How Federal Policy Is Raising the Risk of Maternal and Perinatal Death in the United States
Maternal and Perinatal Mortality are likely Increasing with new policies
A Fragile Landscape
Maternal and perinatal mortality are among the most sensitive barometers of a health system’s performance. When pregnant patients and newborns die at higher-than-expected rates, it signals not just clinical failings but deeper weaknesses in access, equity, and policy. The United States, despite its wealth and advanced technology, has long performed worse than peer nations.
The numbers are sobering. In 2023, the U.S. maternal mortality rate fell to 18.6 deaths per 100,000 live births, down from 22.3 in 2022. While this represents progress, the figure remains far above other high-income nations, and racial inequities persist—Black women experienced a rate of 50.3, nearly three times higher than White women. Infant mortality did not improve meaningfully in 2023, and the perinatal mortality rate remained essentially unchanged, with early fetal deaths rising by 4% year-over-year. These indicators show that while maternal deaths temporarily declined, the overall system remains fragile, and newborn outcomes are stagnating.
Against this backdrop, recent federal policies are creating new risks. Since early 2025, actions by the Trump administration have weakened emergency care protections, narrowed reproductive health access, destabilized vaccination policy, restricted insurance coverage, and undercut initiatives addressing inequities. Together, these shifts are likely to reverse fragile gains and worsen maternal and perinatal mortality.
EMTALA Guidance Rescinded
In June 2025, the Centers for Medicare & Medicaid Services withdrew its post-Dobbs guidance that had explicitly confirmed hospitals’ obligation under EMTALA to provide abortion and miscarriage care in emergencies. While EMTALA technically remains in force, removing the clarifying language introduced dangerous ambiguity. Clinicians facing life-threatening hemorrhage or infection are now left to second-guess whether their actions could bring legal risk. In obstetrics, hesitation can be fatal: a delay of even minutes in treating sepsis or hemorrhage can mean the difference between survival and death for both patient and fetus.
VA Moves Toward a Near-Total Ban
In August 2025, the Department of Veterans Affairs proposed a rule that would reinstate a near-total ban on abortion care in VA facilities, reversing the limited access provided since 2022. Exceptions for rape and incest would disappear. For women veterans—many of whom rely exclusively on the VA system—this effectively strips away a safety net. The consequences are predictable: more pregnancies continued despite lethal anomalies, more maternal complications, and infants born only to die shortly after birth.
Title X Retrenchment
The 2025 federal budget law restricted payments to major family-planning providers and withheld millions in Title X funds. This has forced clinics across the country to close or reduce services, sharply limiting access to contraception, STI care, and preconception counseling. When these services vanish, unintended pregnancies rise—often in settings of poverty, comorbidity, or limited prenatal care. Each of those conditions raises the risk of maternal death and adverse perinatal outcomes.
Medicaid Coverage Cuts
The 2025 reconciliation law imposed new work requirements and verification rules that will shrink Medicaid enrollment by 2027. States are also reconsidering their postpartum Medicaid expansions, which had improved maternal survival in recent years. Losing coverage during pregnancy or soon after birth interrupts care for hypertension, diabetes, depression, and substance use disorders—all leading drivers of maternal mortality and poor neonatal outcomes. Coverage gaps translate directly into lives lost.
Expanding Maternity Care Deserts
Even before 2025, more than a third of U.S. counties qualified as “maternity care deserts.” Medicaid cuts and hospital closures are now accelerating this crisis, especially in rural America. When labor and delivery units shut down, patients must travel farther for urgent evaluation of preeclampsia, bleeding, or preterm labor. Longer travel times correlate with higher rates of maternal death, stillbirth, and neonatal mortality. The deserts are growing—and with them, preventable harm.
CDC Downgrades Maternal Vaccination
In May 2025, the CDC eliminated routine recommendations for COVID-19 vaccination in pregnancy and for healthy children, reframing it as “shared clinical decision-making.” This shift contradicted strong evidence that COVID infection in pregnancy increases ICU admission, preterm birth, and stillbirth. The result is predictable: lower vaccine uptake, more severe maternal infections, and higher risks for newborns. Professional organizations such as ACOG urged continued vaccination in pregnancy, but the damage to public confidence was immediate.
ACIP Dismissed and Disrupted
The dismissal of all 17 members of the Advisory Committee on Immunization Practices in June 2025 destabilized the nation’s immunization framework. ACIP recommendations drive both clinical practice and insurance coverage. Without a stable advisory body, clinicians and payers lack clarity, especially on vaccines central to pregnancy—Tdap, influenza, RSV, and COVID. This instability threatens to reduce maternal immunization rates, undermining decades of progress in preventing neonatal pertussis and influenza deaths.
Barriers to Vaccine Uptake
New federal skepticism toward co-administration of vaccines has introduced additional barriers. FDA leadership has questioned giving COVID and influenza vaccines together, discouraging a practice that increases uptake. In pregnancy, where clinic visits are limited, requiring separate appointments makes vaccination less likely. Reduced maternal immunization translates into more maternal hospitalizations and greater infant vulnerability to pertussis and influenza.
Access and Coverage Ripple Effects
Because many pharmacies and insurers tie coverage to CDC recommendations, downgrading COVID vaccination in pregnancy has already created reimbursement gaps. Some patients now face out-of-pocket costs or new prescription hurdles. These barriers fall hardest on low-income women, further widening disparities. Lower vaccination rates inevitably mean higher maternal morbidity and preventable neonatal deaths from infectious disease.
Fragmented Public Messaging
Several states have responded by issuing their own immunization recommendations for pregnant patients, hoping to preserve uptake. While well-intentioned, this patchwork approach undermines public trust. Patients and clinicians are left to choose between conflicting federal and state messages, creating confusion that depresses vaccination. Confusion in health communication translates directly into preventable illness.
One Bright Spot, Overshadowed
It is important to note that the CDC has added infant RSV antibodies, alongside the maternal RSV vaccine introduced in 2023. These steps should reduce RSV hospitalizations in infants. Yet the broader destabilization of immunization policy, and the rollback of pregnancy vaccine recommendations, threaten to overwhelm this gain. The net effect is likely to be more vulnerability to preventable disease for both mothers and newborns.
Stalled Progress on Equity and Social Determinants
Beyond reproductive and preventive health, the Trump administration has also stalled efforts to address the structural inequities that drive maternal and perinatal mortality. Evidence-based recommendations have long called for mandatory implicit bias training for all perinatal providers, targeted interventions to address housing instability, food insecurity, and neighborhood safety, and systematic integration of mental health services into prenatal care. These initiatives acknowledge that medical care alone cannot close the mortality gap, particularly for Black and Indigenous women who face disproportionate risk. Yet federal leadership has either defunded or deprioritized these programs, framing them as “ideological” rather than lifesaving. The result is paralysis in addressing root causes that every perinatal quality collaborative identifies as essential.
Workforce Diversity and Continuity of Care
Another area of stalled progress is the obstetric workforce. Expanding diversity in obstetric and midwifery training, providing education on the health impacts of structural racism, and implementing models that emphasize continuity of care are all proven to reduce disparities. Community health workers and doula programs have also shown promise in bridging gaps, especially for patients facing mistrust of the medical system. Instead of supporting these strategies, current federal actions have either eliminated funding or shifted priorities away from equity. A failure to invest in workforce reforms and continuity undermines the ability to build trust, reduce preventable deaths, and improve long-term maternal–infant outcomes.
Ethical Implications
These policies do more than harm patients; they undermine the ethical foundation of obstetric practice. The professional responsibility model obliges physicians to protect both the pregnant patient and the fetus by offering timely, evidence-based interventions. When federal actions introduce ambiguity, restrict access, or weaken prevention, they force clinicians into conflict with their ethical obligations. This erosion of trust between policy and practice is itself a public-health risk.
What Should Change
To reverse the trajectory, the federal government should:
Restore clear EMTALA guidance affirming clinicians’ duty to provide stabilizing abortion and miscarriage care in emergencies.
Protect and expand Title X, ensuring contraception and preventive services remain accessible.
Reverse the VA proposal, preserving access in cases of rape, incest, or maternal health risks.
Preserve Medicaid coverage, including postpartum extensions and affordable marketplace plans.
Safeguard maternal immunization, reaffirming COVID, influenza, and Tdap vaccines as standard in pregnancy.
Invest in maternity care deserts, funding rural hospitals, perinatal workforce expansion, and quality collaboratives.
Revive equity initiatives, including implicit bias training, addressing social determinants, integrating mental health, and expanding doula/community health worker programs.
Promote workforce diversity and continuity of care, ensuring that patients encounter trusted providers and culturally responsive models of practice.
Conclusion: A Call to Act Before the Data Catch Up
The temporary decline in maternal mortality in 2023 should not lull us into complacency. The policy trajectory since early 2025 points in the opposite direction—toward reduced access, weaker prevention, and heightened legal risk for emergency care. Early warning signs—rising infant mortality in ban states, stagnant perinatal outcomes, expanding deserts, and stalled equity reforms—are already visible. If action is not taken now, the fragile progress of 2023 will be erased.
Policymakers must hear a clear message: stop making it harder for clinicians to deliver evidence-based, equitable care. The lives of mothers and newborns depend on it.