Maternal & Infant Mortality in the US

What 24 years of data really tell us

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"US maternal mortality has been rising for decades."

This is what the data seemed to show. But the real story is more complicated.

The measurement changed

States gradually added a "pregnancy checkbox" to death certificates between 2003-2017, improving detection but inflating apparent trends.

66%

of the apparent increase was an artifact

Using difference-in-differences analysis, researchers found the pregnancy checkbox explained most of the observed rise from 2000-2019.

Park et al., JAMA Pediatrics 2025

The true rate was stable for 20 years

6.8-10.2
per 100,000 live births
(2000-2020)

After adjusting for measurement changes, maternal mortality remained relatively constant.

Then came COVID-19

18.9

deaths per 100,000 in 2021

Maternal mortality nearly doubled during the Delta wave, reaching its highest point since 2000.

25% of maternal deaths in 2020-2021 were COVID-related (GAO)

By 2022, rates returned to pre-pandemic levels

18.9
2021 (peak)
→
10.2
2022

This demonstrates both the pandemic's impact and the potential for recovery.

But the burden isn't shared equally

3x

higher mortality for Black women

Non-Hispanic Black women had approximately triple the maternal mortality rate of non-Hispanic White women across all time periods studied.

Non-Hispanic White
10.0
Non-Hispanic Black
28.4

Rates per 100,000 live births, 2020-2022

2.6x

increase for Native American women during COVID

Native American or Alaska Native women saw the largest increase of any group, with rates more than doubling from 2011-2019 to 2020-2022.

10.7
2011-2019
→
27.5
2020-2022

Rates per 100,000 live births

The South saw the worst outcomes

Women in the South experienced the greatest increases across all time periods.

10.3
South (2011-2019)
→
17.8
South (2020-2022)

The Northeast was the only region without a statistically significant increase during COVID.

There is some good news

-22%

decline in infant mortality since 2000

6.93
per 1,000 (2000)
→
5.44
per 1,000 (2020)

Infant deaths decreased consistently across all regions and racial/ethnic groups.

Fetal mortality also declined

6.28
per 1,000 (2005)
→
5.53
per 1,000 (2022)

Unlike maternal mortality, fetal and infant outcomes showed continued improvement.

What does this mean?

Three key findings

Finding 1
Measurement matters
Most of the apparent pre-COVID increase in maternal mortality was an artifact of improved detection through the pregnancy checkbox, not a true worsening of outcomes.
Finding 2
COVID had real impact
The pandemic caused a genuine, dramatic spike in maternal deaths in 2021. Public health emergencies directly affect maternal health outcomes.
Finding 3
Disparities persist
Racial and geographic disparities remained stark throughout, with Black women facing 3x the risk and the South seeing the worst outcomes.

Three key findings

Finding 1
Measurement matters
Most of the apparent pre-COVID increase in maternal mortality was an artifact of improved detection through the pregnancy checkbox, not a true worsening of outcomes.
Finding 2
COVID had real impact
The pandemic caused a genuine, dramatic spike in maternal deaths in 2021. Public health emergencies directly affect maternal health outcomes.
Finding 3
Disparities persist
Racial and geographic disparities remained stark throughout, with Black women facing 3x the risk and the South seeing the worst outcomes.

Three key findings

Finding 1
Measurement matters
Most of the apparent pre-COVID increase in maternal mortality was an artifact of improved detection through the pregnancy checkbox, not a true worsening of outcomes.
Finding 2
COVID had real impact
The pandemic caused a genuine, dramatic spike in maternal deaths in 2021. Public health emergencies directly affect maternal health outcomes.
Finding 3
Disparities persist
Racial and geographic disparities remained stark throughout, with Black women facing 3x the risk and the South seeing the worst outcomes.

Three key findings

Finding 1
Measurement matters
Most of the apparent pre-COVID increase in maternal mortality was an artifact of improved detection through the pregnancy checkbox, not a true worsening of outcomes.
Finding 2
COVID had real impact
The pandemic caused a genuine, dramatic spike in maternal deaths in 2021. Public health emergencies directly affect maternal health outcomes.
Finding 3
Disparities persist
Racial and geographic disparities remained stark throughout, with Black women facing 3x the risk and the South seeing the worst outcomes.

Park, Bilinski, Parks & Flaxman, JAMA Pediatrics 2025

The bottom line

Accurate measurement is essential. Pandemic preparedness must include maternal health. And addressing racial disparities requires targeted interventions.

Read the full research

JAMA Pediatrics Paper

Research by Robin Y. Park (University of Oxford), Dr. Alyssa Bilinski (Brown University), Dr. Robbie M. Parks (Columbia University), and Dr. Seth Flaxman (University of Oxford)