America’s Hidden Shame: Rising Maternal and Infant Mortality

The richest country in the world is failing its mothers and babies

Access Denied: The First and Fatal Barrier

The United States is running out of places to have a safe birth. Across the country, maternity units are closing, obstetricians are retiring or leaving, and too few new doctors are entering the field. For women with private insurance, care is increasingly inconvenient. For women with Medicaid—or no insurance at all—care is disappearing altogether.

Hospital clinics, often overwhelmed and underfunded, are left to care for the most vulnerable. Too many practices refuse to accept Medicaid patients, leaving them with nowhere to turn until labor begins. Pregnant women drive hours to find an open labor ward. Some arrive too late. Others never arrive at all.

This is not an accident. It is the predictable consequence of a health system that prioritizes profit over patients, and it is the first step in a cascade that leads directly to America’s disgraceful maternal and infant death rates.

The Alarming Numbers

The statistics are unforgiving.

• In 2021, the U.S. maternal mortality rate soared to nearly 33 deaths per 100,000 live births, more than double what it was two decades ago. In most high-income countries, the number is under 10.

• Black women are nearly three times more likely to die from pregnancy-related causes than white women. This gap persists regardless of education or income.

• Infant mortality in the U.S. remains stubbornly high, with outcomes in the South and rural counties that resemble those of far poorer nations.

Behind each number is a mother who did not survive, or a baby who never reached their first birthday. These are preventable deaths, and yet they continue to rise.

Why We Are Failing

The causes are layered, but three themes stand out.

1. Broken Access

When maternity wards close, when doctors refuse Medicaid, when insurance lapses cut off care, women fall through the cracks. Health care should not depend on geography, insurance status, or income. Yet in the U.S., it does.

2. Rising Chronic Disease

Hypertension, diabetes, and obesity complicate more pregnancies now than at any point in modern history. These conditions multiply risks: stroke, hemorrhage, preterm birth, stillbirth. Other nations manage chronic disease as part of routine public health. We wait until women are pregnant and then struggle to manage crises.

3. Racism and Structural Inequity

Racism in health care is not subtle—it kills. Black women report being ignored, dismissed, or misdiagnosed. Biases about pain, credibility, and compliance directly contribute to fatal delays. Add poverty, housing insecurity, food deserts, and the absence of paid maternity leave, and the inequities compound into catastrophe.

What I See in the Delivery Room

As an obstetrician, I know how thin the line is between life and death in childbirth. A few minutes can determine survival. A rapid cesarean, a blood transfusion, the right medication at the right time—these save lives.

But outside those hospital walls, patients are abandoned. I have seen women arrive in labor after being turned away from multiple clinics. I have discharged mothers with clear instructions for blood pressure follow-up, only to watch them return days later with a massive stroke because they had no insurance and no one would see them.

We pride ourselves on advanced technology and “world-class” hospitals. Yet mothers die because the basics—timely prenatal care, postpartum follow-up, affordable medication—are missing.

The Forgotten Preconception Trimester

Even before a woman becomes pregnant, her health plays a decisive role in whether she and her baby will survive childbirth. Yet the United States has no systematic approach to preconception care. There are almost no clinics dedicated to helping women prepare for pregnancy, and routine primary care rarely addresses it. Most clinics have no idea how to address this crucial isue. The result is that many pregnancies begin without critical steps being taken: starting folic acid to prevent neural tube defects, adjusting or discontinuing medications that can harm the fetus, achieving healthier weight, stopping to drink or smoke, or gaining control of conditions such as hypertension and diabetes. By the time a pregnancy is recognized, it is often too late to prevent complications that were predictable and avoidable. Other nations incorporate preconception counseling into public health, ensuring women of reproductive age receive education, access to supplements, and management of chronic disease before they conceive. In the U.S., we wait until a woman is already pregnant—when the window for prevention has closed. This absence of preconception care is the first missed opportunity in a chain of failures that explains why maternal and infant mortality are climbing rather than falling.

The Forgotten Fourth Trimester

Too often, the danger is not over when a woman leaves the hospital. In fact, most maternal deaths in the United States occur after delivery—in the weeks and months when medical attention thins out or disappears entirely. Postpartum hemorrhage, cardiomyopathy, infection, stroke from untreated hypertension, and severe depression can strike long after the baby is born. Yet most women receive only a single six-week follow-up visit, and if they are covered by Medicaid, insurance often ends at 60 days. This is a formula for disaster. Mothers are discharged, still recovering from the most profound physiologic change of their lives, and then left largely on their own. In other countries, postpartum home visits by nurses or midwives are routine. These visits detect complications early, support breastfeeding, and screen for mental health needs. In the U.S., such outreach is rare, fragmented, and often unfunded. The result is predictable: women who could have been saved die at home, sometimes in front of their newborns. If we are serious about reducing maternal mortality, we must treat the postpartum period as a critical phase of care, with structured follow-up, guaranteed insurance coverage for at least a year, and community-based support that meets mothers where they live.

What Must Change

This is not a mystery. We know what works. We refuse to do it.

1. Universal access to maternity care. No woman should drive two hours in labor because her local hospital closed its unit.

2. National quality standards. Safety bundles in California cut deaths in half. Every state should adopt them. Hospitals must be accountable, not optional participants.

3. Invest in community health. Nurses, doulas, and health workers embedded in vulnerable communities save lives by linking hospitals and homes.

4. Confront racism head-on. Mandatory training, transparent outcome reporting by race, and real accountability for inequities are overdue.

A Political and Moral Failure

These deaths are not inevitable. They are political and moral choices. Every high-income country that treats maternal health as a public good outperforms us. They provide paid maternity leave, universal prenatal and postpartum care, and hold hospitals accountable for outcomes. The United States does none of these consistently.

Our failure is not about medical knowledge. It is about neglect, greed, and indifference. We tolerate a system where survival in childbirth depends on zip code, race, and insurance card.

The Real Call to Action: Universal Healthcare

Expanding Medicaid is not enough. It simply props up a broken three-tiered system where the wealthy buy private care, the insured middle class navigate shrinking networks, and the poor are left with patchwork Medicaid—if they have anything at all.

What America needs is what every other high-income country already has: universal healthcare. A single system where every pregnant patient receives the same standard of care. Where access does not depend on income. Where postpartum coverage is not debated but guaranteed. Where a mother in Mississippi and a mother in Manhattan have the same chance of surviving childbirth.

Until we end the three-tiered system and enact universal healthcare, maternal and infant mortality will remain America’s shame.

Why This Matters to Everyone

Maternal and infant mortality is not a “women’s issue.” It is a mirror held up to our nation. A country that cannot protect mothers during childbirth cannot call itself a leader in health care. These deaths signal deeper fractures: inequality, racism, and the commodification of care.

If we want to value life, then we must start where life begins.