Measuring maternal mortality and mortality disparities: a health-adjusted approach

Abstract Racial and ethnic disparities in maternal mortality are well known, especially the higher rates for Black and Native American women. However, the underlying causes remain unclear. These disparities may stem from disparities in background health across groups or from factors specific to childbirth and maternal care. We examine maternal mortality disparities using a novel method that controls for population differences in overall health. Unadjusted maternal mortality rate (MMR) ratios for Black, Asian, Hispanic, and Native American women relative to White women, measured over 2010-2022, excluding COVID-19 deaths, are 2.7, 0.91, 0.88, and 2.58. In contrast, adjusted ratios are 1.83, 1.31, 1.27, and 1.24, respectively. Poor background health contributes to the high maternal mortality risk among Black and Native American women, while better underlying health among Asian and Hispanic women masks their elevated adjusted maternal mortality risk. We also document substantial cross-state heterogeneity in adjusted MMRs and racial/ethnic disparities in these rates. In some states, minority women face substantially higher maternal mortality risks relative to White women, while in others—notably California—health-adjusted disparities are small.