In 2018, 658 women in the United States died during pregnancy, at delivery, or soon after delivery. According to a January report out of the Centers for Disease Control and Prevention’s National Vital Statistics System, the 2018 maternal mortality rate was 17.4 maternal deaths per 100,000 live births.
Of the states with accessible data, Illinois ranked the best with a rate of 9.7 maternal deaths per 100,000 live births, followed by North Carolina with 10.9 and California with 11.7. On the other hand, Arkansas ranked worst with a rate of 45.9 deaths per every 100,000 live births preceded by Kentucky with 40.8 and Alabama with 36.4.
But figures like this only tell part of the story. While this latest data is a great place to start a conversation about maternal health care in our country, gaps exist due to the fact that there is not a standardized surveillance system of maternal mortality across the nation. Not every state has funded Maternal Mortality Review Committees (MMRCs)—or multidisciplinary committees in states and cities that perform comprehensive reviews of deaths among women within a year of the end of a pregnancy—and some states have launched MMRCs only within the past year. Also, because states might use different definitions for “maternal mortality” in general, there is a large potential for variability in the quality of reported data. This makes "ranking" by any such numbers pretty tough.
To help create a more accurate state-by-state snapshot of maternal health care in the U.S., we worked with the American Association of Birth Centers (AABC) and Review to Action—a resource that promotes the state-based maternal mortality review process—to give you a more holistic look at how your state measures up. While the statistics can be frightening for some states, it's important to talk about the facts so we can help solve the problem. And as part of that, we will be linking to resources for each state to help empower the women that live there.
Here are a few more definitions and facts to keep in mind:
What's a pregnancy-associated death? The death of a woman from any cause while pregnant or within one year of the end of pregnancy.
What's a pregnancy-related death? The death of a woman during pregnancy or within one year of the end of a pregnancy due to complications or health problems related to the pregnancy.
What's a maternal death? The National Center for Health Statistics (NCHS) and the World Health Organization (WHO) define maternal death as the death of a woman while pregnant or within 42 days of the end of a pregnancy, from any cause—but not accidents or incidental causes—related to pregnancy.
Maternal deaths and mortality rates for 2018 for selected states are presented below, but caution should be taken in interpreting this data and comparing states for the following reasons:
Some data is based on small numbers. Indeed, the rates based on fewer than 10 deaths in a state were withheld completely to protect confidentiality. This explains the N/As you will see.
The quality of data varies. Differences in the reporting of state maternal mortality data may result in the underestimation or overestimation of maternal deaths.
Read more of Parents.com’s maternal health investigation here.
The Washington state review panel, funded by legislation in 2016, has a few recommendations for lowering the state's maternal mortality rate: work to prevent complications early enough, educate health care providers on handling complications if they were to occur, and improve access to care for all women. While the state's maternal mortality rates have not increased over time, Native American and Alaska Native mothers in Washington are eight times more likely to die than white women.
Oregon's maternal mortality review was formed in 2019 after legislation officially pased in 2018. While the state's maternal mortality rate is relatively low, "it is also important to note that for every woman who dies, there are approximately 50 who suffer severe maternal morbidity—very severe complications of pregnancy, labor, and delivery that bring them close to death," according to the Oregon Health Authority.
According to the California Department of Public Health, the state lowered its maternal mortality rate by 55 percent between 2006 and 2013. "And it's a state whose impact could make a big difference," NPR reports. "One in eight infants born in the United States is born there." So how'd they do it? With the implementation of early intervention checklists, drills, and carts—especially surrounding hemorrhage and preeclampsia, two of the biggest issues—which are now being adopted in hospitals across the country.
Though Idaho has tracked maternal mortality over the years, it was among the last states to formally establish a review panel. The state's most recent recorded death rate was 27.1 deaths per 100,000 births.
Between 2003 and 2014, Nevada experienced 156 pregnancy-associated deaths. The top causes of these deaths were related to pregnancy, childbirth, and the six weeks directly following labor and delivery.
"Maternal mortality is now a rare event in Montana," according to a 2011 report by the state's Department of Public Health and Human Services. "There was an average of one maternal death per year between 1980 and 2009, and in 13 of those years there were no maternal deaths at all."
"Wyoming does not currently have a Maternal Mortality Review Committee," says Ashley Busacker, Ph.D., senior epidemiology advisor for the Maternal and Child Health unit in Wyoming's Department of Health, which she says is partnering with the Utah Department of Health to implement. "Wyoming cases will be reviewed as part of the Utah Perinatal Mortality Review process. The recommendations from the review will be shared with the Wyoming Perinatal Quality Collaborative for implementation."
Some hospitals in Utah have adopted the same safety practices as California as well as the Alliance for Innovation on Maternal Health (AIM) Program—whose goal is to "eliminate preventable maternal mortality and severe morbidity across the United States"—to reduce its own rate, which was recorded as 25.7 per 100,000 live births for 2016.
According to the Colorado Sun, "half of all deaths in this state among pregnant women and those within the first year after giving birth are the result of self-harm—defined as suicide and overdose." And when it comes to maternal mortality directly related to pregnancy, three main things are to blame: heart conditions, hemorrhage, and suicide tied to postpartum depression.
A look at pregnancy-associated mortality in Alaska in the past decade shows that Alaska Natives face a much higher risk of death—more than five times that of white women, most often due to drug or alcohol overdose or other medical causes.
Hawaii sees anywhere from five to 15 pregnancy-associated deaths each year—reviewed by a committee that meets semiannually—many of which follow little to no prenatal care. The Hawaii State Department of Health reports that women who were younger, less educated, unmarried, uninsured, or had an unintended pregnancy were less likely to receive early prenatal care.
Created by the North Dakota Society of Obstetrics and Gynecology in 1954, North Dakota has one of the country's oldest Maternal Mortality Review Committees. According to North Dakota Medical Association's ND Physician magazine, while hypertension, hemorrhage, and sepsis are among the leading causes of maternal death, cardiovascular events, thromboembolic episodes, and brain aneurysm were primarily to blame in North Dakota between 2008 and 2017.
The 2015 report out of Nebraska's Maternal Mortality Review Committee—mobilized in 2019 following the passing of the state's Child and Maternal Death Review Act, which requires the review all maternal deaths during or after 2014—noted three main contributors to maternal complications: preeclampsia, diabetes, and placental abruption.
Between 2016—when Kansas first began reviewing cases—and 2018, there was a 10 percent decrease in maternal mortality. What's more, nearly 97 percent of women received prenatal care before their third trimester.
The Minnesota Department of Health found that the state's leading causes of maternal death between 2011 and 2017 included obstetric hemorrhage, drug overdose, violence, and suicide. Their recommendations following a review of cases include mental health, depression, and substance use screenings at all prenatal visits, ensuring pregnant women have support networks, and following up before the typical 6-week postpartum checkup.
With only 1.49 doctors per 10,000 women, according to the American College of Obstetricians and Gynecologists (ACOG), there's a real shortage of health care in Iowa. Women are left to travel for prenatal care as well as to give birth, especially since some hospitals in the state have shut down their labor and delivery units altogether. Iowa’s most recent Maternal Mortality Review Committee report points to cardiac issues, hemorrhage, preeclampsia, pulmonary embolism, and drug overdose as the main causes of pregnancy-related deaths.
While the leading causes of Missouri's maternal deaths from 1999 to 2008 were embolism and cardiovascular diseases, increased access to care and health insurance are two ways the state could improve. According to October 2019 findings out of the Institute for Public Health at Washington University, "for many low-income women in Missouri, health needs are not met prior to pregnancy or past 60 days postpartum because of limited access to health care services."
Wisconsin's report for January 2006 through December 2010 showed that the state's maternal mortality ratio was 5.9 deaths per 100,000 live births, with higher rates for Black women. As seen in other parts of the country, many deaths—19 percent, to be exact—were considered to be avoidable. According to the report, "chronic medical conditions" such as hypertension, diabetes, and depression were present in more than half of Wisconsin's pregnancy-related deaths, and when obesity was included among those conditions, that number jumped to 80 percent of cases examined.
The Illinois Maternal Morbidity and Mortality Report from October 2018 had several key findings: Between 2008 and 2016, about 73 women died each year, 72 percent of the pregnancy-related deaths were deemed preventable, Black women were affected six times more than white women, and obesity contributed to 44 percent of all pregnancy-related deaths in 2015. With that, the committee has recommended expanding the state's Medicaid coverage for high-risk women, an expansion of doula and other at-home programs, and increased access to substance abuse and mental health services.
Michigan may have one of the longest-standing maternal mortality review committees, but legislation to make reporting on maternal deaths mandatory didn't pass until 2017. Racial disparity is at the forefront of cases in the state, where Black women are three times more likely to die during pregnancy and childbirth and Black infant mortality rates—especially in urban areas like Detroit and Flint—are higher than the national average.
"Based on data provided by the Indiana State Department of Health and the CIA's World Factbook, women in Iraq and the Gaza Strip have a better chance of surviving childbirth than women in the 33 Indiana counties where inpatient delivery service simply does not exist," the Indianapolis Star reports. Within those counties, which are often called "maternity deserts," women with lower incomes are underserved.
More than half of pregnancy-related deaths in Ohio between 2012 and 2016 could have been prevented. Key findings in the 2019 Ohio Department of Health report—the state's first— included that the leading causes of maternal death included heart conditions, infections, severe bleeding, and preeclampsia and eclampsia.
Arizona's Maternal Mortality Review Committee found that, between 2012 and 2015, 89 percent of the state's maternal deaths were preventable. With about 70 deaths from causes like hypertension, hemorrhage, and suicide each year, Native American women are disproportionately affected—four times more likely to die than white women.
The review of maternal deaths in New Mexico between 2010 and 2015 found that teens and Indigenous women were the most at-risk groups, and the leading causes of death—27 percent of which occurred during pregnancy or within eight days of childbirth—were drug overdose, suicide, car crashes, embolism, and hypertension.
The Maternal Mortality and Morbidity task force and Department of
State Health Services's 2018 report on the 89 deaths from 2012—the year with the highest number of maternal deaths—found that cardiovascular and coronary conditions, obstetric hemorrhage, infection/sepsis, and cardiomyopathy were the leading causes for 76 percent of all pregnancy-related deaths, followed by preeclampsia and mental health issues. Findings also showed that those most at risk of maternal death were 40 years old or older, received late or no prenatal care, or had diabetes, hypertension, or were obese.
A review of pregnancy-associated deaths between 2014 and 2018 showed that more than one-third were "related to cardiovascular diseases, infection, hemorrhage, cardiomyopathy, and embolism." While chronic health conditions—hypertension, diabetes, and obesity—were cited as risk factors for maternal death like in many other states, the Maine review also listed misdiagnosis, inadequate training, and failure to screen or follow up as potential factors.
A 2018 USA Today investigation found that 24 mothers died during or within a year of pregnancy in New Hampshire between 2012 and 2015, and the state's review committee's recommendations included improvements that can be made by health care providers and hospitals.
According to the March of Dimes, "89.2 percent of live births were to women receiving early prenatal care, 8.9 percent were to women beginning care in the second trimester, and 1.9 percent were to women receiving late or no prenatal care" in Vermont in 2018.
According to a review of deaths in Massachusetts between 2012 and 2014, more than half of pregnancy-associated mortalities had at least one documented mental health diagnosis—with depression and anxiety the most common—91.4 percent of which were prevalent during pregnancy. With that, the Massachusetts Department of Public Health noted "opportunities for intervention by prenatal and primary care providers."
Rhode Island boasts the nation's first Maternal Mortality Committee, established in 1931, though it was just formally reinstated following legislation in 2019. According to the Rhode Island Department of Health, the maternal mortality rate for 2013 through 2017 was 11.2 deaths per 100,000 live births. What's more, it was reported that 60 percent of these maternal deaths were deemed preventable.
"In Connecticut, there’s talk that more midwives, who tend to have more time to spend with each client, can decrease deaths among mothers and infants," reports the Connecticut Health Investigative Team. "Currently, just 11 percent of Connecticut births are attended by a midwife."
USA Today's 2018 investigation found that "fewer than half of maternity patients were promptly treated for dangerous blood pressure that put them at risk of stroke" at hospitals in New York, Pennsylvania, and the Carolinas. However, New York's "Taskforce on Maternal Mortality and Disparate Racial Outcomes builds on Governor Cuomo’s Women's Agenda, which is a the multi-pronged initiative to target maternal mortality and eliminate persistent racial disparities in maternal outcomes," says Jeffrey Hammond, a spokesperson for the New York State Department of Health.
In the maternal mortality trends report for 2009 through 2013, the New Jersey review team found that over one-third of cases were pregnancy-related and largely due to cardiac conditions, cardiomyopathy, embolism, septic shock, and cerebral hemorrhage. In those pregnancy-related deaths, women ages 25 to 34 made up nearly 55 percent.
While Pennsylvania's maternal mortality rate is below the national rate—with 11.4 deaths per 100,000 for 2012 to 2016— the state's Department of Health notes opportunities for improvement: increased access to prenatal care, better management of chronic conditions, and the implementation of standardized, high-quality care during and after delivery, especially for women who are considered high-risk.
After spending two years recruiting new members and conducting research on other states to develop policy and procedures, Delaware's review team met for the first time in 2011. Part of the team's standard protocol includes conducting voluntary interviews with grieving families to learn more about their experiences to help shape their reports. In 2017, the team reviewed five maternal deaths and found that only one was related to pregnancy.
According to the 2018 annual report, Maryland's maternal mortality ratio fell below the national average for the first time between 2011 and 2015 and still remains below the 2018 U.S. rate of 17.4 maternal deaths per 100,000 live births. However, Black women in Maryland are nearly four times more likely to die than white women and, while the state's rate has decreased, it's only because less white women are dying.
According to a January 2018 report from the Committee on the Judiciary and Public Safety, Washington, D.C. "is ranked the worst, or near the worst, for maternal deaths when compared to other states." What's more, "for many District women of color and low-income women, access to comprehensive preventative and prenatal care is inconsistent and insufficient, a situation made even more dire by the recent closing of the labor and delivery units at Providence Hospital in Northeast D.C. and United Medical Center in Southeast D.C."
In 2016, at least two-thirds of the maternal deaths in Virginia were preventable. And, according to the CDC, Black women were three times more likely to die than white women. "Many of these Black women lack access to stable health care and face institutional biases and racism that create barriers to receiving appropriate care," reports the Washington Post. "Moreover, these increased rates of death—and oftentimes grave pregnancy-related disabilities—occur regardless of the socioeconomic status, education, or Zip code of Black women. In turn, racial biases affect the health and well-being of their children, sometimes with the most devastating of consequences."
According to the Infant and Maternal Mortality Review Annual Report, West Virginia had a pregnancy-related maternal mortality rate of 9.5 maternal deaths per 100,000 births for 2007 to 2013. And while only 62 percent—or 48 of the deaths—had prenatal care starting in the first trimester, the review uncovered something more unsettling: "medical personnel, especially emergency room (ER) medical personnel, were not recognizing possible causes and were not always performing correct diagnostic procedures to rule out" pregnancy-related conditions such as hypertension or cardiomyopathy.
USA Today's maternal mortality investigation found that one in eight hospitals that deliver babies in the U.S.—and one in nine in Kentucky—have complication rates at least double the median. Hospital officials say they're working on training, safety practices, and reviewing cases in an effort to reduce risks and, mimicking that, key recommendations in the state's most recent Maternal Mortality Review report include improving health care, emergency care, and mental health care throughout a woman's pregnancy as well as expanding maternal education and safety measures.
While Black women are dying at alarming rates across the country, "North Carolina has managed to close its Black-white maternal death gap," reports Vox. "What’s unique about North Carolina, according to doctors, nurses, and researchers there, is a population health management program, called Pregnancy Medical Home, for low-income pregnant women. The program is run through Medicaid ... and 94 percent of Medicaid doctors participate in the program. And it’s just one of several initiatives in the state to make births safer for moms that seem to be saving more lives."
Of the 64 maternal deaths that occurred in South Carolina between 2011 and 2015, nearly 44 percent occurred during pregnancy or on the day of delivery—the majority of which happened inside a hospital. According to an examination of maternal mortality from the South Carolina Department of Health and Environmental Control for that time period, non-Hispanic Black women—who had a maternal mortality rate nearly four times higher that of non-Hispanic white women—and women over 35 were most at risk.
The Tennessee Maternal Mortality Review of maternal deaths in 2017 found that 78 women died while pregnant or within one year of pregnancy. And with pregnancy-related deaths—or a death that would not have occurred had the woman not been pregnant—making up 28 percent of that group, 85 percent were deemed preventable. One of the key recommendations was that "clinics and hospitals should improve protocols, education and screening on several maternal health topics" including preeclampsia, hemorrhage, and the follow-up of patients.
When it comes to the 28 pregnancy-related deaths per 100,000 live births in Georgia between 2012 and 2015, Black women were nearly three times more likely to die than white women, and two out of three deaths—the leading causes of which were cardiomyopathy, cardiovascular, hemorrhage, embolism, and preeclampsia—were preventable.
In 2017, Alabama had the second-highest maternal death rate in the U.S. While the state funds programs to review infant deaths, Alabama's newly-launched Maternal Mortality Review Committee operates largely as a volunteer-run organization. In March 2020, U.S. Rep. Terri Sewell introduced the Black Maternal Health Momnibus Act in Congress to address and fund maternal health care for Black mothers, who are disproportionately affected.
Mississippi's 2017 report on maternal mortality showed that between 2013 and 2016, there were 22.1 maternal deaths per 100,000 live births. Similar to the rest of the nation, Black women are at an increased risk in Mississippi. And as a state with a large Black population, Black women made up nearly 80 percent of pregnancy-related cardiac deaths—nearly five times higher the rate in white women. The annual report concluded that this "dramatic disparity in pregnancy-related mortality between Black and white women in Mississippi demands urgent attention and acknowledgement of how factors like social determinants of health and implicit bias can affect women’s health and health care."
Arkansas passed legislation in April 2019 to establish a maternal mortality review committee that will begin investigating maternal deaths in 2020. While this official reporting has yet to be released, CDC data shows that the state's death rate is one of the highest in the nation. Amy Johnson, an OB-GYN in Arkansas, suggested that the state's obesity rates could be playing a part. Obesity puts women at "a much higher risk of hypertension and infections, especially if they had a C-section," says Johnson. In fact, the Arkansas Coalition for Obesity Prevention notes that the "adult obesity rate is 34.5 percent, up from 25.2 percent in 2003 and from 17.0 percent in 1995."
The Louisiana Department of Health acknowledges that the state has one of the highest maternal mortality rates in the nation. The report looking at 2011 through 2016 shows 45 percent of all pregnancy-related deaths—which were most often caused by hemorrhage, cardiomyopathy, and cardiovascular disease—were preventable. Black women were at four times the risk compared to white women, and women over age 35 were at three times the risk.
In 2017, the leading causes of pregnancy-related deaths in Florida were cardiovascular, hemorrhage, thrombotic embolism, infection, and cardiomyopathy. According to the state's annual report, contributing factors to these deaths included a knowledge assessment, care referrals and follow-ups, a lack or delay of treatment, and a lack or delay of diagnosis. Nearly 40 percent of pregnancy-related deaths in 2017 had a "good chance to alter the outcome."