Severe Maternal Morbidity

Over 25,000 pregnant people experience life-threatening complications during delivery, every year. Severe maternal morbidity increased from 60 to 81 per 10,000 deliveries, from 2008 to 2019.

Severe maternal morbidity rates, U.S. and Southern states

Number of deliveries involving severe maternal morbidity per 10,000 delivery hospitalizations

Source: U.S. Department of Health and Human Services. Notes: Severe maternal morbidity (SMM) is defined using diagnosis and procedure codes across the 21 indicators of SMM  (e.g. heart failure, kidney failure, stroke, embolism, hemorrhage) excluding blood transfusions. If patients receiving blood transfusions due to complications of labor and delivery were included, the SMM rate would be much higher. Data for Alabama is not available.

In 2020, the U.S. had 24 maternal deaths for every 100,000 live births — more than 3 times the rate of other high income countries.¹ For every maternal death, there are 60 pregnant people that experience severe maternal morbidity (SMM)— short- or long-term health problems related to pregnancy, birth, or the postpartum period.² This amounts to over 25,000 people annually when limiting to the 21 indicators of SMM.^3,4 This number skyrockets to an estimated 50,000-60,000 people when including blood transfusions needed due to complications of labor and delivery, many of which experts say can be prevented with appropriate and timely care.^5,6,7

The rate of maternal morbidity has increased across the nation since 2008, including in every Southern state except TN. TN had a massive spike in SMM deliveries between 2011 and 2015 (ranging from 90-106 SMM deliveries for every 10,000 delivery hospitalizations). By 2019, however, those numbers decreased to 73 SMM deliveries for every 10,000 delivery hospitalizations. 3 Southern states remained above the 2019 national average of 81 SMM deliveries per 10,000 delivery hospitalizations (GA: 87, WV: 84, and FL: 82).

Among SMM deliveries, racial disparities persist. Black people were 2 times more likely than white people to experience SMM measured with or without blood transfusions.⁸ Black women have historically faced racial discrimination, bias, and inequity in health care systems, for pregnancy-related and other care.^{9,10,11,12,13,14}

1. “Health and Health Care for Women of Reproductive Age”. Gunja, Seervai, Zephyrin, and Williams. The Commonwealth Fund. April, 2022. https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age

2. “Associations Between State-Level Changes in Reproductive Health Services and Indicators of Severe Maternal Morbidity”. Hawkins Harper, Baum, et al. JAMA Network. November, 2022. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2798515

3. “FEDERALLY AVAILABLE DATA (FAD) RESOURCE DOCUMENT”. Maternal and Child Health Bureau. April, 2023. https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/DownloadContent?fileName=FadResourceDocument.pdf&isForDownload=False

4. “How Does CDC Identify Severe Maternal Morbidity?” CDC. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm

5. “Severe Maternal Morbidity in the United States: A Primer”. Declercq, Zephyrin. The Commonwealth Fund. October, 2021. https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer

6. “Black-White disparities in maternal vulnerability and adverse pregnancy outcomes: an ecological population study in the United States, 2014-2018”. Calerio, Downey, Sgaier, Callaghan, Hammer, and Smittenaar. The Lancet. April, 2023. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(23)00030-3/fulltext 

7. “Associations Between Comorbidities and Severe Maternal Morbidity”. Brown, Adams, George, and Moore. Obstetrics & Gynecology. November, 2020. https://journals.lww.com/greenjournal/Abstract/2020/11000/Associations_Between_Comorbidities_and_Severe.5.aspx

8. “Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010”. Creanga, Bateman, Kuklina, and Callaghan. AJOG. December, 2013. https://www.ajog.org/article/S0002-9378(13)02153-4/fulltext 

9. “Health Equity Among Black Women in the United States”. Chinn, Martin, and Redmond. Journal of Women’s Health. February, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020496/

10. “Implicit Bias and Racial Disparities in Health Care”. Bridges. American Bar Association. https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/

11. “How Our Health Care System Treats Black Mothers Differently”. Seervai. The Commonwealth Fund. October, 2019. https://www.commonwealthfund.org/publications/podcast/2019/oct/how-our-health-care-system-treats-black-mothers-differently

12. “Racial Misconceptions in Healthcare Are Killing Black Women”. Blount, Biggers. Healthline. October, 2022. https://www.healthline.com/health/racial-misconceptions-in-healthcare-are-killing-black-women

13. “Working Together to Reduce Black Maternal Mortality”. CDC. April, 2022. https://www.cdc.gov/healthequity/features/maternal-mortality/index.html

14. “The Article That Could Help Save Black Women's Lives”. Stallings. Oprah.com. https://www.oprah.com/health_wellness/the-article-that-could-help-save-black-womens-lives#ixzz5VRnkBHiz