The United States spends more on healthcare per capita than any other nation on Earth. Our hospitals boast the most advanced neonatal intensive care units, the most sophisticated fetal monitoring systems, and some of the most highly trained obstetricians in the world. And yet, American mothers are dying at rates that would shock most people.
In 2024, the U.S. maternal mortality rate stood at approximately 22 deaths per 100,000 live births. To put that in perspective: the United Kingdom reports 10. Germany reports 7. Japan reports 4. Among the 38 member nations of the OECD, the United States ranks dead last. We are not just underperforming -- we are failing, and the failure is costing lives in the wealthiest zip codes in America.
I have spent my career studying why mothers die in a country that has every resource to keep them alive. The answer is not simple, but it is knowable. And once you see it, you cannot unsee it.
The Numbers Behind the Crisis
Let's start with what the data actually shows, because the headline statistics only scratch the surface.
The CDC's Pregnancy Mortality Surveillance System tracked 1,205 maternal deaths in 2021 alone. But maternal mortality is not distributed evenly. It clusters along lines of race, geography, and income in ways that reveal something deeply structural.
Black women in the United States die from pregnancy-related causes at 2.6 times the rate of white women. In some states, the disparity is even wider -- in certain counties, Black maternal mortality rates exceed 60 per 100,000, comparable to rates in sub-Saharan Africa. This is not a developing-world problem transplanted onto American soil. This is an American problem, born and raised.
And here is the detail that shatters the simplistic narrative about poverty being the sole driver: Black women with college degrees have worse maternal outcomes than white women who never finished high school. Education and income do not erase the disparity. Something else is operating.
That something else is systemic -- woven into the fabric of how American obstetric care is delivered, who is listened to, and whose pain is taken seriously.
Implicit Bias in the Delivery Room
In 2016, a landmark study published in the Proceedings of the National Academy of Sciences found that a significant percentage of white medical students and residents held false beliefs about biological differences between Black and white patients. Some believed that Black patients literally had thicker skin or less sensitive nerve endings. These beliefs directly correlated with treatment recommendations -- providers who held these false beliefs were less likely to prescribe adequate pain medication to Black patients.
Translate this into the obstetric setting, where rapid clinical decision-making can mean the difference between life and death, and the consequences become devastating.
Consider the case of Kira Johnson. Kira was a healthy, 39-year-old Black woman who spoke five languages, had traveled the world, and delivered her second child via planned cesarean section at Cedars-Sinai Medical Center in Los Angeles -- one of the most prestigious hospitals in America. After the procedure, her husband Charles noticed that her catheter bag was filling with blood. He alerted the nursing staff. He alerted them again. And again. For hours, his concerns were dismissed or deferred. By the time Kira was taken back into surgery, she had been bleeding internally for nearly ten hours. She died on the operating table.
Kira did not die because Cedars-Sinai lacked equipment. She did not die because the surgeons were unqualified. She died because the people around her did not treat her husband's urgent warnings with the seriousness they deserved. Her story is not an anomaly -- it is a pattern.
Dr. Joia Crear-Perry, founder of the National Birth Equity Collaborative, has described racism itself as a clinical risk factor. Not race -- racism. The distinction is critical. There is nothing about being Black that makes pregnancy inherently more dangerous. But there is everything about navigating a healthcare system laced with implicit bias that does.
The Postpartum Desert
In the United States, standard obstetric care includes a single postpartum visit at six weeks. Six weeks. In those six weeks, a new mother is expected to recover from one of the most physically demanding experiences a human body can undergo, establish feeding, cope with sleep deprivation, manage potential mood disorders, and monitor her own body for signs of life-threatening complications.
More than half of all maternal deaths occur in the postpartum period -- many of them after that single six-week visit. Cardiomyopathy, postpartum hemorrhage, sepsis, and hypertensive disorders of pregnancy can all present or worsen in the weeks and months after delivery. Yet our care model essentially abandons mothers the moment they leave the hospital.
Contrast this with the Netherlands, where every new mother receives daily home visits from a maternity care assistant for the first eight to ten days after birth. The visitor monitors the mother's physical recovery, checks for signs of postpartum depression, assists with breastfeeding, and connects the family with community resources. The Dutch maternal mortality rate is approximately 5 per 100,000.
Or consider Finland, where the maternity care system provides a comprehensive "baby box" filled with essential supplies, alongside a robust schedule of prenatal and postpartum visits integrated with mental health screening. Finland's maternal mortality rate hovers around 3 per 100,000.
These countries do not have better doctors or more advanced technology. They have better systems -- systems designed around the understanding that the postpartum period is medically critical, not an afterthought.
What's Actually Working in America
Despite the grim national picture, there are pockets of extraordinary progress happening right now, and they offer a roadmap for scaling change.
California's Maternal Quality Care Collaborative (CMQCC) is perhaps the most powerful proof of concept. In 2006, California had one of the highest maternal mortality rates in the country. The CMQCC brought together hospitals, clinicians, and public health officials to implement standardized safety bundles -- evidence-based protocols for managing hemorrhage, hypertension, and venous thromboembolism. By 2023, California had cut its maternal mortality rate by more than 65 percent, even as the national rate continued to climb. Standardized protocols work. They remove the variability that allows bias to operate unchecked.
Community-based doula programs are showing remarkable results, particularly in communities of color. Studies have consistently demonstrated that continuous labor support from a trained doula reduces cesarean rates, shortens labor, decreases the need for pain medication, and improves maternal satisfaction. Programs like the Brooklyn-based Ancient Song Doula Services and the Minneapolis-based Roots Community Birth Center pair Black and Indigenous mothers with culturally concordant doulas who serve as both birth companions and patient advocates.
A 2023 meta-analysis found that doula-supported births were associated with a 25 percent reduction in preterm birth and significantly lower rates of postpartum depression. Several states, including Oregon, Minnesota, and New Jersey, have begun covering doula services under Medicaid -- a policy change that could dramatically improve outcomes for the most vulnerable mothers.
Telehealth-enabled remote monitoring is closing gaps in maternal care deserts. Programs like the Maternal-Fetal Medicine Units Network's remote blood pressure monitoring initiative allow high-risk mothers in rural areas to transmit daily readings to a clinical team, enabling early intervention for preeclampsia without requiring a 90-mile drive to the nearest perinatologist. Early data shows a 40 percent reduction in severe maternal morbidity among participants.
Data-Driven Solutions for the Next Decade
The path forward is not mysterious. It requires political will, sustained investment, and a willingness to center the experiences of the women who are most at risk. Here is what the evidence tells us would work:
1. Extend Medicaid postpartum coverage to 12 months in every state. The American Rescue Plan gave states the option to extend Medicaid coverage from 60 days to 12 months postpartum. As of early 2026, 46 states have adopted this extension. The remaining four must follow. Maternal death does not respect arbitrary insurance cutoff dates.
2. Mandate implicit bias training in obstetric departments. California has already passed legislation requiring implicit bias training for all perinatal healthcare providers. This must become a national standard. Training alone does not eliminate bias, but it creates the conditions for accountability.
3. Fund and scale community-based doula programs. Doulas are not a luxury for affluent white women in Brooklyn brownstones. They are a clinical intervention with proven efficacy, and they should be available to every Medicaid-enrolled mother in America.
4. Implement maternal safety bundles universally. The CMQCC model works. The Alliance for Innovation on Maternal Health (AIM) has developed safety bundles that any hospital can adopt. What's needed is state-level mandates requiring their implementation, coupled with quality reporting and accountability metrics.
5. Establish maternal mortality review committees in every state with diverse representation. These committees must include community members, doulas, midwives, and women who have experienced near-miss maternal events -- not just physicians and hospital administrators. The lived experience of patients must inform the analysis.
6. Invest in predictive analytics and AI-driven early warning systems. Several academic medical centers are piloting machine learning models that analyze vital signs, lab results, and patient history to flag mothers at elevated risk of hemorrhage, sepsis, or cardiomyopathy before symptoms become critical. Early intervention saves lives -- and algorithms, unlike humans, do not carry implicit bias in their calculations.
The Moral Dimension
I want to end with something that rarely appears in policy papers but matters enormously.
Every maternal death leaves behind a family in crisis. A newborn without a mother. A partner without a co-parent. Older children who will carry the loss for the rest of their lives. The ripple effects are generational -- maternal death is associated with increased rates of infant mortality, childhood behavioral problems, and family economic instability.
When we allow mothers to die from preventable causes in the wealthiest country in the history of the world, we are making a statement about whose lives we value. The data makes it painfully clear whose lives we are valuing least.
This is not an intractable problem. California proved that. Finland proves it. The Netherlands proves it. The solutions exist. What has been missing is the collective decision that American mothers -- all American mothers, regardless of race, zip code, or insurance status -- deserve to survive childbirth.
That decision is overdue.
Ada Obi is a maternal-fetal medicine specialist and public health researcher. She has published extensively on racial disparities in obstetric care and serves as a consultant to the WHO's Maternal Health Division. She holds faculty positions at Johns Hopkins Bloomberg School of Public Health and the University of Lagos College of Medicine.