Commonwealth Fund: High Maternal Mortality Persists in U.S.

A new brief by the New York-based Commonwealth Fund compared maternal and child mortality rates at the national, state, and racial and ethnic levels to 200 countries. The study found that the overall U.S. maternal mortality rate most closely resembled rates in Palestine (18.6) and Chile (18.9). In 2023, the United States experienced 18.6 maternal deaths per 100,000 live births, down from 22.3 in 2022. Provisional data for 2024 indicate that the maternal mortality rate stayed steady at 17.9 deaths per 100,000 live births.

Key highlights from the brief included:

• Despite declines in 2023, the overall U.S. maternal mortality rate was higher than rates in the majority of all high-income countries. Mothers in Louisiana had the highest state rate of death in 2023 (41.9).
• Nationally, under-5 mortality stayed steady at 6.7 deaths per 1,000 live births in 2023, similar to rates in Albania (6.6) and Chile (7.0); Mississippi (10.3) had the highest state rate, while Massachusetts (3.8) had the lowest.
• In 2023, the U.S. infant mortality rate (5.6 deaths per 1,000 live births) fell between Qatar (5.5) and Romania (5.8). Of all states, Mississippi (8.9) had the highest infant mortality rate, and New Hampshire (3.1) had the lowest.
• U.S. neonatal mortality (3.6 deaths per 1,000 live births) was similar to Canada (3.4) in 2023; New Hampshire (2.0) had the lowest rate of all U.S. states and ranked among the lowest globally.
• Black maternal and child mortality rates are the highest among any racial or ethnic group in the United States. Additionally, Black children under age 5 experience a higher mortality rate than any state or other demographic group, at 13.4 deaths per 1,000 live births — similar to rates in Mexico (13.0) and Laos (13.5).

The brief further noted that racial and ethnic disparities are a significant issue in the U.S., similar to what is observed in Australia, Brazil, Canada, the United Kingdom, and many other countries. Black mothers in the U.S. die at a rate nearly three times the national average, and the rate for white women is also higher, while it is five times higher for Asian women. Furthermore, American Indian and Alaska Native (AIAN) and Native Hawaiian and Pacific Islander (NHPI) mothers die at a rate more than double the national average and more than four times the rate of Asian mothers. 

The brief concluded that the 2022 Supreme Court decision to overturn Roe v. Wade sharply reduced access to safe abortion care in many states, forcing some women to carry high-risk pregnancies or seek delayed and unsafe procedures. The Commonwealth Fund cautioned that recent funding cuts to Medicaid—the public program that covers more than half of all births in the country—will likely deepen coverage instability during pregnancy and after delivery, periods already marked by high rates of churn and care disruptions that contribute to poor maternal and infant health outcomes.

This study was conducted based on data from the U.S. Centers for Disease Control and Prevention (CDC), national registries, the World Health Organization (WHO), and the United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME).