Maternal Mortality Is a Policy Failure

Maternal mortality is a public health emergency. More than 80 percent of pregnancy-related deaths are considered preventable. Yet, the United States remains the most dangerous place to give birth among high-income nations. Each year, hundreds of women die during pregnancy or within one year postpartum. In 2022, there were roughly 22 maternal deaths per 100,000 live births, a rate more than double and in some cases triple that of peer countries with comparable wealth, which have managed to drive this measurement of the maternal death rate down to single digits.

What we are witnessing is not inevitability. It is failure in policy design, implementation, and accountability. This gap reflects choices about access, coverage, workforce investment, and social supports—and the burden of those policy decisions falls unevenly.

Maternal mortality is a public health emergency. More than 80 percent of pregnancy-related deaths are considered preventable.

The Inequities We See

Black women in the United States are three to four times more likely to die from pregnancy-related causes than White women. These disparities persist across income and education levels, underscoring that the issue cannot be reduced to individual behavior or socioeconomic status. Even at the highest level of education and income, a Black woman still faces a higher risk of maternal death compared to women of other races. This is a crisis of inequity: Such outcomes are the result of systemic injustice, a lack of fairness, and biased policies.

Too often, maternal deaths are treated as isolated clinical failures. In reality, they follow predictable patterns tied to policy gaps. Structural racism, uneven access to quality care, and provider bias are causing harm.

Nearly two-thirds of maternal deaths occur in the postpartum period, yet the United States has historically failed to guarantee comprehensive care during the full year after birth. Many women lose insurance coverage just weeks after delivery, cutting off access to follow-up care when complications such as cardiomyopathy, hypertension, and mental health conditions are most likely to emerge. Postpartum insurance coverage—especially Medicaid—typically ends due to strict postpartum eligibility limits that are designed around childbirth as an end point. This reflects a failure of policy to provide the conditions needed to address a medical necessity.

Geography compounds these risks. Large swaths of the country are now considered maternity care deserts, where hospitals have closed obstetric units and providers are scarce. In these areas, women must travel long distances for prenatal visits or deliver without adequate medical support. The result is delayed care, missed warning signs, and preventable emergencies that escalate into fatalities.

Even when care is available, quality is inconsistent. Studies and patient reports repeatedly show that Black women’s symptoms are more likely to be dismissed or minimized by providers. These failures to listen and respond in a timely manner are not abstract concerns; they are direct contributors to preventable deaths. This concept of “failure to rescue,” widely used in other areas of medicine, is only beginning to be applied to maternal health despite clear evidence that earlier intervention could save lives.

Moving from Policy Failure to Flourishing in Maternal Care

If maternal mortality is a policy failure, then solutions for repair must be policy-driven and measurable. There is no shortage of evidence pointing to what works:

• Continuous coverage matters. States that have extended Medicaid coverage to a full year postpartum are beginning to close dangerous gaps in care. Ensuring that every mother has uninterrupted access to physical and mental health services throughout pregnancy and the postpartum period is one of the most immediate ways to reduce mortality.
• The maternal health workforce must be expanded and diversified. The United States has fewer midwives per capita than many peer nations, despite evidence that midwife-led care improves outcomes and patient satisfaction. Investing in midwives, doulas, and community-based providers can bridge gaps in both access and trust, particularly in communities that have historically experienced discrimination in the healthcare system.
• Data transparency and accountability need to be strengthened. Maternal mortality review committees exist in many states, but their findings are not always translated into enforceable policy changes. Better data collection, including on near misses and complications, would allow policymakers to identify patterns earlier and intervene before deaths occur. Without consistent reporting, failures remain invisible and therefore unaddressed.
• Implicit bias training and hospital quality improvement initiatives must move beyond check-the-box exercises. For example, the Urban Institute has recommended that healthcare institutions incorporate implicit bias training to avoid culturally incompetent care. Black mothers have shared that they’re “not taken seriously” and their pain is downplayed in serious crises.

Hospitals should be required to implement standardized safety protocols for common complications such as hemorrhage and hypertension. These protocols have already been shown to reduce mortality when applied consistently. The problem is uneven policy adoption and enforcement.

• Social determinants of health cannot be separated from maternal outcomes. Stable housing, paid family leave, nutrition support, and protection from environmental hazards all play a role in whether a pregnancy is safe. The United States stands out among peer nations for its lack of guaranteed paid leave and home visiting supports, both of which are associated with better maternal outcomes. Addressing maternal mortality requires policy that extends beyond the healthcare system.
• Community-based organizations must be treated as essential partners, not afterthoughts. Groups led by Black women and other marginalized communities have long been on the front lines of this crisis, providing culturally competent care and advocacy. Yet they remain underfunded relative to large healthcare institutions. Sustained investment in these organizations is critical to reaching those most at risk.

Political Will and the Courage to Invest in What Works

The persistence of maternal mortality in the United States reflects a broader truth about how the country values care work and reproductive health. A system that allows preventable deaths to continue year after year—despite clear evidence of how they can be reduced—signals a lack of political will, not a lack of solutions.

This issue is deeply personal to me: I am a mom who has experienced the shortcomings in our maternal health care system, a doula who has worked to support other mothers, a midwife training to care for our communities, and an advocate fighting for change as the national director for maternal justice at MomsRising.

Reframing maternal mortality as a policy failure is about generating the urgency necessary to take action. Every statistic on maternal mortality represents a life lost and a family forever changed. We have the capacity to make pregnancy, childbirth, and the postpartum period safer for all women. Policymakers have the tools to prevent most of these deaths. The question is whether they will choose to use them.