The Centers for Disease Control reported 22.5 maternal deaths per 100,000 live births in the most recent year of complete data. The comparable rate is roughly 8 per 100,000 in the United Kingdom, 5 in Germany, 4 in Canada, and under 3 in the Nordic countries. The US rate has roughly doubled since 2000. Among OECD nations, the US is the only one where maternal mortality has trended upward over the last two decades.
The Commonwealth Fund, the Kaiser Family Foundation, and the World Health Organization have all published comparative analyses with consistent findings. The Wall Street Journal in March documented closures of rural maternity wards across the South and Midwest. According to the American Hospital Association, more than 200 rural hospitals have closed their labor and delivery units since 2019. In several states, including Texas, Alabama, and Mississippi, more than half of all counties have no practicing obstetrician. The University of Minnesota Rural Health Research Center has linked rural maternity-ward closures directly to elevated maternal death rates in the affected counties.
The clinical picture is well documented. The leading direct causes of US maternal death, per the CDC’s pregnancy mortality surveillance system, are cardiovascular conditions, hemorrhage, infection, and hypertensive disorders, in that order. Roughly a third of deaths occur between one week and one year postpartum, a window when many low-income women lose Medicaid coverage under prior rules. Twelve states have not adopted the federal option to extend postpartum Medicaid to 12 months; in those states the coverage cliff at 60 days remains.
US healthcare spending per capita is higher than any other country in the world, roughly $13,500 in 2024 by OECD measure. That spending produces world-leading outcomes in oncology and cardiac care. It does not produce competitive maternal outcomes. The mismatch reflects how dollars are allocated rather than how many dollars are allocated. Most US maternal deaths are considered preventable by the CDC’s own maternal mortality review committees: between 60 and 80 percent in published state-level reviews.
The interventions that move the number, based on the same review committees and OECD comparisons, are straightforward and not in technical dispute: continuous prenatal coverage, postpartum Medicaid extension, midwife integration into routine deliveries, and maintaining obstetric capacity in rural counties. The barriers are financing and political. There is a recorded vote on postpartum Medicaid extension pending in the 12 holdout states. There are bipartisan rural maternal health bills sitting in committee in Congress. Where they land in the next session is a measurable test of how seriously the country treats the gap.