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Maternal mortality

Is the Black-white maternal death gap narrowing or widening?

The US recorded 669 maternal deaths in 2023, a rate of 18.6 per 100,000 live births, still multiples above every high-income peer. Black women died at 3.5 times the white rate, and CDC judges about four in five of these deaths preventable.

Question

The problem

Maternal mortality is a national safety, access, and equity failure that implicates hospitals, obstetric networks, postpartum care, emergency response, and state policy. Overall rate movement can hide the strategic issue: Black mothers and high-risk states face persistently higher risk, and rural obstetric service loss can further weaken the care continuum.

The recommendation

Manage maternal health as a high-risk service line with explicit equity accountability. The recommended response is to target high-burden states and hospitals, preserve obstetric access, strengthen postpartum care and emergency escalation, and track whether Black-white mortality gaps close as safety programs scale.

The US gap

The US is a maternal-mortality outlier among wealthy nations, and its own rate has fallen back from the 2021 spike rather than clearly improving.

18.6
US maternal deaths per 100,000 live births, 2023
down from 32.9 in 2021 but multiples above every high-income peer
669
maternal deaths recorded in the US in 2023
a rate of 18.6 per 100,000 live births

Maternal mortality, United States vs peer nations

Deaths per 100,000 live births. US figure is 2023, peer figures are each country's most recent available year, mostly 2021.

Read it this way The United States bar is the tallest by a wide margin, more than seven times Sweden's rate, even though most peer figures come from 2021 while the US figure is 2023. Because these are single-year snapshots from different years for different countries, read this as a comparison of overall standing, not a matched trend line. Use this chart to separate overall maternal-risk movement from equity and state variation, then connect the evidence to targeted maternal-safety and access interventions.

Caveat International figures are single-year snapshots from different years, not a matched time series, because most countries do not publish annual maternal mortality series comparable across years.

0 5 10 15 20 United States (2023) 18.6 Chile (2022) 14.3 South Korea (2021) 8.8 Australia (2021) 3.5 Germany (2021) 3.5 Japan (2021) 3.4 Netherlands (2021) 2.8 Sweden (2021) 2.6
⊞ data table⬇ CSV
Country (year)Maternal deaths per 100k births
United States (2023)18.6
Chile (2022)14.3
South Korea (2021)8.8
Australia (2021)3.5
Germany (2021)3.5
Japan (2021)3.4
Netherlands (2021)2.8
Sweden (2021)2.6

CDC NCHS and Commonwealth Fund (OECD Health Statistics) · 2018 to 2023 · source

US maternal mortality rate, 2018 to 2023

One US series. The rate spiked to 32.9 in 2021 during the pandemic, then fell back to 18.6 in 2023, close to its 2018 level.

Read it this way The line rises through the pandemic years, peaks at 32.9 in 2021, then falls back to 18.6 by 2023, close to the 17.4 level recorded in 2018. Six years of data show a spike-and-recovery shape, not enough to say whether the underlying rate is now on a lower long-run path. Use this chart to separate overall maternal-risk movement from equity and state variation, then connect the evidence to targeted maternal-safety and access interventions.

0 12.5 25 37.5 50 201820192020202120222023 US rate
⊞ data table⬇ CSV
YearUS deaths per 100k
201817.4
201920.1
202023.8
202132.9
202222.3
202318.6

CDC NCHS, Maternal Mortality Rates in the United States · 2018 to 2023 · source

Who bears it

How sharply race changes the odds of dying, and whether the Black-white gap is narrowing. The ratio shows it widened to 3.5 in 2023.

3.5x
Black women died at 3.5 times the white rate in 2023
50.3 vs 14.5 deaths per 100,000 live births
~4 in 5
US pregnancy-related deaths judged preventable
CDC review of Maternal Mortality Review Committees, 36 states

Maternal mortality by race and ethnicity, 2023

Deaths per 100,000 live births. The Black rate was 3.5 times the white rate in 2023.

Read it this way The Black bar is more than three times the height of every other group shown, at 50.3 deaths per 100,000 versus 14.5 for White, 12.4 for Hispanic, and 10.7 for Asian. American Indian and Alaska Native mothers are not shown here because CDC could not publish a reliable national rate for that group. Use this chart to separate overall maternal-risk movement from equity and state variation, then connect the evidence to targeted maternal-safety and access interventions.

Caveat American Indian and Alaska Native maternal mortality cannot be displayed nationally due to small sample sizes, so it is omitted here rather than estimated.

0 25 50 75 100 Black 50.3 White 14.5 Hispanic 12.4 Asian 10.7
⊞ data table⬇ CSV
Race and ethnicityMaternal deaths per 100k births
Black50.3
White14.5
Hispanic12.4
Asian10.7

CDC NCHS, Maternal Mortality Rates in the United States, 2023 · 2023 · source

Maternal mortality by race, 2018 to 2023

Four race series. Every group spiked in 2020 and 2021, but the Black line stayed far above the rest throughout.

Read it this way All four lines rise together in 2020 and 2021 and then fall back, but the Black line stays well above the other three in every single year from 2018 to 2023. The shared spike points to a common period effect across groups, while the persistent vertical gap points to a separate, longer-standing disparity. Use this chart to separate overall maternal-risk movement from equity and state variation, then connect the evidence to targeted maternal-safety and access interventions.

0 25 50 75 100 201820192020202120222023 BlackWhiteHispanicAsian
⊞ data table⬇ CSV
YearBlackWhiteHispanicAsian
201837.314.911.813.3
20194417.912.613.8
202055.319.118.212.3
202169.926.62816.8
202249.51916.913.2
202350.314.512.410.7

CDC NCHS, Maternal Mortality Rates in the United States · 2018 to 2023 · source

Black-to-white maternal mortality ratio, 2018 to 2023

A ratio of 1.0 would mean parity. The line never approaches it, and in 2023 it jumped to 3.5 as the white rate fell faster than the Black rate.

Read it this way A ratio of 1.0 would mean equal risk for Black and white mothers; the line stays between 2.5 and 3.5 across all six years and never comes close. The 2023 jump to 3.5 reflects the white rate falling faster than the Black rate that year, not a new rise in Black maternal deaths. Use this chart to separate overall maternal-risk movement from equity and state variation, then connect the evidence to targeted maternal-safety and access interventions.

0.00× 1.25× 2.50× 3.75× 5.00× 201820192020202120222023 Black-to-white ratio
⊞ data table⬇ CSV
YearBlack-to-white ratio
20182.5
20192.5
20202.9
20212.6
20222.6
20233.5

CDC NCHS, Maternal Mortality Rates in the United States · 2018 to 2023 · source

Where

Where risk is highest by rate and where the absolute toll concentrates by count, so state resources can be targeted on the right axis.

41.1
highest state maternal mortality rate, Tennessee, 2018 to 2022
vs 10.5 in California, the lowest reported state rate

Maternal mortality by state, 2018 to 2022 pooled

Deaths per 100,000 live births, pooled over five years. Darker means higher. Fifteen states plus DC are suppressed for too few deaths and are not shown.

Read it this way Darker tiles mark states with higher pooled maternal mortality rates from 2018 to 2022, ranging from 10.5 in California to 41.1 in Tennessee among the states shown. Fifteen states plus DC are left blank because their death counts were too small to publish reliably, so the map does not cover every state. Use this chart to separate overall maternal-risk movement from equity and state variation, then connect the evidence to targeted maternal-safety and access interventions.

Caveat State rates are pooled over 2018-2022 because annual state counts are too small to publish reliably. States with fewer than 20 deaths over the five years are suppressed and omitted.

AK ME WA 18 ID 20 MT ND MN 12.3 WI 13.2 MI 19.1 NY 22.4 VT NH OR 16.6 NV 20.4 WY SD IA 19.5 IL 18.1 IN 30.9 OH 24.5 PA 17.5 NJ 26 MA 16.4 CA 10.5 UT 15.5 CO 16 NE 25.1 MO 23.8 KY 34.6 WV 23.9 VA 32.7 MD 21.3 CT 15.6 RI AZ 30 NM 28 KS 22.8 AR 38.3 TN 41.1 NC 26.7 SC 32.3 DC DE OK 29.6 LA 37.3 MS 39.1 AL 38.6 GA 32.1 TX 28.2 FL 24.1 HI 0 41.1
⊞ data table⬇ CSV
StateMaternal deaths per 100k births
Tennessee41.1
Mississippi39.1
Alabama38.6
Arkansas38.3
Louisiana37.3
Kentucky34.6
Virginia32.7
South Carolina32.3
Georgia32.1
Indiana30.9
Arizona30
Oklahoma29.6
Texas28.2
New Mexico28
North Carolina26.7
New Jersey26
Nebraska25.1
Ohio24.5
Florida24.1
West Virginia23.9
Missouri23.8
Kansas22.8
New York22.4
Maryland21.3
Nevada20.4
Idaho20
Iowa19.5
Michigan19.1
Illinois18.1
Washington18
Pennsylvania17.5
Oregon16.6
Massachusetts16.4
Colorado16
Connecticut15.6
Utah15.5
Wisconsin13.2
Minnesota12.3
California10.5

CDC NCHS, Maternal deaths and mortality rates by state, 2018-2022 · 2018 to 2022 · source

States by number of maternal deaths, 2018 to 2022

Absolute maternal deaths over five years, top 15 by count. High-count states are not always high-rate, since large states have more births. California is high count but low rate.

Read it this way Bar length here is the raw count of maternal deaths over five years, not the rate, so large states like Texas and California rank high mainly because they have more births. The table alongside gives each state's rate too, since a high count and a high rate answer different questions. Use this chart to separate overall maternal-risk movement from equity and state variation, then connect the evidence to targeted maternal-safety and access interventions.

0 250 500 750 1,000 Texas 532 Florida 263 New York 241 California 228 Georgia 201 Tennessee 166 Ohio 161 North Carolina 159 Virginia 158 New Jersey 131 Indiana 124 Illinois 123 Arizona 118 Pennsylvania 116 Alabama 112
⊞ data table⬇ CSV
StateMaternal deaths 2018 to 2022Rate per 100k
Texas53228.2
Florida26324.1
New York24122.4
California22810.5
Georgia20132.1
Tennessee16641.1
Ohio16124.5
North Carolina15926.7
Virginia15832.7
New Jersey13126
Indiana12430.9
Illinois12318.1
Arizona11830
Pennsylvania11617.5
Alabama11238.6

CDC NCHS, Maternal deaths and mortality rates by state, 2018-2022 · 2018 to 2022 · source

Why this matters

CDC's own review of Maternal Mortality Review Committee findings judges about four in five pregnancy-related deaths preventable, which points to a system-response and care-continuity gap rather than an unavoidable clinical outcome. This compounds with sharp state variation, from 10.5 per 100,000 in California to 41.1 in Tennessee, so where a mother lives materially changes her risk.

Recommended actions

  • Fund state Maternal Mortality Review Committees so the roughly four-in-five preventability finding can be converted into concrete, case-level fixes.
  • Extend postpartum Medicaid coverage in the highest-rate states (Tennessee 41.1, Mississippi 39.1, Alabama 38.6 per 100,000).
  • Monitor the Black-white ratio specifically, not just the national rate; it can rise even as the national rate falls, as it did in 2023.
  • Direct resources by both rate and count: high-count states (Texas 532 deaths, Florida 263, New York 241) need volume-scaled interventions even where their rate is moderate, while high-rate states need targeted quality-of-care fixes.
  • Track the national rate against its pre-pandemic 2018 baseline (17.4) rather than only against the 2021 peak, since the 2023 figure of 18.6 is still slightly above that starting point.

The recommendation

Therefore, manage maternal health as a high-risk service line with explicit equity accountability. The recommended response is to target high-burden states and hospitals, preserve obstetric access, strengthen postpartum care and emergency escalation, and track whether Black-white mortality gaps close as safety programs scale.

Demographic slice race, state. CDC NCHS maternal mortality.

Sources