=Commonwealth Fund |date=December 2022 |doi=10.26099/z7dz-8211 |url=https://www.commonwealthfund.org/publications/issue-briefs/2022/dec/us-maternal-health-divide-limited-services-worse-outcomes |access-date=6 August 2025| vauthors = Declercq E, Barnard-Mayers R, Zephyrin L, Johnson K }}</ref> Analysis of CDC data (2019–2023) indicates that mothers in abortion-ban states are twice as likely to die during pregnancy, childbirth, or postpartum than those in states with legal abortion access.<ref>{{cite web |title=Maternal mortality and abortion bans |date=23 April 2025 |publisher=Gender Equity Policy Institute |url=https://thegepi.org/maternal-mortality-abortion-bans/ |access-date=6 August 2025}}</ref>

===Three delays model===
The three delays model describes three critical factors that inhibit women from receiving appropriate maternal health care.<ref name="WHO-2">{{Cite web|url=https://www.who.int/bulletin/volumes/93/6/14-146571/en/|archive-url=https://web.archive.org/web/20150606205340/http://www.who.int/bulletin/volumes/93/6/14-146571/en/|archive-date=June 6, 2015|title=WHO {{!}} Applying the lessons of maternal mortality reduction to global emergency health|website=WHO|access-date=2019-08-02}}</ref> These factors include:

# Delay in seeking care
# Delay in reaching care
# Delay in receiving adequate and appropriate care<ref name="Thaddeus-1994">{{cite journal | vauthors = Thaddeus S, Maine D | title = Too far to walk: maternal mortality in context | journal = Social Science & Medicine | volume = 38 | issue = 8 | pages = 1091–1110 | date = April 1994 | pmid = 8042057 | doi = 10.1016/0277-9536(94)90226-7 | s2cid = 12259036 }}</ref>

Delays in seeking care are due to the decisions made by the women who are pregnant and/or other decision-making individuals. Decision-making individuals can include a spouse and family members.<ref name="Thaddeus-1994" /> Examples of reasons for delays in seeking care include lack of knowledge about when to seek care, inability to afford health care, and women needing permission from family members.<ref name="WHO-2" /><ref name="Thaddeus-1994" />

Delays in reaching care include factors such as limitations in transportation to a medical facility, lack of adequate medical facilities in the area, and lack in confidence in medicine.<ref>{{cite journal | vauthors = Barnes-Josiah D, Myntti C, Augustin A | title = The "three delays" as a framework for examining maternal mortality in Haiti | journal = Social Science & Medicine | volume = 46 | issue = 8 | pages = 981–993 | date = April 1998 | pmid = 9579750 | doi = 10.1016/S0277-9536(97)10018-1 }}</ref>

Delays in receiving adequate and appropriate care may result from an inadequate number of trained providers, lack of appropriate supplies, and the lack of urgency or understanding of an emergency.<ref name="WHO-2" /><ref name="Thaddeus-1994" />

The three delays model illustrates that there are a multitude of complex factors, both socioeconomic and cultural, that can result in maternal death.<ref name="WHO-2" />

==Measurement==

The four measures of maternal death are the [[maternal mortality ratio]] (MMR), maternal mortality rate, lifetime risk of maternal death and proportion of maternal deaths among deaths of women of reproductive years (PM).

Maternal mortality ratio (MMR) is the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time-period.<ref name="maternalmortalitydata.org">{{cite web|url=http://www.maternalmortalitydata.org/Definitions.html|title=MME Info|publisher=maternalmortalitydata.org|archive-url=https://web.archive.org/web/20131014105625/http://maternalmortalitydata.org/Definitions.html|archive-date=October 14, 2013}}</ref> The MMR is used as a measure of the quality of a health care system.

Maternal mortality rate (MMRate) is the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women.<ref name="maternalmortalitydata.org" />

Lifetime risk of maternal death is a calculated prediction of a woman's risk of death after each consecutive pregnancy.<ref name="WHO">{{Cite web|url=https://www.who.int/bulletin/volumes/87/4/07-048280/en/|archive-url=https://web.archive.org/web/20110805084245/http://www.who.int/bulletin/volumes/87/4/07-048280/en/|archive-date=August 5, 2011|title=WHO {{!}} The lifetime risk of maternal mortality: concept and measurement|website=WHO|access-date=2019-08-01}}</ref> The calculation pertains to women during their reproductive years.<ref name="WHO" /> The adult lifetime risk of maternal mortality can be derived using either the maternal mortality ratio (MMR), or the maternal mortality rate (MMRate).<ref name="maternalmortalitydata.org" />

Proportion of maternal deaths among deaths of women of reproductive age (PM) is
the number of maternal deaths in a given time period divided by the total deaths among women aged 15–49 years.<ref name="UNICEF, W. 20123"/>

Approaches to measuring maternal mortality include civil registration system, household surveys, [[census]], reproductive age mortality studies (RAMOS) and verbal autopsies.<ref name="UNICEF, W. 20123">[UNICEF, W. (2012). UNFPA, World Bank (2012) [http://apps.who.int/iris/bitstream/10665/44874/1/9789241503631_eng.pdf Trends in maternal mortality: 1990 to 2010]. WHO, UNICEF.]</ref> The most common household survey method, recommended by the WHO as time- and cost-effective, is the [[sisterhood method]].<ref>{{cite web|title=The Sisterhood Method for Estimating Maternal Mortality: Guidance notes for potential users|url=http://whqlibdoc.who.int/hq/1997/WHO_RHT_97.28.pdf?ua=1|website=Who.org|publisher=World Health Organization|access-date=13 March 2015}}</ref>

===Trends===
The United Nations Population Fund (UNFPA; formerly known as the United Nations Fund for Population Activities) have established programs that support efforts in reducing maternal death. These efforts include education and training for midwives, supporting access to emergency services in obstetric and newborn care networks, and providing essential drugs and family planning services to pregnant women or those planning to become pregnant.<ref name="unfpa.org23"/> They also support efforts for review and response systems regarding maternal deaths.

According to the 2010 [[United Nations Population Fund]] report, low-resource nations account for ninety-nine percent of maternal deaths with the majority of those deaths occurring in Sub-Saharan Africa and Southern Asia.<ref name="UNICEF, W. 20123"/> Globally, high and middle income countries experience lower maternal deaths than low income countries. The [[Human Development Index]] (HDI) accounts for between 82 and 85 percent of the maternal mortality rates among countries.<ref>{{cite journal | vauthors = Lee KS, Park SC, Khoshnood B, Hsieh HL, Mittendorf R | title = Human development index as a predictor of infant and maternal mortality rates | journal = The Journal of Pediatrics | volume = 131 | issue = 3 | pages = 430–3 | date = September 1997 | pmid = 9329421 | doi = 10.1016/S0022-3476(97)80070-4 }}</ref> In most cases, high rates of maternal deaths occur in the same countries that have high rates of [[infant mortality]]. These trends are a reflection that higher income countries have stronger healthcare infrastructure, more doctors, use more advanced medical technologies and have fewer barriers to accessing care than low income countries. In low income countries, the most common cause of maternal death is [[obstetrical hemorrhage]], followed by hypertensive disorders of pregnancy. This is contrast to high income countries, for which the most common cause is [[Thrombosis|thromboembolism]].<ref name="uppsala">Venös tromboembolism (VTE) - Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008</ref>

Between 1990 and 2015, the maternal mortality ratio has decreased from 385 deaths per 100,000 live births to 216 maternal deaths per 100,000 live births.<ref name="unfpa.org23"/><ref>{{cite web|title=Maternal Morality Comparison: USA vs. Israel vs. Europe|url=https://juravin.com/research/world-health-safety/maternal-mortality-comparison-usa-vs-israel-vs-best-of-europe-germany-france-italy/|website=Juravin|date=19 January 2019|access-date=2 July 2019}}{{Dead link|date=October 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> Some factors that have been attributed to the decreased maternal deaths seen between this period are in part to the access that women have gained to family planning services and skilled birth attendance, meaning a midwife, doctor, or trained nurse), with back-up obstetric care for emergency situations that may occur during the process of labor.<ref name="unfpa.org23"/> This can be examined further by looking at statistics in some areas of the world where inequities in access to health care services reflect an increased number of maternal deaths. The high maternal death rates also reflect disparate access to health services between resource communities and those that are high-resource or affluent.<ref name="World Health Organisation"/>

From 2000 to 2020, the global maternal mortality ratio declined 34.8%—from 342 to 223 deaths per 100,000 live births—since 2000; however, over 700 women still died each day from preventable pregnancy- or childbirth-related causes. According to the World Health Organization, in 2023 a maternal death occurred almost every two minutes.<ref>{{cite web |title=Maternal mortality |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |access-date=6 August 2025 |publisher=World Health Organization}}</ref><ref>{{cite journal |last=Chou |first=Diana |year=2023 |title=Global causes of maternal death: A WHO systematic analysis |journal=The Lancet Global Health |volume=11 |issue=2 |pages=e179–e186 |doi=10.1016/S2214-109X(23)00247-4 |pmid=37474218 |doi-access=free}}</ref> In 2023, just over 90 % of maternal deaths occurred in low- and lower-middle-income countries. The maternal mortality ratio in these countries was 346 per 100 000 live births, compared with 10 per 100 000 live births in high-income countries. In high-income settings, racial, ethnic, and income disparities continue to impact maternal outcomes.<ref>{{cite web |title=Maternal mortality |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |access-date=6 August 2025 |publisher=World Health Organization}}</ref>

==Prevention==
According to [[UNFPA]], there are four essential elements for prevention of maternal death.<ref name="unfpa.org23" /> These include, [[prenatal care]], assistance with birth, access to emergency obstetric care and adequate postnatal care. It is recommended that expectant mothers receive at least four antenatal visits to check and monitor the health of mother and [[fetus]]. Second, skilled birth attendance with emergency backup such as doctors, nurses and [[midwives]] who have the skills to manage normal deliveries and recognize the onset of complications. Third, emergency [[obstetric]] care to address the major causes of maternal death which are [[hemorrhage]], [[sepsis]], unsafe abortion, [[hypertensive]] disorders and [[obstructed labour|obstructed labor]]. Lastly, postnatal care which is the six weeks following delivery. During this time, bleeding, sepsis and hypertensive disorders can occur, and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker to assess the health of both mother and child in the postnatal period is strongly recommended.

Additionally, reliable access to information, compassionate counseling and quality services for the management of any issues that arise from abortions (whether safe or unsafe) can be beneficial in reducing the number of maternal deaths.<ref name="Dixon-Mueller-2007" /> In regions where abortion is legal,  abortion practices need to be safe in order to effectively reduce the number of maternal deaths related to abortion.

Maternal Death Surveillance and Response is another strategy that has been used to prevent maternal death. This is one of the interventions proposed to reduce maternal mortality where maternal deaths are continuously reviewed to learn the causes and factors that led to the death. The information from the reviews is used to make recommendations for action to prevent future similar deaths.<ref>{{cite book|last1=World Health Organization and partner organizations|url=https://www.who.int/maternal_child_adolescent/documents/maternal_death_surveillance/en/|archive-url=https://web.archive.org/web/20141013085444/http://www.who.int/maternal_child_adolescent/documents/maternal_death_surveillance/en/|archive-date=October 13, 2014|title=Maternal death surveillance and response: technical guidance. Information for action to prevent maternal death|date=2013|publisher=WHO press|isbn=978-92-4-150608-3|location=Switzerland|page=128|access-date=4 October 2017}}</ref> Maternal and perinatal death reviews have been in practice for a long time worldwide, and the [[World Health Organization]] (WHO) introduced the Maternal and Perinatal Death Surveillance and Response (MPDSR) with a guideline in 2013. Studies have shown that acting on recommendations from MPDSR can reduce maternal and perinatal mortality by improving quality of care in the community and health facilities.

According to a 2023 systematic review published by the [[Patient-Centered Outcomes Research Institute|Patient Centered Outcomes Research Institute]] (PCORI) and the [[Agency for Healthcare Research and Quality]] (AHRQ), "More than 60 percent of pregnancy-related deaths are considered preventable".<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/postpartum-care-one-year/research |title=Postpartum Care up to 1 Year After Pregnancy: A Systematic Review and Meta-Analysis |date=2023-06-02 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer261 |url-access=subscription |vauthors=Saldanha IJ, Adam GP, Kanaan G, Zahradnik ML, Steele DW, Danilack VA, Peahl AF, Chen KK, Stuebe AM, Balk EM}}</ref> The World Health Organization (WHO) has developed a global goal to end [[preventable death]] related to maternal mortality.<ref name="World Health Organisation" /> A major goal of this strategy is to identify and address the causes of maternal and reproductive morbidities and mortalities. This strategy aims to address inequalities in access to reproductive, maternal, and newborn services, as well as the quality of care with universal health coverage. Maternal mortality is difficult to measure. Health information systems, such as the CRVS (Civil registration and Vital Statistics), in most low-income countries are weak. Therefore, these systems cannot provide accurate assessments of maternal mortality. Even estimates derived from complete system such as the CRVs, suffer misclassification, and underreporting statistics of maternal death. The WHO strategy also aims to ensure quality data collection in order to better respond to the needs of women and girls while improving the equity and quality of care provided to women.<ref>{{Cite web |title=Maternal mortality |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |access-date=2023-12-11 |website=www.who.int |language=en}}</ref>

=== Prenatal care ===
It was estimated that in 2015, a total of 303,000 women died due to causes related to pregnancy or childbirth.<ref name="unfpa.org23" /> The majority of these were due to severe bleeding, sepsis or infections, eclampsia, obstructed labor, and consequences from unsafe abortions. Most of these causes are either preventable or have highly effective interventions.<ref name="unfpa.org23" /> An important factor that contributes to the maternal mortality rate is access and opportunity to receive prenatal care. Women who do not receive prenatal care are between three and four times more likely to die from complications resulting from pregnancy or delivery than those who receive prenatal care. Even in high-resource countries, many women do not receive the appropriate preventative or prenatal care. For example, 25% of women in the United States do not receive the recommended number of prenatal visits. This number increases for women among traditionally marginalized populations—32% of African American women and 41% for American Indian and Alaska Native women do not receive the recommended preventative health services prior to delivery.<ref>{{Cite web|url=https://www.mhtf.org/topics/maternal-health-in-the-united-states/|title=Maternal Health in the United States|date=2015-08-14|website=Maternal Health Task Force |access-date=2018-11-09}}</ref>

In 2023, a study reported that deaths among  Native American women was three-and-a-half times that of white women. The report attributed the high rate in part to the fact that Native American women are cared for under a poorly funded Federal Health Care System that is so stretched that the average monthly visit lasts only from three to seven minutes. Such a short visit allows neither time for performing an adequate health assessment nor time for the patient to discuss any problems she may be experiencing.<ref>{{cite web |title=Sharp rise in deaths among pregnant women and new mothers |url=https://video.azpbs.org/video/at-risk-1676327693/ |website=PBS Newshour |access-date=February 13, 2023}}</ref>

===Medical technologies===
The decline in maternal deaths has been due largely to improved [[asepsis|aseptic techniques]], better fluid management and quicker access to [[blood transfusion]]s, and better [[prenatal care]].

Technologies have been designed for resource poor settings that have been effective in reducing maternal deaths as well. The [[non-pneumatic anti-shock garment]] is a low-technology pressure device that decreases blood loss, restores vital signs and helps buy time in delay of women receiving adequate emergency care during [[obstetric hemorrhage]].<ref>{{cite journal | vauthors = Miller S, Turan JM, Dau K, Fathalla M, Mourad M, Sutherland T, Hamza S, Lester F, Gibson EB, Gipson R, Nada K, Hensleigh P  | title = Use of the non-pneumatic anti-shock garment (NASG) to reduce blood loss and time to recovery from shock for women with obstetric haemorrhage in Egypt | journal = Global Public Health | volume = 2 | issue = 2 | pages = 110–24 | year = 2007 | pmid = 19280394 | doi = 10.1080/17441690601012536 | s2cid = 11392183 }} (NASG)</ref> It has proven to be a valuable resource. [[Condoms]] used as uterine [[tamponade]]s have also been effective in stopping post-partum hemorrhage.<ref>{{cite journal | vauthors = Akhter S, Begum MR, Kabir Z, Rashid M, Laila TR, Zabeen F | title = Use of a condom to control massive postpartum hemorrhage | journal = MedGenMed | volume = 5 | issue = 3 | page = 38 | date = September 2003 | pmid = 14600674 | url = http://mnhtech.org/uploads/Use%20of%20a%20Condom%20to%20Control%20Massive%20Postpartum%20Hemorrhage.pdf  }}</ref>

=== Medications and surgical management ===
Some maternal deaths can be prevented through medication use. Injectable oxytocin can be used to prevent death due to [[postpartum bleeding]].<ref name="WHO Fact Sheet 201423" /> Additionally, postpartum infections can be treated using antibiotics. In fact, the use of broad-spectrum antibiotics both for the prevention and treatment of maternal infection is common in low-income countries.<ref>{{cite book |chapter=Background |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK327082/ |title=WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections |date=2015 |publisher=World Health Organization }}</ref> Maternal death due to [[eclampsia]] can also be prevented through the use of medications such as magnesium sulfate.<ref name="WHO Fact Sheet 201423" />

Many complications can be managed with procedures and/or surgery if there is access to a qualified surgeon and appropriate facilities and supplies. For example, the contents of the uterus can be cleaned if there is concern for remaining pregnancy tissue or infection. If there is concern for excess bleeding, special ties, stitches or tools ([[Bakri balloon|Bakri Balloon]]) can be placed if there is concern for excess bleeding.<ref>{{cite journal | vauthors = Shah M, Wright JD | title = Surgical intervention in the management of postpartum hemorrhage | journal = Seminars in Perinatology | volume = 33 | issue = 2 | pages = 109–115 | date = April 2009 | pmid = 19324240 | doi = 10.1053/j.semperi.2008.12.006 }}</ref>

===Public health===
[[File:Maternal health (4798750001).jpg|thumb|In April 2010 [[Sierra Leone]] launched free healthcare for pregnant and breastfeeding women.]]

A [[public health]] approach to addressing maternal mortality includes gathering information on the scope of the problem, identifying key causes, and implementing interventions, both prior to pregnancy and during pregnancy, to combat those causes and prevent maternal mortality.<ref name="Rai-2012">{{cite journal | vauthors = Rai SK, Anand K, Misra P, Kant S, Upadhyay RP | title = Public health approach to address maternal mortality | journal = Indian Journal of Public Health | volume = 56 | issue = 3 | pages = 196–203 | date = 2012 | pmid = 23229211 | doi = 10.4103/0019-557x.104231 | doi-access = free }}</ref>

Public health has a role to play in the analysis of maternal death. One important aspect in the review of maternal death and its causes are Maternal Mortality Review Committees or Boards. The goal of these review committees are to analyze each maternal death and determine its cause. After this analysis, the information can be combined in order to determine specific interventions that could lead to preventing future maternal deaths. These review boards are generally comprehensive in their analysis of maternal deaths, examining details that include [[mental health]] factors, public transportation, [[chronic illnesses]], and [[substance use disorder]]s. All of this information can be combined to give a detailed picture of what is causing maternal mortality and help to determine recommendations to reduce their impact.<ref>{{Cite web|url=http://reviewtoaction.org/Report_from_Nine_MMRCs|title=Review to Action|website=reviewtoaction.org|language=en|access-date=2018-11-20|archive-date=2018-11-21|archive-url=https://web.archive.org/web/20181121021919/http://reviewtoaction.org/Report_from_Nine_MMRCs}}</ref>

Many states within the US are taking Maternal Mortality Review Committees a step further and are collaborating with various professional organizations to improve quality of perinatal care. These teams of organizations form a "perinatal quality collaborative" (PQC) and include state health departments, the state hospital association and clinical professionals such as doctors and nurses. These PQCs can also involve community health organizations, Medicaid representatives, Maternal Mortality Review Committees and patient advocacy groups. By involving all of these major players within maternal health, the goal is to collaborate and determine opportunities to improve quality of care. Through this collaborative effort, PQCs can aim to make impacts on quality both at the direct patient care level and through larger system devices like policy. It is thought that the institution of PQCs in California was the main contributor to the maternal mortality rate decreasing by 50% in the years following. The PQC developed review guides and quality improvement initiatives aimed at the most preventable and prevalent maternal deaths: those due to bleeding and high blood pressure. Success has also been observed with PQCs in Illinois and Florida.<ref>{{cite journal | vauthors = Main EK | title = Reducing Maternal Mortality and Severe Maternal Morbidity Through State-based Quality Improvement Initiatives | journal = Clinical Obstetrics and Gynecology | volume = 61 | issue = 2 | pages = 319–331 | date = June 2018 | pmid = 29505420 | doi = 10.1097/grf.0000000000000361 | s2cid = 3673030 }}</ref>

Several interventions prior to pregnancy have been recommended in efforts to reduce maternal mortality. Increasing access to reproductive healthcare services, such as family planning services and safe abortion practices, is recommended in order to prevent unintended pregnancies.<ref name="Rai-2012" /> Several countries, including India, Brazil, and Mexico, have seen some success in efforts to promote the use of reproductive healthcare services.<ref>{{cite journal | vauthors = ((GBD 2015 Maternal Mortality Collaborators)) | title = Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1775–1812 | date = October 2016 | pmid = 27733286 | pmc = 5224694 | doi = 10.1016/S0140-6736(16)31470-2 }}</ref> Other interventions include high quality [[sex education]], which includes pregnancy prevention and [[sexually transmitted infection]] (STI) prevention and treatment. By addressing STIs, this not only reduces perinatal infections, but can also help reduce [[ectopic pregnancy]] caused by STIs.<ref name="Centers for Disease Control and Prevention-2001">{{cite book | veditors = Berg C, Danel I, Atrash H, Zane S, Bartlett L | title = Strategies to reduce pregnancy-related deaths: from identification and review to action. | location = Atlanta | publisher = Centers for Disease Control and Prevention | date = 2001 | url = http://www.amchp.org/programsandtopics/womens-health/Focus%20Areas/MMR/Documents/2001-Strategies-to-Reduce-PR-Deaths.pdf}}</ref> Adolescent mothers are between two and five times more likely to die than a female twenty years or older. Access to reproductive services and sex education could make a large impact, specifically on adolescents, who are generally uneducated in regards to carrying a healthy pregnancy. Education level is a strong predictor of maternal health as it gives women the knowledge to seek care when it is needed.<ref name="Rai-2012" /> Public health efforts can also intervene during pregnancy to improve maternal outcomes. Areas for intervention have been identified in access to care, public knowledge, awareness about signs and symptoms of pregnancy complications, and improving relationships between healthcare professionals and expecting mothers.<ref name="Centers for Disease Control and Prevention-2001" />

Access to care during pregnancy is a significant issue in the face of maternal mortality. "Access" encompasses a wide range of potential difficulties including costs, location of healthcare services, availability of appointments, availability of trained health care workers, transportation services, and cultural or language barriers that could inhibit a woman from receiving proper care.<ref name="Centers for Disease Control and Prevention-2001" /> For women carrying a pregnancy to term, access to necessary antenatal (prior to delivery) healthcare visits is crucial to ensuring healthy outcomes. These antenatal visits allow for early recognition and treatment of complications, treatment of infections and the opportunity to educate the expecting mother on how to manage her current pregnancy and the health advantages of spacing pregnancies apart.<ref name="Rai-2012" />

Access to birth at a facility with a skilled healthcare provider present has been associated with safer deliveries and better outcomes.<ref name="Rai-2012" /> The two areas bearing the largest burden of maternal mortality, Sub-Saharan Africa and South Asia, also had the lowest percentage of births attended by a skilled provider, at just 45% and 41% respectively.<ref>{{cite web | title = The State of the World's Children 2009: Maternal and newborn health. | publisher = United Nations Children's Fund (UNICEF) | date = December 2008 | url = http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf | access-date = 2018-11-20 | archive-date = 2021-06-11 | archive-url = https://web.archive.org/web/20210611034544/https://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf }}</ref> Emergency obstetric care is also crucial in preventing maternal mortality by offering services like emergency cesarean sections, blood transfusions, antibiotics for infections and assisted vaginal delivery with forceps or vacuum.<ref name="Rai-2012" /> In addition to physical barriers that restrict access to healthcare, financial barriers also exist. Close to one out of seven women of child-bearing age have no health insurance. This lack of insurance impacts access to pregnancy prevention, treatment of complications, as well as perinatal care visits contributing to maternal mortality.<ref>{{cite journal | vauthors = Lu MC | title = Reducing Maternal Mortality in the United States | journal = JAMA | volume = 320 | issue = 12 | pages = 1237–1238 | date = September 2018 | pmid = 30208484 | doi = 10.1001/jama.2018.11652 | s2cid = 205095772 }}</ref>

By increasing public knowledge and awareness through health education programs about pregnancy, including signs of complications that need addressed by a healthcare provider, this will increase the likelihood of an expecting mother to seek help when it is necessary.<ref name="Centers for Disease Control and Prevention-2001" /> Higher levels of education have been associated with increased use of contraception and family planning services as well as antenatal care.<ref>{{cite journal | vauthors = Weitzman A | title = The effects of women's education on maternal health: Evidence from Peru | journal = Social Science & Medicine | volume = 180 | pages = 1–9 | date = May 2017 | pmid = 28301806 | pmc = 5423409 | doi = 10.1016/j.socscimed.2017.03.004 }}</ref> Addressing complications at the earliest sign of a problem can improve outcomes for expecting mothers, which makes it extremely important for a pregnant woman to be knowledgeable enough to seek healthcare for potential complications.<ref name="Rai-2012" /> Improving the relationships between patients and the healthcare system as a whole will make it easier for a pregnant woman to feel comfortable seeking help. Good communication between patients and providers, as well as cultural competence of the providers, could also assist in increasing compliance with recommended treatments.<ref name="Centers for Disease Control and Prevention-2001" />

Another important preventive measure being implemented is specialized education for mothers. Doctors and medical professionals providing simple information to women, especially women in lower socioeconomic areas will decrease the miscommunication that often occurs between doctors and patients.<ref>{{cite journal | vauthors = Vilda D, Wallace M, Dyer L, Harville E, Theall K | title = Income inequality and racial disparities in pregnancy-related mortality in the US | journal = SSM - Population Health | volume = 9 | article-number = 100477 | date = December 2019 | pmid = 31517017 | pmc = 6734101 | doi = 10.1016/j.ssmph.2019.100477 }}</ref> Training health care professionals will be another important aspect in decreasing the rate of maternal death,<ref>{{Cite journal|last1=Roth|first1=Louise Marie|last2=Henley|first2=Megan M.|date=2012|title=Unequal Motherhood: Racial-Ethnic and Socioeconomic Disparities in Cesarean Sections in the United States|journal=Social Problems|volume=59|issue=2|pages=207–227|doi=10.1525/sp.2012.59.2.207|issn=0037-7791|jstor=10.1525/sp.2012.59.2.207}}</ref> "The study found that white medical students and residents often believed incorrect and sometimes 'fantastical' biological fallacies about racial differences in patients. For these assumptions, researchers blamed not individual prejudice but deeply ingrained unconscious stereotypes about people of color, as well as physicians' difficulty in empathizing with patients whose experiences differ from their own."<ref>{{Cite web|url=https://static1.squarespace.com/static/5949dcd872af65c387d48484/t/5d263a062c708800011eed6d/1562786313617/Why+America%E2%80%99s+Black+Mothers+and+Babies+Are+in+a+Life-or-Death+Crisis+-+The+New+York+Times.pdf|title=Why America's Black Mothers and Babies Are in a Life-or-Death Crisis|last=Villarosa|first=Linda|date=April 11, 2018|website=The New York Times Magazine|access-date=2019-12-06|archive-date=2021-07-01|archive-url=https://web.archive.org/web/20210701073052/https://static1.squarespace.com/static/5949dcd872af65c387d48484/t/5d263a062c708800011eed6d/1562786313617/Why+America%E2%80%99s+Black+Mothers+and+Babies+Are+in+a+Life-or-Death+Crisis+-+The+New+York+Times.pdf}}</ref>

===Policy===

The biggest global policy initiative for maternal health came from the United Nations' Millennium Declaration which created the [[Millennium Development Goals]]. In 2012, this evolved at the United Nations Conference on Sustainable Development to become the Sustainable Development Goals (SDGs) with a target year of 2030. The SDGs are 17 goals that call for global collaboration to tackle a wide variety of recognized problems. Goal 3 is focused on ensuring health and well-being for women of all ages.<ref>{{Cite web|url=https://sustainabledevelopment.un.org/?menu=1300|title=Sustainable Development Goals |website=Sustainable Development Knowledge Platform|access-date=2018-11-25 |url-status=live |archive-url= https://web.archive.org/web/20181125094707/https://sustainabledevelopment.un.org/?menu=1300 |archive-date=2018-11-25  }}</ref> A specific target is to achieve a global maternal mortality ratio of less than 70 per 100,000 live births. So far, specific progress has been made in births attended by a skilled provider, now at 80% of births worldwide compared with 62% in 2005.<ref>{{Cite web|url=https://sustainabledevelopment.un.org/sdg3|title=Goal 3 |website=Sustainable Development Knowledge Platform|access-date=2018-11-25}}</ref>

Countries and local governments have taken political steps in reducing maternal deaths. Researchers at the [[Overseas Development Institute]] studied maternal health systems in four apparently similar countries: [[Rwanda]], [[Malawi]], [[Niger]], and [[Uganda]].<ref>{{cite web|vauthors=Chambers V, Booth D|date= 31 May 2012 |title=Delivering maternal health: why is Rwanda doing better than Malawi, Niger and Uganda?|type=Briefing Paper|publisher=Overseas Development Institute|url=https://odi.org/en/publications/delivering-maternal-health-why-is-rwanda-doing-better-than-malawi-niger-and-uganda/ |url-status=live |archive-url=https://web.archive.org/web/20230603105735/https://odi.org/en/publications/delivering-maternal-health-why-is-rwanda-doing-better-than-malawi-niger-and-uganda/ |archive-date= Jun 3, 2023 }}</ref> In comparison to the other three countries, Rwanda has an excellent record of improving maternal death rates. Based on their investigation of these varying country case studies, the researchers conclude that improving maternal health depends on three key factors:

# reviewing all maternal health-related policies frequently to ensure that they are internally coherent;
# enforcing standards on providers of maternal health services;
# any local solutions to problems discovered should be promoted, not discouraged.

In terms of aid policy, proportionally, aid given to improve maternal mortality rates has shrunken as other public health issues, such as [[HIV]]/[[AIDS]] and [[malaria]] have become major international concerns.<ref>{{cite web|url=http://www.healthmetricsandevaluation.org/tools/data-visualization/development-assistance-health-health-focus-area-global-1990-2009-interactiv#/overview/terms|title=Development assistance for health by health focus area (Global), 1990-2009, interactive treemap|publisher=Institute for Health Metrics and Evaluation|archive-url=https://web.archive.org/web/20140317021516/http://www.healthmetricsandevaluation.org/tools/data-visualization/development-assistance-health-health-focus-area-global-1990-2009-interactiv|archive-date=2014-03-17}}</ref> Maternal health aid contributions tend to be lumped together with newborn and child health, so it is difficult to assess how much aid is given directly to maternal health to help lower the rates of maternal mortality. Regardless, there has been progress in reducing maternal mortality rates internationally.<ref>{{cite web|url=http://www.healthmetricsandevaluation.org/tools/data-visualization/progress-maternal-and-child-mortality-country-age-and-year-global-1990-2011#/overview/explore|title=Progress in maternal and child mortality by country, age, and year (Global), 1990-2011|archive-url=https://web.archive.org/web/20140317022301/http://www.healthmetricsandevaluation.org/tools/data-visualization/progress-maternal-and-child-mortality-country-age-and-year-global-1990-2011|archive-date=2014-03-17}}</ref>

In countries where abortion practices are not considered legal, it is necessary to look at the access that women have to high-quality family planning services, since some of the restrictive policies around abortion could impede access to these services. These policies may also affect the proper collection of information for monitoring maternal health around the world.<ref name="Dixon-Mueller-2007" />

As a result of cuts to foreign aid during the [[Second presidency of Donald Trump|second administration of US president Donald Trump]], maternal health clinics closed, disrupting "vital services for maternal, newborn and child health" according to the World Health Organization (WHO).<ref>{{cite web |date=7 April 2025 |title=Aid cuts threaten gains in maternal health, WHO warns |url=https://www.cnn.com/2025/04/07/health/aid-cuts-maternal-deaths-who-intl-scli |access-date=6 August 2025 |publisher=CNN}}</ref>

Significant progress has been made since the United Nations made the reduction of maternal mortality part of the [[Millennium Development Goals]] (MDGs) in 2000.<ref name="Lancet_Khan_20063">{{cite journal |vauthors=Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF |date=April 2006 |title=WHO analysis of causes of maternal death: a systematic review |url=http://www.hpc4.go.th/director/data/region/WHO_MMR.pdf |journal=Lancet |volume=367 |issue=9516 |pages=1066–1074 |doi=10.1016/S0140-6736(06)68397-9 |pmid=16581405 |s2cid=2190885 |archive-url=https://web.archive.org/web/20171031163757/http://www.hpc4.go.th/director/data/region/WHO_MMR.pdf |archive-date=2017-10-31 |access-date=2018-08-05}}</ref>{{rp|1066}} Bangladesh, for example, cut the number of deaths per live births by almost two-thirds from 1990 to 2015.  A further reduction of maternal mortality is now part of the Agenda 2030 for sustainable development. The United Nations recently developed a list of goals termed the Sustainable Development Goals. Some of the specific aims of the Sustainable Development Goals are to prevent unintended pregnancies by ensuring more women have access to contraceptives, as well as providing women who become pregnant with a safe environment for delivery with respectful and skilled care. This initiative also included access to emergency services for women who developed complications during delivery.<ref name="unfpa.org23" />
==Epidemiology==
{{update section|date=September 2019}}
[[File:Maternal mortality ratio per 100,000 live births.png|thumb|upright=1.6|Maternal mortality ratio per 100,000 live births.<ref name="OWID">[https://ourworldindata.org/grapher/maternal-mortality-ratio-who-gho Maternal mortality ratio]. From [[Our World in Data]] (OWID). Page has detailed definition of maternal mortality ratio. Also the various ways it is measured. Data source: [[World Health Organization]], "Global Health Observatory". Table tab has data. Click map tab, and then the download tab to get latest map.</ref>]]

Maternal mortality and morbidity are leading contributors in women's health. It is estimated that 303,000 women are killed each year in childbirth and pregnancy worldwide.<ref name="WHO20153">{{cite web|date=November 2015|title=Trends in maternal mortality: 1990 to 2015|url=https://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/|publisher=[[World Health Organization]]|page=16}}</ref> The global rate in 2017 is 211 maternal deaths per 100,000 live births and 45% of postpartum deaths occur within 24 hours.<ref name="nour3">{{cite journal|vauthors=Nour NM|year=2008|title=An introduction to maternal mortality|journal=Reviews in Obstetrics & Gynecology|volume=1|issue=2|pages=77–81|pmc=2505173|pmid=18769668}}</ref> Whereas in 2020, the global rate was 223 deaths per 100,000 live births.<ref>{{Cite web |title=A woman dies every two minutes due to pregnancy or childbirth: UN agencies - PAHO/WHO {{!}} Pan American Health Organization |url=https://www.paho.org/en/news/23-2-2023-woman-dies-every-two-minutes-due-pregnancy-or-childbirth-agencies |access-date=2023-12-11 |website=www.paho.org |date=23 February 2023 |language=en}}</ref><ref name="OWID" /> Ninety-nine percent of maternal deaths occur in low-resource countries.<ref name="WHO Fact Sheet 201423" />

=== Prevalence by country ===
{{see also|List of countries by maternal mortality ratio}}
[[India]] (19% or 56,000) and [[Nigeria]] (14% or 40,000) accounted for roughly one third of the maternal deaths in 2010.<ref>{{Cite web|title=WHO {{!}} Facility-based maternal death review in Nigeria|url=https://www.who.int/maternal_child_adolescent/epidemiology/maternal-death-surveillance/case-studies/nigeria-study/en/|archive-url=https://web.archive.org/web/20170523042235/http://www.who.int/maternal_child_adolescent/epidemiology/maternal-death-surveillance/case-studies/nigeria-study/en/|archive-date=May 23, 2017|access-date=2020-09-24|website=WHO}}</ref> [[Democratic Republic of the Congo]], [[Pakistan]], [[Sudan]], [[Indonesia]], [[Ethiopia]], [[United Republic of Tanzania]], [[Bangladesh]] and [[Afghanistan]] accounted for between 3 and 5 percent of maternal deaths each.<ref name="UNICEF, W. 20123" /> These ten countries combined accounted for 60% of all the maternal deaths in 2010 according to the United Nations Population Fund report. Countries with the lowest maternal deaths were [[Health care in Greece|Greece]], [[Healthcare in Iceland|Iceland]], [[Healthcare in Poland|Poland]], and [[Healthcare in Finland|Finland]].<ref>{{cite web|title=Comparison: Maternal Mortality Rate|url=https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html|archive-url=https://web.archive.org/web/20111030110139/https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html|archive-date=October 30, 2011|work=The World Factbook|publisher=Central Intelligence Agency}}</ref>

In 2017, countries in Southeast Asia and Sub-Saharan Africa account for approximately 86% of all maternal deaths worldwide. As of 2020, Sub-Saharan African countries such as South Sudan, Chad, and Nigeria had the highest maternal deaths per 100,000 live births.<ref>{{Cite journal |date= |title=Maternal mortality: The urgency of a systemic and multisectoral approach in mitigating maternal deaths in Africa |url=https://files.aho.afro.who.int/afahobckpcontainer/production/files/iAHO_Maternal_Mortality_Regional_Factsheet.pdf |journal=Integrated African Health Observatory}}</ref> Since 2000, Southeast Asian countries have seen a significant decrease in maternal mortality of almost 60%.<ref name="Maternal mortality3">{{Cite web|title=Maternal mortality|url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality|access-date=2021-04-12|website=www.who.int|language=en}}</ref> Sub-Saharan Africa also saw an almost 40% decrease in maternal mortality between 2000 and 2017.

The maternal mortality ratio (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).

{| class="wikitable sortable"
! Country
! Maternal mortality ratio (2017) <ref name="WB3">{{cite web |title=Maternal mortality ratio (modeled estimate, per 100,000 live births) {{!}} Data |url=https://data.worldbank.org/indicator/SH.STA.MMRT?locations=FI-VE&year_high_desc=false |access-date=2018-06-27 |language=en-us}}</ref><ref name="US-rate3">[https://qz.com/1108193/whats-killing-americas-new-mothers What's killing America's new mothers?] By Annalisa Merelli. October 29, 2017. ''[[Quartz (publication)|Quartz]].'' "The dire state of US data collection on maternal health and mortality is also distressing. Until the early 1990s, death certificates did not note if a woman was pregnant or had recently given birth when she died. It took until 2017 for all US states to add that check box to their death certificates."</ref>
|-
|[[Italy]]
|2
|-
|[[Spain]]
|4
|-
|[[Health care in Sweden|Sweden]]
|4
|-
|[[Health care in Japan|Japan]]
|5
|-
|[[Health care in Australia|Australia]]
|6
|-
|[[Health care in Germany|Germany]]
|7
|-
|[[Health care in the United Kingdom|UK]]
|7
|-
|[[Health care in France|France]]
|8
|-
|[[New Zealand]]
|9
|-
|[[Health care in Canada|Canada]]
|10
|-
|[[South Korea]]
|11
|-
|[[Russia]]
|17
|-
|[[Health care in the United States|US]]
|19
|-
|[[Mexico]]
|33
|-
|[[China]]
|29
|-
|[[South Africa]]
|119
|-
|[[India]]
|145
|-
|[[Ghana]]
|308
|}

=== Prevalence by race and ethnicity ===

==== In the United States ====
{{Split portions|date=August 2025|Maternal mortality in the United States|Black maternal mortality in the United States|section=y|existing=y}}
In the United States, women who are black and non-Hispanic experience pregnancy-related death at a significantly higher rate. They are three to four times as likely to succumb to maternal mortality than non-Hispanic white women.<ref name="Howell 387–399">{{cite journal | vauthors = Howell EA | title = Reducing Disparities in Severe Maternal Morbidity and Mortality | journal = Clinical Obstetrics and Gynecology | volume = 61 | issue = 2 | pages = 387–399 | date = June 2018 | pmid = 29346121 | pmc = 5915910 | doi = 10.1097/GRF.0000000000000349 }}</ref> In the United States between the years of 2007 and 2014, women who identify as non-Hispanic and black had a significant increase in death related to pregnancy.<ref name="Howell 387–399" /> 

In the United States, according to the Center for Disease Control and Prevention (CDC), the maternal mortality rate in 2021 was 32.9 deaths per 100,000 live births.<ref>{{Cite web |date=2023-03-16 |title=Maternal Mortality Rates in the United States, 2021 |url=https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm |access-date=2023-11-19 |website=www.cdc.gov |language=en-us}}</ref> This is significantly higher than the rates in 2020 defined as 23.8 deaths per 100,000 live births and 20.1 in 2019.<ref>{{Cite web |date=2023-03-16 |title=Maternal Mortality Rates in the United States, 2021 |url=https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm |access-date=2023-11-19 |website=www.cdc.gov |language=en-us}}</ref> In 2021, the maternal mortality rate for non-Hispanic Black women was 69.9 deaths per 100,000 live births, which is 2.6 times higher than non-Hispanic White women.<ref>{{Cite web |date=2023-03-16 |title=Maternal Mortality Rates in the United States, 2021 |url=https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm |access-date=2023-11-19 |website=www.cdc.gov |language=en-us}}</ref> The mortality rate for women over the age of 40 was 6.8 times higher than the rate for women under the age of 25.<ref>{{Cite web |date=2023-03-16 |title=Maternal Mortality Rates in the United States, 2021 |url=https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm |access-date=2023-11-19 |website=www.cdc.gov |language=en-us}}</ref>

Research indicates that these disparities in the U.S. are not due to genetic differences, but rather systemic factors, including racial bias in healthcare, inadequate access to high-quality maternity care, and higher rates of chronic conditions like hypertension and preeclampsia.<ref>{{Cite journal |vauthors=Josiah N, Russell N, Devaughn L, Dorcelly N, Charles M, Shoola H, Ballard M, Baptiste D |date=2023-06-16 |title=Implicit bias, neuroscience and reproductive health amid increasing maternal mortality rates among Black birthing women |journal=Nursing Open |language=en-us |volume=10 |issue=9 |pages=5780–5783 |doi=10.1002/nop2.1759 |pmc=10416051 |pmid=37327404}}</ref>

Implicit bias among healthcare providers has been documented as a contributing factor to these disparities, leading to the dismissal of Black women's pain and symptoms, resulting in delayed or inadequate treatment.<ref>{{Cite journal |vauthors=Josiah N, Russell N, Devaughn L, Dorcelly N, Charles M, Shoola H, Ballard M, Baptiste D |date=2023-06-16 |title=Implicit bias, neuroscience and reproductive health amid increasing maternal mortality rates among Black birthing women |journal=Nursing Open |language=en-us |volume=10 |issue=9 |pages=5780–5783 |doi=10.1002/nop2.1759 |pmc=10416051 |pmid=37327404}}</ref> Studies have found that some healthcare providers incorrectly believe that Black patients feel less pain, which has been linked to delays in diagnosing and managing pregnancy-related complications like preeclampsia and hemorrhage <ref>{{Cite journal |vauthors=Josiah N, Russell N, Devaughn L, Dorcelly N, Charles M, Shoola H, Ballard M, Baptiste D |date=2023-06-16 |title=Implicit bias, neuroscience and reproductive health amid increasing maternal mortality rates among Black birthing women |journal=Nursing Open |language=en-us |volume=10 |issue=9 |pages=5780–5783 |doi=10.1002/nop2.1759 |pmc=10416051 |pmid=37327404}}</ref>

Additionally, Black women face barriers to high-quality maternal care, including living in maternity care deserts, lack of access to midwifery and doula services, and financial challenges due to inadequate insurance coverage.<ref>{{Cite journal |vauthors=Courtot B, Hill I, Cross-Barnet C, Markell J |date=2020-12-15 |title=Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High-Value Model of Care |journal=The Milbank Quarterly |language=en-us |volume=98 |issue=4 |pages=1091–1113 |doi=10.1111/1468-0009.12473 |hdl=11603/22727 |pmc=7772638 |pmid=32930433 |hdl-access=free}}</ref> Many states have restrictive policies on midwifery care, which further limits Black women's access to alternatives that have been shown to improve maternal outcomes<ref>{{Cite journal |vauthors=Courtot B, Hill I, Cross-Barnet C, Markell J |date=2020-12-15 |title=Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High-Value Model of Care |journal=The Milbank Quarterly |language=en-us |volume=98 |issue=4 |pages=1091–1113 |doi=10.1111/1468-0009.12473 |hdl=11603/22727 |pmc=7772638 |pmid=32930433 |hdl-access=free}}</ref>

The disparities in maternal health outcomes are also present among racial groups. Black and American Indian/Alaska Native (AI/AN) women experience pregnancy-related mortality rates over three times those of White women. In 2020, rates were 55.9 and 63.4 per 100 000 live births for Black and AI/AN women, respectively, versus 18.1 for White women; Native Hawaiian/Pacific Islander women had a rate of 62.8.<ref>{{cite web |title=Racial disparities in maternal and infant health |date=25 October 2024 |url=https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/ |access-date=6 August 2025 |publisher=KFF}}</ref> In 2023, the CDC's Pregnancy Mortality Surveillance System reported pregnancy-related mortality ratios of 49.4 for Black women and 14.9 for White women per 100 000 live births.<ref>{{cite web |title=Pregnancy Mortality Surveillance System |url=https://www.cdc.gov/maternal-mortality/php/pregnancy-mortality-surveillance-system.htm |access-date=6 August 2025 |publisher=CDC}}</ref>

These disparities persist across educational and income levels—Black women with a college degree have higher maternal mortality rates than White women without a high school diploma—and reflect systemic inequities in access to high-quality care, prevalence of chronic conditions, and hospital quality.<ref>{{cite pmid|pmid=PMC5915910|title=Disparities in maternal mortality and morbidity|journal=American Journal of Public Health|year=2018}}</ref> In the United States, black women are 3-4 times more likely to die from maternal mortality than white women. Unequal access to quality medical care, socioeconomic disparities, and systemic racism by health care providers are factors that have contributed to the high maternal mortality rates among black women.<ref name="mjs" /> Discounting factors such as pre-existing conditions, do not impact the rate of this disparity.<ref>{{cite journal |vauthors=Njoku A, Evans M, Nimo-Sefah L, Bailey J |date=February 2023 |title=Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States |journal=Healthcare |volume=11 |issue=3 |page=438 |doi=10.3390/healthcare11030438 |pmc=9914526 |pmid=36767014 |doi-access=free}}</ref> 

The Covid-19 pandemic heightened maternal mortality rates, disproportionately impacting communities of color. Multiple factors contribute to this widening disparity, notably, social factors such as implicit bias, repeated racial discrimination, and limited access to healthcare. All issues are further exacerbated for people of color who face systemic barriers to adequate medical care.<ref>{{cite journal |vauthors=Wang S, Rexrode KM, Florio AA, Rich-Edwards JW, Chavarro JE |date=January 2023 |title=Maternal Mortality in the United States: Trends and Opportunities for Prevention |journal=Annual Review of Medicine |volume=74 |issue=1 |pages=199–216 |doi=10.1146/annurev-med-042921-123851 |pmid=36706746 |s2cid=256325844 |doi-access=free}}</ref> Overall, the maternal mortality rate increased from 23.8 deaths per 100,000 live births in 2020, to 32.9 deaths per 100,000 live births in 2021.<ref>{{Cite web |date=2023-03-16 |title=Maternal Mortality Rates in the United States, 2021 |url=https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm |access-date=2023-11-26 |website=www.cdc.gov |language=en-us}}</ref> An apparent spike in this rate can be noted in 2021.<ref>{{cite journal |vauthors=Njoku A, Evans M, Nimo-Sefah L, Bailey J |date=February 2023 |title=Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States |journal=Healthcare |volume=11 |issue=3 |page=438 |doi=10.3390/healthcare11030438 |pmc=9914526 |pmid=36767014 |doi-access=free}}</ref> For non-hispanic black women the rate of maternal deaths per 100,00 live births increased from 44.0 in 2019 to 69.9 in 2021.<ref>{{cite journal |vauthors=Dahl AA, Yada FN, Butts SJ, Tolley A, Hirsch S, Lalgondar P, Wilson KS, Shade L |date=August 2023 |title=Contextualizing the experiences of Black pregnant women during the COVID-19 pandemic: 'It's been a lonely ride' |journal=Reproductive Health |volume=20 |issue=1 |article-number=124 |doi=10.1186/s12978-023-01670-4 |pmc=10463995 |pmid=37626357 |doi-access=free}}</ref>

==== Elsewhere ====
Similar patterns exist in other countries. In Brazil, women who are not white were 3.5 times as likely to die because of obstetric mortality compared to white women.<ref name="mjs">{{cite journal |vauthors=Small MJ, Allen TK, Brown HL |date=August 2017 |title=Global disparities in maternal morbidity and mortality |journal=Seminars in Perinatology |volume=41 |issue=5 |pages=318–322 |doi=10.1053/j.semperi.2017.04.009 |pmc=5608036 |pmid=28669415}}</ref><ref>{{cite journal | vauthors = Small MJ, Allen TK, Brown HL | title = Global disparities in maternal morbidity and mortality | journal = Seminars in Perinatology | volume = 41 | issue = 5 | pages = 318–322 | date = August 2017 | pmid = 28669415 | pmc = 5608036 | doi = 10.1053/j.semperi.2017.04.009 }}</ref> The maternal mortality ratio is larger in women who are from Sub-Saharan African in France.<ref name="mjs" />

=== COVID-19 effects ===
Global maternal mortality and fetal outcomes have worsened during the COVID-19 pandemic. Increases in maternal deaths, stillbirths, ruptured ectopic pregnancies, and maternal depression occurred globally during this time.<ref name="doi.org">{{cite journal | vauthors = Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, O'Brien P, Morris E, Draycott T, Thangaratinam S, Le Doare K, Ladhani S, von Dadelszen P, Magee L, Khalil A | title = Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis | journal = The Lancet. Global Health | volume = 9 | issue = 6 | pages = e759–e772 | date = June 2021 | pmid = 33811827 | pmc = 8012052 | doi = 10.1016/s2214-109x(21)00079-6 }}</ref> According to The Lancet Global Health, their search, which included over 40 studies, identified significant increases in stillbirth and maternal death during the pandemic versus before the pandemic.<ref name="doi.org" /> According to the United Nations Population Fund, UNFPA, a proportion of total COVID-19 deaths were indirect obstetric deaths where a woman's death was due to the aggravation between the disease and the state of pregnancy. Some outcomes show considerable disparity between low- and high-resource settings.<ref>{{Cite web |title=Trends in Maternal Mortality 2000-2020 |url=https://www.unfpa.org/publications/trends-maternal-mortality-2000-2020 |access-date=2023-11-19 |website=United Nations Population Fund |language=en}}</ref> This drives the urgent global need to prioritize safe, equitable, and accessible maternal care in future healthcare crises.<ref name="doi.org" />

===Variation within countries===
There are significant maternal mortality intra-country variations, especially in nations with large equality gaps in income and education and high healthcare disparities. Women living in rural areas experience higher maternal mortality than women living in urban and sub-urban centers because<ref>{{cite web|title=WHO Maternal Health|url=https://www.who.int/mediacentre/factsheets/fs348/en/|publisher=WHO}}</ref> those living in wealthier households, having higher education, or living in urban areas, have higher use of healthcare services than their poorer, less-educated, or rural counterparts.<ref>{{cite web|year=2011|title=Levels and trends in the use of maternal health services in developing countries|url=https://dhsprogram.com/pubs/pdf/CR26/CR26.pdf|publisher=ICF Macro|location=Calverton, MD|page=85|id=(DHS Comparative Reports 26)|vauthors=Wang W, Alva S, Wang S, Fort A}}</ref> There are also racial and ethnic [[Social inequality|disparities]] in maternal health outcomes which increases maternal mortality in marginalized groups.<ref>{{cite journal|vauthors=Lu MC, Halfon N|date=March 2003|title=Racial and ethnic disparities in birth outcomes: a life-course perspective|journal=Maternal and Child Health Journal|volume=7|issue=1|pages=13–30|doi=10.1023/A:1022537516969|pmid=12710797|s2cid=19973932}}</ref>

== Related terms ==

===Severe maternal morbidity===
Severe maternal morbidity (SMM) is an unanticipated acute or chronic health outcome after labor and delivery that detrimentally affects a woman's health. Severe Maternal Morbidity (SMM) includes any unexpected outcomes from labor or delivery that cause both short and long-term consequences to the mother's overall health.<ref name="CDC-2017">{{Cite web|url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html|title=Severe Maternal Morbidity in the United States|date=2017-11-27|website=CDC}}</ref> There are nineteen total indicators used by the CDC to help identify SMM, with the most prevalent indicator being a blood transfusion.<ref>{{Cite web|url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html|title=Severe Maternal Morbidity in the United States {{!}} Pregnancy {{!}} Reproductive Health {{!}}CDC|date=2017-11-27|website=www.cdc.gov|language=en-us|access-date=2018-11-20}}</ref> Other indicators include an acute myocardial infarction ("heart attack"), aneurysm, and kidney failure. All of this identification is done by using ICD-10 codes, which are disease identification codes found in hospital discharge data.<ref>{{Cite web|url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm|title=Severe Maternal Morbidity Indicators and Corresponding ICD Codes during Delivery Hospitalizations|date=2018-08-21|website=www.cdc.gov|language=en-us|access-date=2018-11-20}}</ref> Using these definitions that rely on these codes should be used with careful consideration since some may miss some cases, have a low predictive value, or may be difficult for different facilities to operationalize.<ref name="ACOG_SMFM_20162"/> There are certain screening criteria that may be helpful and are recommended through the American College of Obstetricians and Gynecologists as well as the Society for Maternal-Fetal Medicine (SMFM). These screening criteria for SMM are for transfusions of four or more units of blood and admission of a pregnant woman or a postpartum woman to an ICU facility or unit.<ref name="ACOG_SMFM_20162"/>

The greatest proportion of women with SMM are those who require a blood transfusion during delivery, mostly due to excessive bleeding. Blood transfusions given during delivery due to excessive bleeding has increased the rate of mothers with SMM.<ref name="CDC-2017" /> The rate of SMM has increased almost 200% between 1993 (49.5 per 100,000 live births) and 2014 (144.0 per 100,000 live births). This can be seen with the increased rate of blood transfusions given during delivery, which increased from 1993 (24.5 per 100,000 live births) to 2014 (122.3 per 100,000 live births).<ref name="CDC-2017" />

In the United States, severe maternal morbidity has increased over the last several years, impacting greater than 50,000 women in 2014 alone. There is no conclusive reason for this dramatic increase. It is thought that the overall state of health for pregnant women is impacting these rates. For example, complications can derive from underlying chronic medical conditions like diabetes, obesity, HIV/AIDS, and high blood pressure. These underlying conditions are also thought to lead to increased risk of maternal mortality.<ref>{{cite journal|vauthors=Campbell KH, Savitz D, Werner EF, Pettker CM, Goffman D, Chazotte C, Lipkind HS|date=September 2013|title=Maternal morbidity and risk of death at delivery hospitalization|journal=Obstetrics and Gynecology|volume=122|issue=3|pages=627–33|doi=10.1097/aog.0b013e3182a06f4e|pmid=23921870|s2cid=25347341}}</ref>

The increased rate for SMM can also be indicative of potentially increased rates for maternal mortality, since without identification and treatment of SMM, these conditions would lead to increased maternal death rates. Therefore, diagnosis of SMM can be considered a "near miss" for maternal mortality.<ref name="ACOG_SMFM_20162"/> With this consideration, several different expert groups have urged obstetric hospitals to review SMM cases for opportunities that can lead to improved care, which in turn would lead to improvements with maternal health and a decrease in the number of maternal deaths.

== See also ==
{{div col|colwidth=22em}}
* [[Pediatric nursing|Child health]]
* [[Confidential Enquiry into Maternal Deaths in the UK]]
* [[Infant mortality]]
* [[Child mortality]]
* [[List of women who died in childbirth]]
* [[Maternal mortality in fiction]]
* [[Maternal near miss]]
* [[Obstetric transition]]
* [[Perinatal mortality]]
* [[Black maternal mortality in the United States]]{{div col end}}
* [[Egg binding]], a complication in oviparous animals that can cause maternal death in them.

== References ==
{{Reflist}}
<references group="World Health Organization"/>
{{Reflist|group=United Nations}}

== Bibliography ==
{{refbegin}}
* {{cite book|last1= World Health Organization|author-link=World Health Organization|title=Trends in maternal mortality: 1990 to 2013|date=2014|publisher=WHO|isbn=978-92-4-150722-6|url=http://www.unfpa.org/sites/default/files/pub-pdf/9789241507226_eng.pdf|access-date=2 August 2016}}
* {{cite book  | veditors = Jashnani KD |title=Maternal Mortality - Lessons Learnt from Autopsy |date=27 September 2022 |publisher=Springer |isbn=978-981-19-3420-9}}
* {{cite book | vauthors = Drife JO, Lewis G, Neilson JP, Knight M, Cooper G, Cantwell R | title=Why Mothers Died and How their Lives are Saved | publisher=Cambridge University Press | date=2023-01-31 | isbn=978-1-009-21880-1}}
{{refend}}

== External links ==
{{Medical resources
|   ICD10       = O95
|   ICD9        = {{ICD9|646.9}}
}}
* [https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9241562900/en/ The World Health Report 2005 – Make Every Mother and Child Count]
{{Women's health|state=collapsed}}
{{Pathology of pregnancy, childbirth and the puerperium}}

{{DEFAULTSORT:Maternal Death}}
[[Category:Maternal death| ]]
[[Category:Medical aspects of death]]
[[Category:Pathology of pregnancy, childbirth and the puerperium]]
[[Category:Medical terminology]]
[[Category:Demography]]
[[Category:Midwifery]]