A new study published in JAMA Pediatrics confirms the devastating impact of the COVID-19 pandemic on maternal deaths rates for women across all racial and ethnic groups in the U.S. Conducted by researchers from the University of Oxford, Brown University, and Columbia University Mailman School of Public Health, the study offers the most detailed insight yet into maternal mortality trends from 2000 to 2023.
The research is notable for distinguishing real health outcomes from statistical distortions caused by changes in death reporting—specifically, the introduction of a “pregnancy checkbox” on death certificates. Using a difference-in-differences analysis, the team compared maternal death trends in states that had adopted the checkbox with those that had not. The checkbox alone accounted for two-thirds (66%) of the rise in maternal mortality between 2000 and 2019, increasing reported deaths by 6.8 per 100,000 live births annually. Once adjusted, maternal mortality remained largely stable during that period.
However, the study reveals a dramatic spike during the COVID-19 pandemic. In 2021, adjusted maternal mortality rates surged to 18.9 deaths per 100,000 live births—nearly double the pre-pandemic range of 6.8 to 10.2. This rise affected women of all age groups (except those aged 15–19) and across all racial and ethnic categories. Rates returned to pre-pandemic levels by 2022.
“We started by asking a simple question: has maternal mortality gone up or down since 2000?” said senior author Professor Seth Flaxman of the University of Oxford. “Surprisingly, the answer is neither—until COVID-19 hit. The pandemic led to a stark and temporary surge in maternal deaths.”
The study also underscores persistent racial disparities. Maternal mortality for non-Hispanic Black women consistently remained three to four times higher than for non-Hispanic White women. Before the pandemic, the rate stood at 20.7 deaths per 100,000 live births for Black women, compared to 5.0 for White women.
The greatest pandemic-era increase occurred among Native American or Alaska Native women, whose maternal mortality rates nearly tripled from 10.7 to 27.5 per 100,000 live births.
In contrast, fetal and infant mortality rates steadily declined between 2000 and 2020. Infant mortality dropped from 6.9 to 5.4 deaths per 1,000 live births, although a slight uptick occurred after 2021.
Lead author Robin Y. Park emphasized the public health implications: “Our findings highlight how crucial it is for pandemic preparedness plans to include maternal care. Clear, accurate reporting combined with targeted health policies can help prevent avoidable maternal deaths in future crises.”
