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Data show persistent disparities in maternal and infant health outcomes by race/ethnicity and socioeconomic status
Maternal Mortality
The U.S. rate of maternal mortality (i.e., maternal deaths) is the highest among high-income countries and has been steadily increasing since 1990, according to the Organization for Economic Co-operation and Development (OECD).¹ As highlighted in the 2023 Health of Women and Children Report, in 2017-2021, there were 22.4 deaths per 100,000 live births, which is higher than the Healthy People 2030 target of 15.7 deaths per 100,000 live births. Maternal deaths, also known as maternal mortality, is a Healthy People 2030 Leading Health Indicator. Healthy People 2030 and the World Health Organization define maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” In 2017-2021, six states had maternal mortality rates below the Healthy People 2030 target: California, Massachusetts, Minnesota, Pennsylvania, Utah, and Wisconsin.
Nationally, American Indian/Alaska Native (60.6 per 100,000), Black (51.3), and Hawaiian/Pacific Islander (49.5) women had rates of maternal mortality that are 2.5 to 4.5 times greater than other groups. There were also disparities by education, as the maternal mortality rate was 2.9 times higher among high school graduates (34.4 per 100,000) than college graduates (11.9).
Severe Maternal Morbidity
Severe maternal morbidity — the number of significant life-threatening maternal complications during delivery per 10,000 delivery hospitalizations — includes serious events like hemorrhage, eclampsia, and hysterectomy.3 Prevalence of severe maternal morbidity has steadily increased in recent years, and impacted individuals incur higher medical costs and experience longer hospitalizations.3 The national rate of 88.3 complications per 10,000 delivery hospitalizations exceeds the Healthy People 2030 target of 64.4 severe maternal complications per 10,000 delivery hospitalizations. In 2020, seven states had severe maternal morbidity rates below this target: Maine, Nebraska, North Dakota, Oregon, South Dakota, Utah, and Wyoming.
Nationally, Black mothers experience pronounced disparities in severe maternal morbidity compared to other groups. In 2020, severe maternal morbidity was 2.0 times higher among Black (139.0 per 10,000) than white (69.9) mothers and 1.5 times higher among Black than Hispanic (94.6) mothers.
Infant Mortality
Infant mortality (i.e., infant deaths) remains consistently higher in the U.S. than in other OECD countries.4 As a health outcome measure and Healthy People 2030 Leading Health Indicator, infant mortality is the number of infant deaths (before age one) per 1,000 live births. Unlike maternal mortality, the infant mortality rate has improved in the past decade by 13%, decreasing from 6.3 to 5.5 per 1,000 live births, between 2008-2011 and 2018-2021 — moving closer to the Healthy People 2030 target of 5.0 per 1,000 live births. In 2018-2021, 15 states had infant mortality rates that met the target: California, Colorado, Connecticut, Idaho, Iowa, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, Oregon, Rhode Island, Vermont, and Washington.
Between 2008-2011 and 2018-2021, infant mortality rates improved among some racial/ethnic groups — 15% for infants born to white mothers (5.3 to 4.5 per 1,000), 12% for infants born to Black mothers (12.1 to 10.6), and 9% for infants born to Hispanic mothers (5.3 to 4.8). Despite these improvements, disparities by race/ethnicity persist. Nationally in 2018-2021, infants born to Black, American Indian/Alaska Native, and Hawaiian/Pacific Islander mothers experienced disparities in infant mortality relative to Asian, Hispanic, multiracial, and white mothers. Notable infant mortality disparity ratios were:
- 2.9 times higher among infants born to Black (10.6 per 1,000) than Asian (3.6) mothers, 2.4 times higher than white (4.5), and 2.2 times higher than Hispanic (4.8) mothers.
- 2.2 times higher among infants born to American Indian/Alaska Native (7.9 per 1,000) than Asian (3.6) mothers.
Infant mortality trends by education were analyzed for periods 2013-2016 and 2018-2021. During this time, the infant mortality rate improved among infants born to mothers with higher education — 11% for infants born to college graduates (3.5 to 3.1 per 1,000) and 4% for infants born to those with some post–high school education (5.7 to 5.4). There was no change, however, for infants born to those with less than a high school education. Infant mortality was 2.5 times higher among infants born to those with less than a high school education (7.7 per 1,000) compared with college graduates (3.1) and 2.3 times higher among infants born to high school graduates (7.0) compared with college graduates.
Low Birth Weight
As a health outcome measure, low birth weight is defined as an infant weighing less than 2,500 grams (5 pounds, 8 ounces) at birth. Low birth weight is a common cause of infant mortality, as infants with low birth weight have a 20 times higher risk of death compared to infants with a normal birth weight, as well as increased risk for chronic conditions later in life.5,6,7
Between 2007-2010 and 2019-2022, the overall percentage of infants with low birth weight worsened by 2% from 8.2% to 8.4%. During this time, low birth weight improved 3% among infants born to white mothers (7.2% to 7.0%) while low birth weight rates worsened for several groups — 12% among infants born to Hispanic mothers (6.9% to 7.7%), 9% among infants born to American Indian/Alaska Native mothers (7.5% to 8.2%), 7% among infants born to Asian and Pacific Islander mothers (8.3% to 8.9%) and 5% among infants born to Black mothers (13.7% to 14.4%).
Low birth weight trends by education were available only for periods 2013-2016 and 2019-2022. Between these periods, overall low birth weight rates worsened by 4% (8.1% to 8.4%). Infants born to mothers with a high school education experienced the largest increase in low birth weight, with a 9% increase (8.9% to 9.7%).
Nationally in 2019-2022, low birth weight was 2.1 times higher among infants born to Black mothers (14.4%) than white mothers (7.0%), 1.9 times higher than Hispanic mothers (7.7%), 1.8 times higher than American Indian/Alaska Native mothers (8.2%), and 1.6 times higher than Asian mothers (9.0%).