Maternal mortality and severe illness are critical issues in the United States. There are racial, ethnic, and geographic differences in death rates. Severe maternal illness is far more common than death.

More than 700 women die each year in the US from pregnancy-related causes. Especially concerning is that:

• Non-Hispanic Black women and American Indian/Alaska Native women are two to three times as likely to die of pregnancy-related causes as compared to their white, Asian Pacific Islander, and Hispanic counterparts.
• Four of every five pregnancy-related deaths are preventable.
• Thousands of women experience unintended outcomes of labor and delivery that result in significant short- or long-term health consequences.

Racial and ethnic disparities in maternal mortality — deaths related to pregnancy or childbirth — in the United States may be larger than previously reported, suggests a study funded by the National Institutes of Health. By re-examining information on death certificates from 2016 and 2017, researchers found that the maternal mortality rate among non-Hispanic Black women was 3.5 times higher than among non-Hispanic white women. Previously, standard analyses had indicated a 2.5-times-higher death rate for Black women.

The new analysis also revealed that these disparities were concentrated among a few causes of death. Postpartum cardiomyopathy (disease of the heart muscle) and the blood pressure disorders preeclampsia and eclampsia were leading causes of maternal death for Black women, with mortality rates five times higher than those for white women. Pregnant and postpartum Black women were two to three times more likely than white women to die of hemorrhage (severe bleeding) or embolisms (blood vessel blockages).

The study was funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and led by Marian MacDorman, Ph.D., of the Maryland Population Research Center at the University of Maryland. It appears in the American Journal of Public Health.

“These sobering findings highlight the urgent need to address racial and ethnic disparities in maternal deaths,” said NICHD Director Diana W. Bianchi, M.D. “Accurate data are essential to guide efforts to reduce maternal deaths, many of which are preventable, and to improve the equity of healthcare for women during and after pregnancy.”

U.S. maternal mortality statistics are determined from death certificates completed by a physician, coroner or medical examiner and reported to state vital records offices. Information about the cause of death is translated into medical codes, which the Centers for Disease Control and Prevention compile into national datasets. In 2003, states began adding a checkbox to the certificates to indicate whether a woman was pregnant or postpartum at the time of death. However, validation studies revealed frequent checkbox errors and found that maternal deaths often are coded to poorly defined causes.

In the current study, researchers re-examined death certificates from 2016 and 2017, carefully evaluating the text on the death certificates that describes in detail the factors that led to death. This allowed the researchers to identify deaths that could be clearly confirmed as maternal ones. In most cases, they also were able to determine the primary cause of death, reducing the percentage of deaths attributed to poorly defined causes from 43% in standard datasets to 2.5% among their set of confirmed maternal deaths.

In their analysis, embolisms and preeclampsia/eclampsia tied for the leading overall cause of maternal death across all racial and ethnic groups during pregnancy or within six weeks after pregnancy. These were followed by postpartum cardiomyopathy, hemorrhage and complications from obstetric surgeries such as cesarean sections. Rankings were similar among white and Hispanic women. For Black women, preeclampsia/eclampsia was the leading cause of maternal death, followed by postpartum cardiomyopathy, embolism and hemorrhage. Ectopic pregnancy was the fifth leading cause of maternal death for Black women but was not a leading cause for white or Hispanic women.

Late maternal deaths — those occurring between six weeks and one year postpartum — were 3.5 times more likely among Black women than white women. Postpartum cardiomyopathy was the leading overall cause of late maternal deaths, with Black women having a six-times-higher risk than white women.

“We conclude that the prominence of cardiovascular conditions among the leading causes of maternal deaths, particularly for Black women, highlights the importance of increased vigilance to improve early diagnosis and treatment of these complications,” said Dr. MacDorman.

The study was funded by NICHD under award number R21HD095236. A summary of the findings was presented at the Population Association of America Annual Meeting in May 2021.

Most Pregnancy-Related Deaths are Preventable

Each year in the United States, about 700 people die during pregnancy or in the year after. Another 50,000 people each year have unexpected outcomes of labor and delivery with serious short- or long-term health consequences. Every pregnancy-related death is tragic, especially because two in three of them are preventable. Recognizing urgent maternal warning signs and providing timely treatment and quality care can prevent many pregnancy-related deaths.

Racial Disparities Exist

Black women are three times more likely to die from a pregnancy-related cause than White women. Multiple factors contribute to these disparities, such as variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias. Social determinants of health prevent many people from racial and ethnic minority groups from having fair opportunities for economic, physical, and emotional health.

Working Together to Reduce Black Maternal Mortality

During Black Maternal Health Week, learn how you can support pregnant people in your life to reduce factors that contribute to pregnancy-related complications and death.

Pregnant people and their families can:

Talk to a healthcare provider if anything doesn’t feel right or is concerning.

• Know and seek immediate care if experiencing any of the urgent maternal warning signs, including severe headache, extreme swelling of hands or face, trouble breathing, heavy vaginal bleeding or discharge, overwhelming tiredness, and more. These symptoms could indicate a potentially life-threatening complication.
• Document and share pregnancy history during each medical care visit for up to one year after delivery.
• Maintain ongoing healthcare and social support systems before, during, and after pregnancy.

Healthcare providers can:

Ask questions to better understand their patient and things that may be affecting their lives.

• Help patients, and those accompanying them, understand the urgent maternal warning signs and when to seek medical attention right away.
• Help patients manage chronic conditions or conditions that may arise during pregnancy like hypertension, diabetes, or depression.
• Recognize unconscious bias in themselves and in their office.
• Address any concerns patients may have.
• Provide all patients with respectful care.

Hospitals and healthcare systems can:

• Identify and address unconscious bias in healthcare.
• Standardize coordination of care and response to emergencies.
• Improve delivery of quality prenatal and postpartum care.
• Train non-obstetric care providers to ask about pregnancy history in the preceding year.

States and communities can:

• Assess and coordinate delivery hospitals for risk-appropriate care.
• Support review of the causes behind every maternal death.
• Identify and address social factors influencing maternal health such as unstable housing, transportation access, food insecurity, substance use, violence, and racial and economic inequality.

CDC Activities to Prevent Maternal Mortality

To prevent pregnancy-related deaths, CDC:

• Supports states through the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. This work facilitates an understanding of the drivers of maternal mortality and complications of pregnancy to better prevent maternal deaths and reduce racial disparities.
• Supports state perinatal quality collaboratives (PQCs) to improve the quality of care for mothers and their babies. This work supports the capabilities of PQCs to improve the quality of perinatal care in their states, including efforts to reduce racial/ethnic and geographic disparities.
• Helps states standardize their assessments of levels of maternal and newborn care for their delivery hospitals by offering the CDC Levels of Care Assessment Tool and providing technical assistance to those who want to use it.
• Promotes the Hear Her campaign to raise awareness of potentially life-threatening warning signs during and after pregnancy and improve communication between patients and their healthcare providers.

COVID-19 and Pregnancy

People who are pregnant or were recently pregnant are more likely to get severely ill from COVID-19 compared to people who are not pregnant. Getting a COVID-19 vaccine can help protect pregnant people from getting very sick from COVID-19. COVID-19 vaccination is recommended for people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Non-Hispanic Black women have lower COVID-19 vaccination coverage during pregnancy compared to pregnant women from other racial and ethnic groups. This inequity is related to past and other existing inequities in health and its social determinants.

Although deaths related to pregnancy are rare, most are preventable. We lose too many American Indian and Alaska Native mothers each year from complications related to pregnancy.

What to know

Ongoing and historical trauma contribute to the maternal health inequities and systemic barriers to care many American Indian and Alaska Native people experience. Despite these challenges, American Indian and Alaska Native people build resilience through culture, spirituality, shared values, and a strong sense of identity.

Resilience in the face of disparities

Although deaths related to pregnancy are rare, most are preventable. We lose too many American Indian and Alaska Native mothers each year from complications related to pregnancy.

Unacceptable Disparities ‎

American Indian and Alaska Native people experience disparities in pregnancy-related death and other maternal health conditions. Ongoing and historical trauma—due to colonization, genocide, forced migration, and cultural erasure—contribute to health inequities. Due to ongoing and historical trauma, American Indian and Alaska Native people are more likely to have underlying chronic health conditions and experience sexual or interpersonal violence. American Indian and Alaska Native people often experience discrimination or racism. They also often face systemic barriers to care, including higher rates of poverty and longer distances to quality health care services.

Despite these challenges, American Indian and Alaska Native people continue to be resilient and thrive.

Many American Indian and Alaska Native people draw strength from culture and tradition. Their resilience is built through culture, spirituality, shared values, and a strong sense of identity. Culture serves as a protective factor in the health and well-being of American Indian and Alaska Native people.

We honor the lives of those who have passed on, and work to prevent future losses.

Overview

Every pregnancy-related death is tragic, especially because about 60% are preventable. Still, about 700 women die each year from complications of pregnancy. A pregnancy-related death can happen during pregnancy, at delivery, and even up to a year afterward (postpartum).

For 2011-2015:

• • about 1/3 of deaths (31%) happened during pregnancy;
  • about 1/3 (36%) happened at delivery or in the week after; and
  • about 1/3 (33%) happened 1 week to 1 year postpartum.
• Heart disease and stroke caused more than 1 in 3 deaths (34%). Other leading causes of death included infections and severe bleeding.
• Black and American Indian/Alaska Native women were about 3 times as likely to die from a pregnancy-related cause as White women.

Preventing pregnancy-related death every step of the way.

During Pregnancy: Improve access to and delivery of quality prenatal care, which includes managing chronic conditions and educating about warning signs.

At Delivery: Standardize patient care, including delivering high-risk women at hospitals with specialized providers and equipment.

Postpartum: Provide high-quality care for mothers up to one year after birth, which includes communicating with patients about warning signs and connecting to prompt follow-up care.

Leading causes of death differ throughout pregnancy and after.

• Heart disease and stroke cause most deaths overall.
• Obstetric emergencies, like severe bleeding and amniotic fluid embolism (when amniotic fluid enters a mother’s bloodstream), cause most deaths at delivery.
• In the week after delivery, severe bleeding, high blood pressure and infection are most common.
• Cardiomyopathy (weakened heart muscle) is the leading cause of deaths 1 week to 1 year after delivery.

Problem

Pregnancy-related death can happen throughout pregnancy and after.

EVERY DEATH REFLECTS A WEB OF MISSED OPPORTUNITIES.

• Factors playing a part can include:
  • access to care;
  • missed or delayed diagnoses;
  • not recognizing warning signs.
• Most deaths are preventable, no matter when they occur.
• We can better identify and close gaps in access to quality care.

The Way Forward

Healthcare Providers Can:

• Help patients manage chronic conditions.

• Communicate with patients about warning signs.

• Use tools to flag warning signs early so women can receive timely treatment.

Hospitals and Health Systems Can:

• Standardize coordination of care and response to emergencies.

• Improve delivery of quality prenatal and postpartum care.

• Train non-obstetric providers to consider recent pregnancy history.

States and Communities Can:

• Assess and coordinate delivery hospitals for risk-appropriate care.

• Support review of the causes behind every maternal death.

Women & Their Families Can:

• Know and communicate about symptoms of complications.

• Note pregnancy history any time medical care is received in the year after delivery.

A developing baby goes through important growth throughout pregnancy—including in the final months and weeks. Premature (also known as preterm) birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. The earlier a baby is born, the higher the risk of death or serious disability. In 2020, preterm birth and low birth weight accounted for about 16% of infant deaths. Babies who survive can have breathing issues, intestinal (digestive) problems, and bleeding in their brains. Long-term problems may include developmental delay (not meeting the developmental milestones for his or her age) and lower performance in school.

Preterm Birth in the United States

Reducing preterm birth is a national public health priority. The preterm birth rate rose 4% in in 2021, from 10.1% in 2020 to 10.5% in 2021. However, racial and ethnic differences in preterm birth rates remain. In 2021, the rate of preterm birth among non-Hispanic black women (14.8%) was about 50% higher than the rate of preterm birth among non-Hispanic white women (9.5%) or Hispanic women (10.2%).

Risk Factors

Experts don’t know all the reasons that some babies are born too early. Some things (called risk factors) can increase the chance that a woman will have a preterm birth. However, a woman can still have a premature birth even if she has no known risk factors. Some risk factors for preterm birth include delivering a premature baby in the past, being pregnant with multiples, tobacco use and substance abuse, and short time (less than 18 months) between pregnancies. Additionally, pregnancy complications can result in preterm birth because the baby has to be delivered early.

Signs and Symptoms of Preterm Labor

In most cases, preterm labor (labor that happens too soon, before 37 weeks of pregnancy) begins unexpectedly and the cause is unknown. Like regular labor, signs of early labor include—

• Contractions (the abdomen tightens like a fist) every 10 minutes or more often
• Change in vaginal discharge (a significant increase in the amount of discharge or leaking fluid or bleeding from the vagina)
• Pelvic pressure—the feeling that the baby is pushing down
• Low, dull backache
• Abdominal cramps with or without diarrhea

If you have any signs or symptoms of preterm labor, call your healthcare provider right away.

What Can We Do?

We can work to reduce preterm birth using the following strategies:

• Providing women access to health care before and between pregnancies;
• Identifying women at risk for preterm delivery and offering treatments that may reduce the risk of preterm birth;
• Preventing unintended pregnancies and waiting at least 18 months between pregnancies;
• Choosing single embryo transfer as appropriate when undergoing in vitro fertilization because being pregnant with multiples (twins, triplets, or more) has a higher risk of preterm birth.

Many families are affected by stillbirth, which is the loss of a baby at or after 20 weeks of pregnancy. A study from the Centers for Disease Control and Prevention (CDC) found that Black mothers were more than twice as likely to experience stillbirth compared to Hispanic and white mothers. While the full reason for these racial disparities is not clear, differences in health problems that occur during pregnancy or underlying health conditions may be linked to these differences. Improvements in women’s health, with regular access to quality prenatal care, can potentially reduce the risk of stillbirth for women and families.

Main Findings

• During 2015-2017, 1 in every 166 pregnancies ended in stillbirth in the United States.
• Almost 1 in 3 stillbirths did not have a cause specified.
• Stillbirth rates were higher in the southern United States.
• Black mothers were more than twice as likely to experience a stillbirth compared to Hispanic and white mothers.
• Health problems that occurred during pregnancy or underlying health conditions were listed as the cause of the stillbirth three times more often among Black mothers than among white mothers.
• Improvements in women’s health, with regular access to quality prenatal care, can potentially reduce the risk of stillbirth for women and families.
• Trained healthcare professionals can be a great resource for mothers and families during the grieving process. Grief counseling can help mothers and families cope with loss.

About This Study

CDC scientists looked at information from 2015-2017 Fetal Death Data Files and birth certificates provided by the National Vital Statistics System, which represented the most current data at the time of analysis.

About Stillbirth

A stillbirth is the death or loss of a baby before or during delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs. In the United States, a miscarriage is usually defined as loss of a baby before the 20th week of pregnancy, and a stillbirth is loss of a baby after 20 weeks of pregnancy.

Infant mortality is the death of an infant before his or her first birthday. The infant mortality rate is the number of infant deaths for every 1,000 live births. In addition to giving us key information about maternal and infant health, the infant mortality rate is an important marker of the overall health of a society. In 2020, the infant mortality rate in the United States was 5.4 deaths per 1,000 live births.

Causes of Infant Mortality

Almost 20,000 infants died in the United States in 2020. The five leading causes of infant death in 2020 were:

1. Birth defects.
2. Preterm birth and low birth weight.
3. Sudden infant death syndrome.
4. Injuries (e.g., suffocation).
5. Maternal pregnancy complications.

Infant Mortality Rates by State, 2020

Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. One of the Healthy People objectives is to reduce the rate of all infant deaths. In 2020, 16 states met the Healthy People 2030 target of 5.0 infant deaths per 1,000 live births. Geographically, infant mortality rates in 2020 were highest among states in the south.

Infant Mortality Rates by Race and Ethnicity, 2019

In 2019, infant mortality rates by race and ethnicity were as follows:

• Non-Hispanic Black: 10.6
• Non-Hispanic Native Hawaiian or other Pacific Islander: 8.2
• Non-Hispanic American Indian/Alaska Native: 7.9
• Hispanic: 5.0
• Non-Hispanic white: 4.5
• Non-Hispanic Asian: 3.4

*Source: Infant Mortality in the United States, 2019: Data From the Period Linked Birth/Infant Death File – Rates calculated via CDC WONDER using latest available data by subpopulation (2019).

All records that indicted Hispanic ethnicity are classified as Hispanic regardless of race. For brevity, text references omit the term “single-race.”

What is Infant Mortality?

According to the Centers for Disease Control and Prevention (CDC), infant mortality is the death of an infant before his or her first birthday. The infant mortality rate is the number of infant deaths for every 1,000 live births. In addition to giving us key information about maternal and infant health, the infant mortality rate is an important marker of the overall health of a society.

How Does Infant Mortality Affect African American Populations?

• Non-Hispanic blacks/African Americans have 2.4 times the infant mortality rate as non-Hispanic whites.
• Non-Hispanic black/African American infants are almost four times as likely to die from complications related to low birthweight as compared to non-Hispanic white infants.
• Non-Hispanic black/African American infants had 2.9 times the sudden infant death syndrome mortality rate as non-Hispanic whites, in 2020.
• In 2020, non-Hispanic black/African American mothers were twice as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.

• American Indian/Alaska Natives have almost twice the infant mortality rate as non-Hispanic whites.
• American Indian/Alaska Native infants are 2.7 times more likely than non-Hispanic white infants to die from accidental deaths before the age of one year.
• American Indian/Alaska Native infants are 50 percent more likely to die from complications related to low birthweight as compared to non-Hispanic white infants.
• In 2019, American Indian/Alaska Native mothers were almost three times as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
• American Indian/Alaska Native mothers are 70 percent more likely to smoke during pregnancy as compared to non-Hispanic white mothers.

Infant Mortality Rate

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 2.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Leading Causes of Infant Mortality

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 4.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Characteristics of Mother

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1MB]

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1MB]

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1MB]

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 2.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

*All data in the above surveys relate to non-Hispanic American Indians/Alaska Natives and non-Hispanic whites.

• Asian women generally have lower infant mortality rates than the overall population, however recent statistics for Asian American subgroups are limited for this topic.
• Asian American infants are 40 percent more likely to die from maternal complications as compared to non-Hispanic white mothers.

Infant Mortality Rate

Source:  CDC 2019.  Infant Mortality Statistics from the 2017 Period Linked Birth/Infant Death Data Set.  National Vital Statistics Reports. Table 2.
https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_10-508.pdf [474.53KB]

Leading Causes of Infant Mortality

Source:  CDC 2019.  Infant Mortality Statistics from the 2017 Period Linked Birth/Infant Death Data Set.  National Vital Statistics Reports. Table 5.
https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_10-508.pdf [474.53KB]

Characteristics of Mother

Source:  CDC 2019.  Births: Final Data for 2017  National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf [987.68KB]
 

Source:  CDC 2019.  Births: Final Data for 2017  National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf [987.68KB]
 

Source:  CDC 2019.  Births: Final Data for 2017  National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf [987.68KB]
 

Source:  CDC 2019.  Infant Mortality Statistics from the 2017 Period Linked Birth/Infant Death Data Set.  National Vital Statistics Reports. Table 2.
https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_10-508.pdf [474.53KB]

*All data in the above surveys relate to non-Hispanic Asian Americans.

• Among Hispanic Americans, the infant mortality rate ranges from 3.8 per 1,000 live births for Cuban Americans to 5.6 per 1,000 live births for Puerto Ricans.
• Puerto Ricans had a 20 percent higher infant mortality rate as compared to non-Hispanic whites in 2018.
• Puerto Rican infants were 2.5 times as likely to die from causes related to maternal complications than non-Hispanic white infants in 2018.
• In 2019, Hispanic mothers were 80 percent as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
• In 2019, Central and South American mothers were 2.5 times as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.

Infant Mortality Rate

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 2.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Leading Causes of Infant Mortality

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 4.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 4.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 4.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 4.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Characteristics of Mother

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13 and 14.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1.1MB]

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13 and 14.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1.1MB]

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13 and 14.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1.1MB]

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 2.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

*All data in the above surveys relate to non-Hispanic whites.

While the overall infant mortality rate for Native Hawaiians/Pacific Islanders is comparable to the white population, disparities still exist among Pacific Islander sub-populations. Data from national surveillance reports is limited.

• Native Hawaiians/Pacific Islanders have almost twice the infant mortality rate as compared to non-Hispanic whites in 2018.
• In 2019, Native Hawaiian/Pacific Islander mothers were 4.6 times more likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
• According to CDC data, the infant mortality rate on the island of Guam was 2.5 times higher than that of non-Hispanic white infants born on the mainland of the United States, in 2018.

Infant Mortality Rate

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 2.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Source: CDC 2020. Infant Mortality Statistics from the 2018 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 5.
https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf [PDF 487KB]

Source: Central Intelligence Agency (CIA) 2021. The World Factbook 2021.
https://www.cia.gov/the-world-factbook/field/infant-mortality-rate/

Leading Causes of Infant Mortality

National data not available at this time.
 

Characteristics of Mother

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1MB]

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1MB]

Source: CDC 2021. Births: Final Data for 2019 National Vital Statistics Reports. Table 13.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf [PDF 1MB]

*All data in the above surveys relate to non-Hispanic Native Hawaiian/Pacific Islander and non-Hispanic whites.

Source: Child Trends Databank, 2019.
https://www.childtrends.org/indicators/late-or-no-prenatal-care/

Having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early and regular prenatal care improves the chances of a healthy pregnancy. This care can begin even before pregnancy with a pre-pregnancy care visit to a health care provider.

Pre-Pregnancy Care

A pre-pregnancy care visit can help women take steps toward a healthy pregnancy before they even get pregnant.
Women can help to promote a healthy pregnancy and birth of a healthy baby by taking the following steps before they become pregnant:

• Develop a plan for their reproductive life.
• Increase their daily intake of folic acid (one of the B vitamins) to at least 400 micrograms.
• Make sure their immunizations are up to date.
• Control diabetes and other medical conditions.
• Avoid smoking, drinking alcohol, and using drugs.
• Attain a healthy weight.
• Learn about their family health history and that of their partner.
• Seek help for depression, anxiety, or other mental health issues.

Prenatal Care

Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider usually include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother's health, the fetus's health, and any questions about the pregnancy.

Pre-Pregnancy and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:

• Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting regular exercise as advised by a health care provider; and avoiding exposure to potentially harmful substances such as lead and radiation can help reduce the risk for problems during pregnancy and promote fetal health and development. Controlling existing conditions, such as high blood pressure and diabetes, is important to prevent serious complications and their effects.

• Reduce the fetus's and infant's risk for complications. Tobacco smoke and alcohol use during pregnancy have been shown to increase the risk for Sudden Infant Death Syndrome. Alcohol use also increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems such as abnormal facial features, having a small head, poor coordination, poor memory, intellectual disability, and problems with the heart, kidneys, or bones. According to one recent study supported by the NIH, these and other long-term problems can occur even with low levels of prenatal alcohol exposure.
  
  In addition, taking 400 micrograms of folic acid daily reduces the risk for neural tube defects by 70%. Most prenatal vitamins contain the recommended 400 micrograms of folic acid as well as other vitamins that pregnant women and their developing fetus need. Folic acid has been added to foods like cereals, breads, pasta, and other grain-based foods. Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.

• Help ensure the medications women take are safe. Women should not take certain medications, including some acne treatments and dietary and herbal supplements, during pregnancy because they can harm the fetus.

Moms and moms-to-be deserve the best,— including the very best mental health, especially in the context of the COVID-19 pandemic. Depression during and after pregnancy is common and treatable. If you think you have depression, seek treatment from your health care provider as soon as possible.

Depression causes severe symptoms that affect daily life

Everyone feels sad sometimes, but these feelings normally pass within a few days. Depression is a serious mood disorder that may last for weeks or months at a time.

Depression doesn’t feel the same for everyone

Some people may experience a few symptoms, and others might experience many. How often symptoms occur, how long they last, and how intense they may feel can be different for each person.

Depression symptoms

• Having a lasting sad, anxious, or “empty” mood.
• Feelings of hopelessness or pessimism.
• Feelings of guilt, worthlessness, or helplessness.
• Feelings of irritability or restlessness.
• Problems concentrating, recalling details, and making decisions.
• Loss of energy.
• Difficulty falling asleep or sleeping too much.
• Overeating or loss of appetite.
• Suicidal thoughts or suicide attempts.
• Aches or pains that do not get better with treatment.

Postpartum depression is different from the baby blues

Postpartum depression is depression that occurs after having a baby. Feelings of postpartum depression are more intense and last longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby.

Symptoms of postpartum depression

The symptoms of postpartum depression are similar to symptoms of depression, but may also include:

• Crying more often than usual.
• Feelings of anger.
• Withdrawing from loved ones.
• Feeling distant from your baby.
• Worrying or feeling overly anxious.
• Thinking about hurting yourself or your baby.
• Doubting your ability to care for your baby.

Depression during and after pregnancy is common and treatable

Recent CDC research shows that about 1 in 8 women experience symptoms of postpartum depression. Additionally, a recent analysis by CDC found the rate of depression diagnoses at delivery is increasing and it was seven times higher in 2015 than in 2000.

Having a baby is challenging and every woman deserves support. If you are experiencing emotional changes or think that you may be depressed, make an appointment to talk to your health care provider as soon as possible. Most people get better with treatment and getting help is the best thing you can do for you and your baby.

Effective depression treatment can include a combination of medication therapy, counseling, and referrals. is talking to your health care provider. After your visit, make sure to follow-up on all referrals and treatment that he or she suggests. When discussing medications with your provider, let her or him know if you are pregnant, thinking about becoming pregnant, or breastfeeding. You and your provider can decide if taking medicine while pregnant or breastfeeding is right for you.

Women: Take five! Or less! Learn about five things you can do that can go a long way to improve or maintain good health.

In Five Minutes or Less, You Can:

1. Learn about the number one killer of women.
   Heart disease is the leading cause of death for women in the United States. Learn the symptoms of a heart attack and stroke. You can save a life by knowing the signs and symptoms!

2. Schedule a check-up.
   Regular check-ups are important. Schedule an appointment with your health care provider to discuss what screenings and exams you need and when you need them.

3. Protect your skin from the sun.
   Skin cancer is one of the most common cancers among women in the United States. In just minutes you can protect your skin and put on broad spectrum sunscreen with at least SPF 15 before you go outside, even on slightly cloudy or cool days.

4. Find an HIV, STD, and Hepatitis testing site near you.
   Untreated sexually transmitted diseases (STDs) can have long-term consequences for women, such as infertility. Find testing near you to know your status.

5. Take folic acid before and during pregnancy.
   The B vitamin folic acid can help prevent certain birth defects. If a woman has enough folic acid in her body before and during pregnancy, her baby may be less likely to be born with certain birth defects of the brain or spine. All women who could possibly get pregnant should take 400 micrograms of folic acid every day in a vitamin or in foods that have been enriched with it.

These tips are just a few of the many things you can do in five minutes or less. Learn more small steps you can take to improve your health.

An estimated 700 U.S. women die each year from conditions related to or associated with pregnancy or childbirth, the highest maternal mortality rate among developed nations. In addition, more than 50,000 women experience severe maternal morbidity (SMM), life-threatening health problems that are present during labor and delivery that can cause significant short- and long-term health problems for mothers.

The NIH-wide IMPROVE initiative supports research on how to reduce preventable maternal mortality, decrease SMM, and promote health equity. Using an integrated approach to understand biological, behavioral, sociocultural, and structural factors contributing to maternal mortality, SMM, and maternal morbidity, including a focus on the ongoing COVID-19 pandemic, the IMPROVE initiative will build an evidence base for improved care and outcomes in specific populations and regions of the country.

This multipronged, innovative research initiative is designed to understand and reduce health disparities among populations disproportionately affected by maternal morbidity and mortality, including African American, American Indian/Alaska Native, Asian/Pacific Islander, Hispanic/Latina, very young women, older women, and women with disabilities. Many of these populations are also disproportionately affected by the COVID-19 pandemic. The IMPROVE approach also addresses geographic disparities and social determinants of health, including education, racism, and socioeconomic standing.

Initiative Goals

The IMPROVE initiative aims to:

• Address the foremost causes of maternal mortality in the United States, which include cardiovascular disease, infection, embolism, and immunity—as well as significant pregnancy-associated and pregnancy-related health complications, such as diabetes, obesity, mental health disorders, and substance use disorders.
• Identify biological, behavioral, sociocultural, and structural factors that contribute to disparities in maternal health and delays or disruptions in maternal care.
• Investigate the potential effects of emerging infections, such as SARS-CoV-2, on pregnancy-related deaths and complications in different geographic regions and communities.
• Support the development of technologies, tools, devices, and interventions that predict or diagnose risk for maternal morbidity and mortality, reduce preventable causes of maternal deaths and improve health with a focus on mitigating maternal health disparities.
• Help create tailored, evidence-based maternal health-related solutions for women across the country to promote maternal health equity