New study finds most maternal-related deaths in the US happen after birth

A new study analyzing maternal mortality rates found that nearly two-thirds of maternal-related deaths in the U.S. happen up to a year after a woman has given birth.

The finding is part of a wider study by The Commonwealth Fund that analyzed maternal mortality rates among 14 developed nations, concluding that maternal mortality in the U.S. continues to far exceed that of other high-income nations.

Researchers used data from the U.S. Centers for Disease Control and Prevention (CDC) and the Organisation for Economic Co-operation and Development (OECD). They found 22 women die for every 100,000 live births in the United States, compared to 0-14 maternal deaths per 100,000 live births in other countries. Sixty-five percent of deaths happened after delivery.

“This is unacceptably high. We know that nearly 80% of the deaths are preventable with the right treatment and right care for women,” Munira Z. Gunja, the lead author in the study and a Senior Researcher in the International Health Policy Program at The Commonwealth Fund, told ABC News.

“In the U.S., we are really leaving women behind and not making sure we're providing them with the right care to allow them to give birth in a safe way,” she said.

The Commonwealth Fund analyzed data from the United States, Australia, Canada, Chile, France, Germany, Japan, Korea, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

In the United States, 22% of maternal deaths happened during pregnancy, most often the result of heart conditions and stroke. Approximately 13% of all deaths occurred on the day of delivery.

After delivery, 12% of deaths took place in the first week postpartum, the most common contributors being high blood pressure, severe bleeding and infection. Twenty-three percent of deaths occurred up to 42 days after birth. Late deaths, which accounted for 30% of all deaths, happened up to one year after birth and were frequently associated with cardiomyopathy.

Black mothers experience the highest rate of death in the U.S. According to the report, 49.5 Black women die for every 100,000 live births.

The United States was found to be the only country in the study without a universal health system. Roughly eight million women are left uninsured, and Black women are disproportionately affected, Gunta said.

“We know that there are many steps the U.S. could implement to really reduce or eliminate maternal deaths altogether. Other countries have been able to achieve this; the U.S. could do the same,” Gunja said, later adding that understanding the timing of deaths is really important when it comes to maternal care so barriers to care can be identified to make sure women are doing well postpartum.

When looking at maternal care provided in other countries, the U.S. is the only country that does not guarantee at least one home visit by a midwife or nurse within one week of delivery, despite evidence suggesting home visits are associated with better mental health, breastfeeding outcomes and reduced health care costs.

Data found that in most high-income countries, midwives far outnumber obstetrician-gynecologists (ob-gyns). The U.S., Canada and Korea were the only countries where ob-gyns outnumbered midwives, with the lowest total supply of providers, with 16 midwives and 13 ob-gyns for every 1,000 live births.

Gunja said expanding midwifery care and diversifying the workforce is critical in reducing mortality rates in the United States, especially for Black women.

“Having a midwife … come to your home, provide care, really create a relationship with you, be a trusted source and be someone who may look like you racially or ethnically, is really also proven to be a big part in building trust,” Gunja said. “Midwives can really be a trusted source of care for patients that we don't always get when we go to see our ob-gyn.”

The study found that an increase in the midwife and obstetrician workforce, comprehensive maternal care coverage, guaranteed paid maternity leave and postpartum home visits could help reduce the alarming rates of maternal mortality in the U.S.

The Commonwealth Fund study comes just four weeks after the CDC published its yearly report on maternal mortality in the U.S., finding that there was a decrease in maternal mortality rates in 2022 following three years of continuous increases. While this decrease is a step in the right direction, Gunja said there is still a lot of work to do.

“We know that most of these deaths are preventable, and we know that a lot of other countries have been able to achieve near-zero or zero deaths,” Gunja said.

“Starting to actually implement policies, and not just at a state level but at a federal level, so that way we can ensure that every woman, so not just women who have the right employer or women who live in the right state have the right support to take care of themselves before pregnancy, during and after pregnancy,” she said.

Parmida Jafari MD, Board-Certified Family Physician and graduating resident at Temple Northwest Community FM and a member of the ABC News Medical Unit