Safer Pregnancies and Births in the United States

Bread for the World members advocate steadfastly for ending hunger among children, most recently through Bread’s Nourish Our Future campaign. Bread draws particular attention to the “1,000 Days,” the period between pregnancy and a child’s second birthday, because experts have identified it as the most critical window for human nutrition. 

Bread also emphasizes that a major cause of hunger in the United States is poverty. The racial and gender pay gaps mean that women, particularly women of color, are at higher risk of poverty. Parents, particularly mothers, are also more likely to be poor, which means that children are also more likely to live below the poverty line. In 2020, for example, households with single mothers had a poverty rate of 32.1 percent. Mothers of color and their children had even higher poverty rates: 35.6 percent of Black families and 36.9 percent of non-white Hispanic families with single mothers lived below the poverty line.

There is no doubt that raising children is expensive. From pregnancy on, a steady stream of costs adds up, from diapers to new shoes to childcare costs that, in some areas, can rival college tuition. Becoming a parent is a major economic investment. 

Ensuring that pregnant women, new mothers, and newborns get the nutrition, health care, and support they need is pivotal to ending hunger in our country for good. Safer pregnancy, childbirth, and postpartum care have an outsized impact on individuals, families, communities, the country, and the future. 

Yet the U.S. has not made as much progress as most other countries with an abundance of resources. In 2020, Norway, Belarus, Israel, and several other countries had maternal mortality rates of 3 or less per 100,000 live births. That year, the U.S. maternal mortality rate was 23.8 per 100,000 live births—more than three times the rate of most high-income peer countries. The U.S. record on maternal mortality is particularly striking because the country spends two, three, or even four times as much per person on health care as most industrialized countries.

A chief cause of the high maternal mortality rate is racial inequity. The maternal mortality rate among Black women in 2022 was 49.5 per 100,000 live births—far higher than among white, Latina, and Asian women, whose mortality rates were 19, 16.9, and 13.2 per 100,000 live births, respectively.

The U.S. has a long way to go before pregnancy and childbirth is as safe here as it is in Belarus or Norway. But maternal mortality among Black women in particular is a national emergency, both because of the very high death rate and the wide disparities with women from other racial/ethnic groups.

“Social determinants” of health are a wide range of conditions that together play a significant role in maternal mortality. The social determinants of health are the conditions where people live, learn, work, play, and age. They affect a wide range of health risks and outcomes. In fact, research from the Robert Wood Johnson Foundation has found that these social determinants “can drive as much as 80 percent of health outcomes.” According to the National Perinatal Task Force, “Focusing on the social determinants of health is an important step to addressing these root causes for these unwavering gaps in maternal and infant health.”  

How do larger socioeconomic problems such as racial inequity and poverty contribute to maternal mortality? There are many interconnected factors, but one of the most significant causes is preterm birth, defined as birth before 37 weeks of gestation. 

In 2023, the rate of preterm births in the U.S. was 10.4 percent. Among Black women, it was 14.7 percent. The March of Dimes reported that “an alarmingly high preterm birth rate” is one of the contributing factors to maternal and infant mortality and gave the U.S. a grade of D+ on its preterm birth performance.

The brighter news is that data from professional review committees who study the specific causes of maternal mortality shows that more than 80 percent of pregnancy-related deaths were preventable. Some strategies relate to strengthening the U.S. healthcare system, particularly in rural areas. Women in “maternity care deserts” are at higher risk because of factors such as delays in care for life-threatening complications. Others relate to preventing specific medical problems. For example, California reduced its death rate from preeclampsia–dangerously high blood pressure–by 76 percent by expanding its use of best practices in monitoring and treatment.

Reducing maternal mortality calls for a combination of efforts: improved racial and gender equity; better laws and policies, particularly on ensuring access to quality health care; research-based recommendations that stakeholders can begin to implement without delay; and allocation of the necessary resources. The country is backsliding in some of these areas, but it is completely within the power of the United States to save the lives of many more pregnant women and new mothers.

Michele Learner is Managing Editor of the Policy and Research Institute at Bread for the World.