Understanding Maternal Health Disparities
Stark racial disparities in maternal and infant health have persisted throughout the United States for decades, even as medical technology and treatment protocols continue advancing. Among high-income nations, the U.S. maintains the unfortunate distinction of having the highest maternal mortality rate. The COVID-19 pandemic disproportionately affected communities of color, bringing renewed attention to longstanding health inequities, particularly in maternal and infant care.
This comprehensive analysis examines selected measures of maternal and infant health across racial and ethnic groups, explores the underlying factors driving these disparities, and reviews recent policy changes that may impact health outcomes. The data presented comes from CDC WONDER online database, National Center for Health Statistics (NCHS) National Vital Statistics Reports, and the CDC Pregnancy Mortality Surveillance System.
Beyond Racial Disparities
While this analysis focuses primarily on racial and ethnic health disparities, significant gaps also exist across income levels, educational attainment, geographic location, and age demographics. Rural communities often face different challenges than urban areas, and state-by-state variations reveal dramatic differences in maternal health outcomes. Additionally, existing data collection methods typically assume cisgender identities and may not adequately capture experiences of transgender and non-binary individuals.
Pregnancy-Related Mortality Statistics
In 2023, approximately 676 women died in the United States from causes related to or aggravated by pregnancy, representing a decrease from 793 maternal deaths recorded in 2022. Pregnancy-related deaths encompass fatalities occurring within one year of pregnancy. The mortality rate declined among White and Hispanic women, though no significant changes were observed for Asian or Black women.
The timing of these deaths reveals critical patterns: approximately 20% occur during pregnancy itself, nearly 23% happen during labor or within the first postpartum week, and more than 57% occur between one week to one year postpartum. These statistics underscore the vital importance of comprehensive healthcare access extending well beyond the pregnancy period. Recent research indicates that more than 87% of pregnancy-related deaths are preventable with appropriate medical intervention.
Alarming Racial Disparities in Mortality
As of 2023, Black individuals face more than three times the risk of pregnancy-related death compared to White individuals—49.4 versus 14.9 deaths per 100,000 live births. Hispanic and Asian populations demonstrate lower rates than White populations (12.3 and 10.7 versus 14.9 deaths per 100,000 live births, respectively). While 2023 data proved insufficient for identifying mortality rates among American Indian or Alaska Native (AIAN) and Native Hawaiian or Pacific Islander (NHPI) women, 2021 data revealed these groups experienced the highest pregnancy-related mortality rates across all racial and ethnic categories—118.7 and 111.7 per 100,000 live births, respectively.
Research demonstrates that disparities for Black women intensify with age and persist regardless of education or income levels. Black women who completed college education face higher pregnancy-related mortality rates than White women with identical educational attainment and even White women without high school diplomas. Black women also experience significantly elevated risks for severe maternal morbidity, including conditions like preeclampsia, which occurs far more frequently than maternal death.
Birth Risk Factors and Outcomes
Black, AIAN, and NHPI women experience higher rates of birth risk factors that contribute to infant mortality and can have lasting consequences for children’s physical and cognitive development. Preterm birth—delivery before 37 weeks gestation—and low birthweight (babies born weighing less than 5.5 pounds) rank among the leading causes of infant mortality.
Delayed prenatal care, defined as beginning in the third trimester, or receiving no prenatal care whatsoever, substantially increases pregnancy complication risks. Black, AIAN, and NHPI women consistently show higher rates of preterm births, low birthweight deliveries, and late or absent prenatal care compared to White women. Notably, NHPI women are four times more likely than White women to begin prenatal care in the third trimester or receive no prenatal care at all—22.4% versus 4.7%. Black women are nearly twice as likely as White women to deliver without adequate prenatal care.
Teen Pregnancy Rates by Race
Although teen birth rates have declined nationwide over time, they remain markedly higher among Black, Hispanic, AIAN, and NHPI teenagers compared to their White counterparts. Conversely, Asian teens demonstrate lower birth rates than White teens. Many teen pregnancies occur unintentionally, and pregnant teenagers often receive inadequate early and regular prenatal care.
Teen pregnancy carries increased risks for complications during pregnancy and delivery, including preterm birth. Beyond health impacts, teen pregnancy and childbirth create significant social and economic consequences for young parents and their children, potentially disrupting educational completion for parents and contributing to lower academic achievement for children. Research indicates that increased contraceptive use combined with declining teen sexual activity has helped reduce national teen birth rates.
Infant Mortality Disparities
Reflecting these elevated risk factors, infants born to AIAN, Hispanic, Black, and NHPI women face substantially higher mortality risks compared to those born to White women. Infant mortality—defined as death within the first year of life—most frequently occurs within the first month after birth. Primary causes include birth defects, preterm birth and low birthweight, sudden infant death syndrome (SIDS), injuries, and maternal pregnancy complications.
While infant mortality rates have declined over time, the 2023 rate remained unchanged from 2022 at 5.6 deaths per 1,000 births. However, disparities in infant mortality have persisted and sometimes widened for over a century, particularly between Black and White infants. As of 2023, infants born to Black women face more than double the mortality risk of those born to White women—10.9 versus 4.5 per 1,000 live births. Mortality rates for infants born to AIAN and NHPI women (9.2 and 8.2 per 1,000, respectively) approach twice the White infant mortality rate.
Data also reveal that fetal death or stillbirth—pregnancy loss after 20 weeks gestation—occurs more frequently among NHPI, Black, and AIAN women compared to White and Hispanic women. Moreover, stillbirth causes vary by race and ethnicity, with higher rates attributed to diabetes and maternal complications among Black women versus White women.
Mental Health During Pregnancy
Based on the most recent federally published estimates from 2018, approximately one in five AIAN, Asian or Pacific Islander, and Black women reported symptoms of pregnancy-related depression, compared to roughly one in ten White women. Hispanic women (12%) experienced similar depression rates during and after childbirth compared to their White counterparts (11%).
A recent Southern California study suggests postpartum depression (PPD) prevalence has increased over the past decade, driven primarily by increases among Black and Asian and Pacific Islander women. Women of color encounter heightened barriers to mental health care and resources, compounded by racism, trauma, and cultural obstacles. Research indicates perinatal mental health conditions represent a leading underlying cause of pregnancy-related deaths, and individuals with perinatal depression face increased risks for chronic health complications including hypertension and diabetes. Infants whose mothers experience depression show higher rates of hospitalization and first-year mortality.
Root Causes of Health Inequities
The factors driving maternal and infant health disparities are complex and multifaceted, encompassing differences in health insurance coverage and healthcare access. However, broader social and economic factors combined with structural and systemic racism and discrimination play major roles. Within maternal and infant health specifically, the intersection of race, gender, poverty, and other social factors profoundly shapes individual experiences and outcomes.
Recent years have brought increased recognition of reproductive justice principles, which emphasize the role that social determinants of health and other factors play in reproductive health for communities of color. Notably, Hispanic women and infants demonstrate outcomes similar to their White counterparts on many maternal and infant health measures despite experiencing increased access barriers and social and economic challenges typically associated with poorer health outcomes—a phenomenon sometimes called the Hispanic or Latino health paradox.
Healthcare Access Barriers
Maternal and infant health disparities partially reflect increased care barriers for people of color. Research confirms that coverage before, during, and after pregnancy facilitates access to care supporting healthy pregnancies and positive maternal and infant outcomes following childbirth. Overall, people of color face higher uninsurance rates and additional care barriers. Medicaid helps fill coverage gaps during pregnancy and for children, covering more than two-thirds of births to Black or AIAN women.
Given Medicaid’s significant role as a maternity care payer for women of color, numerous healthcare professionals and state Medicaid programs have developed initiatives to improve maternal health and decrease maternal mortality and morbidity, such as broader inclusion of doulas as Medicaid providers. However, AIAN, Hispanic, and Black individuals face elevated uninsurance risks prior to pregnancy, affecting pre-pregnancy care access and timely prenatal care entry.
Beyond health coverage, people of color encounter additional care barriers, including limited provider and hospital access and lack of culturally and linguistically appropriate care. Several regions, particularly throughout the South—home to a large share of the Black population—face obstetrics provider shortages. AIAN women also more frequently reside in communities with reduced obstetric care access. These challenges may intensify in rural and medically underserved areas.
Impact of Recent Policy Changes
Since President Trump assumed office in January 2025, the Administration and Congress have implemented significant health policy changes. While pregnant and postpartum individuals have been specifically exempted or protected from some changes, many modifications may significantly impact maternal and infant health, potentially exacerbating existing disparities.
President Trump’s executive orders rolling back federal diversity efforts could worsen longstanding maternal health disparities. As one of his first actions, President Trump signed executive orders revoking federal DEI-related programs and actions throughout the federal government and among federal contractors and grantees. In implementing these executive orders, the administration has taken significantly broader actions beyond eliminating DEI programs to include eliminating priorities, actions, information, data, and funding related to diversity concepts or disparities among federal agencies and their contractors and grantees.
Federal Program Disruptions
On March 27, 2025, the Trump administration announced an Executive Order reorganizing the Department of Health and Human Services (HHS), disrupting key programs affecting maternal health. Impacts included laying off most staff in the CDC’s Division of Reproductive Health, halting community-based maternal health grants, erasing the prior White House Blueprint for Addressing the Maternal Health Crisis, and closing several federal offices that supported state and local efforts to address racial disparities in maternal care.
The restructuring also eliminated key initiatives, including the Pregnancy Risk Assessment Monitoring System (PRAMS), which for decades provided data to track maternal experiences and inform evidence-based policies, and the Safe to Sleep Campaign, a national effort to reduce sudden infant death syndrome. These rollbacks coincide with sleep-related infant deaths rising nearly 12% between 2020 and 2022, with SIDS among Black infants increasing by 15% in 2020.
Medicaid Coverage Reductions
The 2025 tax and spending legislation implements large federal Medicaid spending cutbacks expected to cause substantial coverage losses, likely reducing healthcare access, including maternal care. According to the Congressional Budget Office (CBO), the law will reduce federal Medicaid spending over the next decade by an estimated $911 billion and increase the uninsured population by 10 million.
Given Medicaid’s disproportionate role covering women of color, they face increased risks from program cutbacks. In 2023, Medicaid covered 37% of AIAN, 30% of Black, and 26% of Hispanic reproductive-age women, compared to 20% of reproductive-age women overall. Moreover, among reproductive-age women enrolled in Medicaid, nearly four in ten receive coverage through Medicaid expansion and could risk losing coverage due to new work and eligibility requirements.
The law also imposes a one-year ban on federal Medicaid payments to certain family planning providers, including all Planned Parenthood clinics, potentially weakening resources and care supporting maternal and infant health. This policy prohibits some family planning clinics offering abortion services from receiving Medicaid payments for contraceptive and other preventive services.
Abortion Access Restrictions
State abortion bans and restrictions may exacerbate poor maternal and infant health outcomes and care access. Since the Dobbs ruling in June 2022, approximately half of states have banned abortion or restricted it to early pregnancy. People of color are disproportionately affected by these bans and restrictions as they face higher pregnancy-related mortality and morbidity risks, obtain abortions more frequently, and more likely face structural barriers making out-of-state travel difficult.
A recent JAMA study found fertility rates increased in states with complete or 6-week abortion bans, particularly among Black and Hispanic populations compared to White populations. A concurrent study showed infant mortality rates also rose in these states, with larger increases among Black infants. Abortion bans are exacerbating maternity workforce shortages, as some clinicians refuse to work in areas criminalizing their practice and restricting evidence-based care provision.
