Maternal, Child Mortality Higher in the US Compared With Majority of High-Income Countries

The overall maternal mortality rate in the US was found to be higher than most high-income countries around the world, according to a new report published by The Commonwealth Fund.¹ These trends were particularly notable in Louisiana and Mississippi, as well as among Black and Native American women and children.

The Commonwealth Fund had previously released data on 2022 mortality rates for both women and children in January of 2023,² which showed that the US had the highest rates of infant and maternal mortality of any other high-income country, despite the amount of money spent on health care each year. These countries included Australia, Canada, Japan, the United Kingdom, France, and Germany, among others, where the US ranked last in life expectancy and health outcomes compared with the other countries.

This report looked at the 2023 mortality rates for mothers and children.¹ The overall rates of maternal mortality totaled 18.6 deaths per 100,000 births, with Louisiana having the highest maternal mortality rate of 41.9 deaths per 100,000 and California having the lowest at 9.5 deaths per 100,000. This was a decrease in deaths per 100,000 from 2022, where 22.3 mothers per 100,000 live births died. The overall maternal mortality rate of 18.6 was in line with Palestine (18.6) and Chile’s (18.9) maternal mortality rates.

A total of 50.3 deaths per 100,000 live births were found in Black mothers in the US, the highest maternal mortality rate in the country, whereas American Indian/Alaska Natives had a maternal mortality rate of 40.7 per 100,000 births and Native Hawaiian and Pacific Islanders had a maternal mortality rate of 37.0 per 100,000 live births.

The rate of deaths for children younger than 5 years was 6.7 deaths per 1000 live births, with the highest rate in Mississippi (10.3) and the lowest in Massachusetts (3.8). The overall rate is lower than it had been in 2000, when it was 8.1 deaths per 1000 live births. The highest mortality rates were seen for Black children younger than 5 years, who had a mortality rate of 13.4 deaths per 1000 live births.

Infant deaths remained the same in the US from 2022 to 2023, holding firm at 5.6 infant deaths per 1000 live births. Mississippi had the highest infant death rate at 8.9 and New Hampshire had the lowest at 3.1. Black, American Indian/Alaska Native, and Native Hawaiian and Pacific Islanders had an infant mortality rate of 7.4 deaths per 1000 live births. Asian American infants had the lowest death rate in the US at 2.7 deaths per 1000 live births.

Neonatal deaths were similar to 2022, at 3.6 neonatal deaths per 1000 live births, in line with Canada’s rate of 3.4. Puerto Rico and Arkansas had the highest neonatal mortality rates at 5.4 and 5.5, respectively, compared with New Hampshire, which had a neonatal mortality rate of 2.0, among the lowest rates in the world.

The Commonwealth Fund elaborated on the policies that have allowed for reductions in mortality of mothers and children. This includes expanding the roles of midwives, which has been undertaken in New Mexico and Chile, the latter of which has seen a 50% decrease in maternal deaths since 2000. Safe abortion access has also proven to be a method of preventing maternal mortality, as states that defended abortion access had a 21% decrease in maternal mortality compared with states that did not.

Postpartum home visits have been effective worldwide, with Ireland providing guaranteed home visits up to 6 months after birth from a midwife or public health nurse and a public health nurse being available for visits for 4 years after birth, leading Ireland to report no maternal deaths in 2022. Medicaid reimbursement for home visiting services is available in 28 states. Access to reproductive health and family planning can also prevent unintended pregnancies, which can help in keeping mothers and children healthy if mothers are not able to bear a child or provide for the child thereafter.

The Commonwealth Fund advocates for expanding equitable access to care, investing in the maternal health workforce, strengthening data collection, and guaranteeing postpartum support to address the problems with maternal mortality in the US specifically. For child mortality, The Commonwealth Fund encourages strengthening social and physical infrastructure that supports children and ensuring universal insurance coverage for infants and young children.

The study authors concluded that the overturning of Roe v Wade and the recent cuts to Medicaid will likely have negative impacts on maternal and child mortality overall in states that do not provide access to abortions or who rely on Medicaid to cover their births.

“Variations [in outcomes] highlight the need for federal protections to ensure consistent coverage, maternal and child health services, and quality of care regardless of state of residence, race and/or ethnicity, or economic background,” the authors wrote. “Continuing to learn from countries and states where policy changes have resulted in marked improvements can help reduce preventable deaths and secure safer and healthier futures for all mothers and children in the US.”

References

1. Gumas ED, Gunja MZ, Papanicolas I. Maternal and child mortality: how do U.S. states compare internationally? The Commonwealth Fund. October 1, 2025. Accessed October 2, 2025. https://www.commonwealthfund.org/publications/issue-briefs/2025/oct/maternal-child-mortality-how-do-us-states-compare-internationally

2. Petrullo J. US has highest infant, maternal mortality rates despite the most health care spending. AJMC^®. Published January 31, 2023. Accessed October 2, 2025. https://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-most-health-care-spending