HHS Study Shows In-hospital Delivery-related Maternal Death Rates Decreased More than Half from 2008 to 2021

Increases identified in severe maternal morbidity signal the need to better understand and manage risk factors leading to pregnancy-related harm and death

A large nationally representative study shows in-hospital delivery-related maternal mortality rates improved 57% between 2008 and 2021, despite identified increases in severe maternal morbidity (SMM). This observational study of over 11 million hospital discharges, conducted by the HHS Office on Women’s Health (OWH) and published in JAMA Open Network, intends to more clearly define trends and risk factors leading to maternal mortality and morbidity in the United States and to improve overall national prevention and treatment efforts.

This decline in deaths during delivery hospitalization likely demonstrates the impact of national and local strategies to improve the quality of care by hospitals during delivery-related hospitalizations. This includes HHS quality improvement activities such as state Perinatal Quality Collaboratives and the Alliance for Innovation on Maternal Health, and ties into the Administration’s commitment to addressing the maternal health crisis, with the United States facing some of the highest maternal death rates among developed nations.

“We are committed to improving health outcomes before, during, and after pregnancy,” said ADM Rachel L. Levine, M.D., HHS Assistant Secretary for Health. “These results underscore the need to better manage women’s health, including identifying the most significant risk factors and supporting access to improved care.”

Specifically, this study found that in-hospital maternal death rates decreased 57 percent, from 10.6 per 100,000 discharges in 2008 to 4.6 per 100,000 discharges in 2021 across the United States. Mortality for American Indian women decreased 92%, Asian women decreased 73%, Black women decreased 76%, Hispanic women decreased 60%, Pacific Islander women decreased 79% and White women decreased 40% during the study period.

However, for every individual who dies as a result of their pregnancy, it is estimated that 20 to 30 more women experience SMM. SMM’s are serious pregnancy-related complications that have significant consequences to a woman’s overall short and long-term health. This study found an increasing trend in SMM for all racial and ethnic groups, from 146.8 per 10,000 discharges in 2008 to 179.8 per 10,000 discharges in 2021. The highest overall rates of SMM were observed in Asian, American Indian, and Pacific Islander women.

The most common delivery-related complications were disseminated intravascular coagulation, acute respiratory distress syndrome, acute kidney failure, sepsis, and eclampsia. Racial and ethnic minority patients experienced higher increases in these complications over time across all ages. The most common risk factors for these complications are obesity, gestational diabetes, tobacco use, gestational hypertension, and asthma. The authors concluded that the overall increase in SMM over time may be attributable to an increase in preexisting conditions, arising during and prior to pregnancy, and the national trend towards increased maternal age over the past decade.

“Further understanding these trends and risk factors is critical in public health decision-making,” said Deputy Assistant Secretary for Women’s Health Dorothy Fink, M.D. “The data enable us to update programs and policies to have the most significant impact on maternal health outcomes.”

HHS is committed to continuing efforts to utilize current nationally representative data to generate evidence-based information and gain additional insights to help us better predict outcomes and ways to improve overall healthcare for women and their families. This study is an important step toward better understanding the root causes of poor maternal health outcomes and where to target future efforts to improve such outcomes.

HHS continues to implement important initiatives focused on improving maternal and infant health. The Centers for Medicare and Medicaid Services recently finalized two new hospital quality measures on severe obstetric complications and the rate of low-risk Cesarean deliveries, as well as a new “Birthing-Friendly“ designation that requires hospitals engage in such quality improvement activities.  This new “Birthing-Friendly” designation and other initiatives included in the White House Blueprint for Addressing the Maternal Health Crisis demonstrate that HHS and the entire Biden-Harris Administration are prioritizing efforts to improve maternal health outcomes.