U.S. Maternal Mortality Within a Global Context: Historical Trends, Current State, and Future Directions

Abstract

In the United States, despite significant investment and the efforts of multiple maternal health stakeholders, maternal mortality (MM) has reemerged since 1987 and MM disparity has persisted since 1935. This article provides a review of the U.S. MM trajectory throughout its history up to its current state. From this longitudinal perspective, MM trends and themes are evaluated within a global context in an effort to understand the problems and contributing factors. This article describes domestic and worldwide strategies recommended by maternal health stakeholders to reduce MM.

Keywords: United States; disparity; global context; maternal mortality; strategies.

FIG. 1.

MMR and PRMR by Race and Ethnicity, NVSS, and PMSS, United States, 1935–2018^,– NVSS 2018 Black = 37.1, overall = 17.4, White = 14.7. NVSS is administered by the DVS at the National Center for Health Statistics, and PMSS is managed by the DRH at the National Center for Chronic Disease Prevention and Health Promotion. NVSS is the official source for mortality statistics in the United States, and DVS has been reporting MM since 1900. In 2007, however, reporting was interrupted with 2003 data due to implementation by the states of the Pregnancy Checkbox added in the U.S. Standard Certificate of Death in 2003. In 1986, recognizing the gaps in collecting more comprehensive MM data, DRH, and the American College of Obstetricians and Gynecologists established PMSS to collect additional clinical information for pregnancy-related deaths and has reported PRMR since 1987. In 2020, DVS resumes reporting of MM with 2018 data. A/PI, Asian/Pacific Islander; AI/AN, American Indian/Alaska Native; Black, non-Hispanic Black; DRH, Division of Reproductive Health; DVS, Division of Vital Statistics; MM, maternal mortality; MMR, maternal mortality ratio; NVSS, National Vital Statistics System; PMSS, Pregnancy Mortality Surveillance System; PRMR, Pregnancy-Related Mortality Ratio; White, non-Hispanic White. Sources: Centers for Disease Control and Prevention, NVSS 1935–2003, 2018; PMSS 1987–2016.