A surge of maternal health advocacy in the United States that began in 2014 has achieved greater investment in research, programs, care quality, and insurance coverage of maternal health. Today, as a result, many more individuals and families can access high-quality perinatal care that meets their needs. That is something worth celebrating—but evidence shows that more progress is still needed.

Despite recent investments in maternal health, the United States still has the highest rate of maternal death among its economic peer nations.1 Overall, the United States’ higher spending on health care does not translate to better outcomes and wellbeing.2 Somewhere, these investments have been misplaced. It’s also possible that what has been done so far is simply insufficient to overcome the failing of the American health care system and social policies.

Now, the political climate has turned toward the disinvestment of government programs and initiatives that provide the most basic level of care that moms and babies need to be healthy. Programs like Medicare and Medicaid, which cover over 40 percent of all births in the United States, are under attack. The health care provider shortage persists and maternity care deserts continue to grow. Moreover, Project 2025 has outlined key ways that its proponents intend to eliminate access to basic health care and FDA-approved medications, and disrupt critical perinatal data collection. If Project 2025 is successful, access to health care will decline, the quality of care will worsen, more people will die, and many more will suffer the long-term effects of poor health.3

This brief highlights the current state of maternal health and identifies new threats to making progress for moms and babies. It also presents feasible solutions to protect, enhance, and expand essential maternal health programs and services.

New Data on Maternal Health in the United States

As mentioned, despite over a decade of successful advocacy and progress on maternal health, outcomes in the United States continue to trail those of peer nations. Recent troubling data include the following.

  • Compared to its peer nations, the United States has the highest maternal mortality ratio and one of the lowest ratios of obstetrician/gynecologists and midwives per live births.4
  • A Centers for Disease Control and Prevention (CDC) report on 2023 maternal mortality data indicates that the maternal mortality rate decreased for every racial/ethnic group except for Black women.5
Figure 1

  • The leading cause of maternal death in the United States is mental health. This includes suicide and drug overdose.6 A report from the Policy Center for Maternal Mental Health estimates that 62 million birthing-age women, or 96 percent of the potential perinatal population, live in areas with a shortage of maternal mental health professionals.7
  • Cardiovascular conditions, infection, and hemorrhage (in that order) are also leading causes of maternal death.8
  • Severe maternal morbidity—that is, unexpected outcomes of labor or delivery resulting in significant short- or long-term consequences to health—impacts approximately 60,000 women each year, a number that is still on the rise.9
  • Severe maternal morbidity risk factors include belonging to a racial/ethnic minority group and living in a low-income household (and thus being insured by Medicaid).10
  • In the United States, for each maternal death, there are seventy to eighty women who survive a near-death event related to a complication during pregnancy or childbirth or within forty-two days of the end of pregnancy.11 Researchers have identified poor patient–provider communication, discrimination, and systems issues as factors involved in near-miss events for Black women.12
  • The cesarean section (C-section) rate in the United States is 32.1 percent, well above the 10 percent rate that the World Health Organization deems helpful to prevent maternal and infant mortality.13 Elected C-sections, despite being relatively safe, are major surgeries that come with risks and are more likely to result in maternal death and severe maternal morbidity than vaginal delivery.14
  • Black women are 25 percent more likely to deliver by C-section than white women, putting them at greater risk for negative outcomes.15
  • Over 35 percent of counties in the United States qualify as maternity care deserts—locales where obstetric and prenatal care providers and birthing facilities are nonexistent.16 Maternity care is becoming more scarce as health systems close their obstetric units or hospitals close altogether.17

New Threats to Maternal Health

Maternal health is facing threats on multiple fronts, including federal funding cuts, inadequate health care coverage, declining access to care, insufficient data, and direct attacks on reproductive health.

Federal Funding Cuts

The Trump administration, guided by the tenets of Project 2025, has threatened at various times to cut Medicaid and funds for programs that many pregnant and postpartum people rely on.

In January 2025, various executive orders were issued that would cut funds to programs such as the Title V Maternal and Child Health Services Block Grant, Title X Family Planning Services program, the CMS Innovation Center including the Transformation Maternal Health (TMaH) Model, and more. Each of these programs works to improve access to quality care and support good perinatal outcomes for both moms and babies. These programs and more remain under threat as the new administration seeks drastic government budget changes. Some experts assert that the administration’s desired budget modifications will be impossible without disrupting or reducing major public service programs such as Medicaid.

Medicaid provides health care access for millions of women before, during, and after pregnancy. In 2014, Medicaid expansion related to the Affordable Care Act (ACA) allowed women to improve their health before becoming pregnant. This improved birth outcomes as women could receive care to manage chronic health conditions prior to pregnancy. Forty states and Washington, D.C.18 have adopted Medicaid expansion, and research links the expansion to decreases in maternal19 and infant20 mortality. Without Medicaid and other affordable health care coverage options, few women and families have the resources to finance critical maternal health care services, especially services needed by patients experiencing high-risk pregnancies.21 More than 40 percent of all births each year are financed by Medicaid and the Children’s Health Insurance Program (CHIP), including a disproportionate share of births to women of color and women living in rural areas.22

More than 80 percent of obstetrician-gynecologists (OB-GYNs) providing prenatal and postpartum services outside of hospital settings have patients who are partially or mostly covered by Medicaid. For these care providers, reductions in payment rates can have a devastating impact on their practices.23 The American Rescue Plan Act provided states with the option to expand Medicaid coverage for up to one year postpartum.24 As of March 2025, forty-eight states and Washington, D.C.25 have adopted the postpartum extension. To sustain and continue the progress made to improve access to continuous postpartum care, state Medicaid programs need uninterrupted federal funding to support individuals and families.26 States can improve Medicaid to cover services for doula care,27 community health workers,28 lactation consultants,29 and home visiting.30 Threats to Medicaid funding put all of these services at risk of being lost, which would derail the progress that has been made for maternal health over the past decade.

Medicare could also be subject to cuts with drastic consequences. Any significant federal Medicare funding cuts may affect the financial stability of hospitals, which could lead to reduced quality of care,31 higher health care costs,32 and the continued closures of obstetric wards33 (especially in rural areas where hospitals struggle)34 as hospitals are forced to balance costs and dwindling revenues. Specifically, hospitals have to meet certain conditions of participation to receive Medicare funds, and recently, the federal government began requiring35 hospitals to meet specific quality and safety standards in maternal health care. Medicare reimbursements represent more than 25 percent of hospital revenue in the United States.36

Inadequate and Uneven Health Care Coverage

Women and families who receive health care coverage outside of Medicaid and CHIP still face challenges when seeking comprehensive maternal health care coverage. Among women aged 19 to 64, about 58.6 million women (60 percent) received their health care coverage from employer-sponsored insurance.37 Women in families with at least one full-time worker are more likely to have job-based health care coverage (70 percent) than women in families with only part-time workers (33 percent) or without any workers (17 percent).38 Despite the wide range of plans and services available for prenatal and postpartum care under employer-sponsored health plans, there are critical maternal health care services that may not be covered.

Currently, there is no minimum standard for maternal health care coverage across public and private payers. The Affordable Care Act drastically improved access to maternal and infant care by requiring individual and small group plans to cover key services under the Essential Health Benefits (EHB) requirement. Notably, this led to 13 million women gaining access to these services. Still, states have been given a significant amount of flexibility to determine which specific services should be covered, and research has demonstrated that there is significant variation in coverage of labor and delivery, post-partum, education and counseling, provider types, and other services. Similarly, the ACA requires most insurers to provide a sufficient provider network to plan enrollees. However, this standard has been loosely defined and enforced.

Declining Access to Care

Turbulence in the health care sector after the pandemic has ushered in an era of health care system consolidations and closures as well as workforce shortages that have been especially detrimental to providing maternal care.

Hospital Closures

Since 2022, more than 100 hospitals across the United States have shuttered their obstetric units. Proposed Medicaid cuts might accelerate obstetric ward closures and community health center closures. Americans living in rural states are particularly affected by hospital closures and provider shortages. Rural hospitals, which serve approximately 60 million Americans, are closing at an alarming rate. Since 2010, 86 rural hospitals have shut down and 64 hospitals no longer provide inpatient services.39 Another 700 rural-serving hospitals are at risk of closing because of financial troubles.40 Hospitals in rural areas lose money providing services to patients. Rural counties that have lost obstetric units experience higher rates of births that occur in emergency departments.41 As long as health care is treated as a commodity, it will be subject to a financial approach that prioritizes profit over people.

Community Health Center Closures

With rural hospital closures, community health centers (CHCs) are a vital source of health care. Community health centers help fill in the gap42 when there is a void in health care services, and their role is vital for maternity care. CHCs provide follow-up appointments, medication management, and diagnostic testing for maternity patients. The freeze on federal funding could lead to many CHCs scaling down or ceasing to operate. For example, in Virginia, half of CHCs have been cut off from federal funding, which has forced closures. Closures like these can lead to pregnant women missing prenatal visits and other necessary care.43

Perinatal Workforce Shortages

For the past half a century, the United States has suffered from a shortage of health care providers, including obstetrician-gynecologists (OB-GYNs), midwives, and others who provide maternity care. Barriers to education and training, burnout and stress, and payment problems all contribute to this growing shortage. Since the COVID-19 pandemic, more health care providers (including physicians) are moving to nonclinical positions or leaving health care altogether.

While OB-GYNs comprise over 70 percent of the obstetric workforce,44 family physicians also play a crucial role, particularly in rural communities. Unfortunately, the percentage of family physicians trained to provide obstetric services has sharply declined45 and many with training are leaving the health care workforce.

In July 2023, the Health Resources and Services Administration (HRSA) announced $11 million in funding to strengthen the family physician workforce by supporting the development of fifteen new residency programs in rural areas.46 But initiatives like these rely on federal funding to function, and that funding remains under threat.

The historic, intentional divestment from and attacks on midwifery continue to affect access to midwifery care today. Midwives provide holistic maternal health care in hospitals, at birthing centers, and for people choosing to give birth at home. Demand for out-of-hospital birth among the general public has grown by nearly 20 percent since the COVID-19 pandemic.47 For Black women, the demand has grown by nearly 30 percent. Unfortunately, there are not enough midwives to meet the growing demand with only four midwives per 1,000 births in the United States.48

Maternal Mental Health Workforce Shortages

According to the Centers for Disease Control and Prevention (CDC), maternal mental health conditions are the leading cause of maternal mortality in the United States.49 Several risk factors contribute to the development of maternal mental health disorders, but chronic stress and a shortage of specialized care (especially in rural settings) continue to be drivers of maternal health complications, depression, and anxiety.

Licensed specialists with training in treating a broad span of mental health conditions in the perinatal and postpartum period, known as perinatal mental health-certified professionals (PMH-Cs), are an evidence-backed, proven intervention. The desperate need for PMH-C providers, psychiatrists, and other family medicine providers with expertise in maternal mental health necessitates a strategic workforce expansion to address the growing crisis. An estimated 13,885 providers are needed across the United States to fill these gaps.50

It is worth noting that the maternal mental health crisis disproportionately affects Black women—at a rate nearly twice that for all other women—as they face additional barriers due to systemic discrimination, racism, and inequities in the health care system. These structural issues compound the risk of developing maternal mental health disorders, highlighting the urgent need for culturally competent, accessible care.

Insufficient Data

The Trump administration has expressed a disdain for scientific evidence and has threatened to make broad budget cuts, some of which include funding for programs that collect and analyze maternal health data. In 2024, the CDC committed to a five-year, $118 million investment in maternal mortality review committees (MMRCs).51 Budget cuts and the mass firings of hundreds of workers at the CDC could have some consequences for the implementation of this investment, ultimately impacting MMRCs ability to function, gather data, report findings to the CDC, and have the CDC use that data to make meaningful recommendations to address maternal death.52

There were also mass firings at the National Institutes of Health (NIH), the primary agency responsible for medical research and home of the Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) Initiative.53 Disruption of this initiative would delay advances in preventing maternal death.

In February 2025, Talking Points Memo reported that the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) was shuttered indefinitely, with all data collection at the state level and reporting to the CDC suspended.54 Any federal PRAMS disruptions may affect efforts to improve health care delivery for pregnant and parenting women and families. PRAMS data provide information on key indicators of maternal and infant health before, during, and after pregnancy that are not widely available from any other data source.55 Any extended disruptions of the PRAMS program may exacerbate existing data limitations in PRAMS data and make it more difficult to create population-level recommendations for maternal and infant health.56

Barriers to Care for Immigrant Groups

The decision to rescind a Biden-era policy protecting certain areas, including hospitals, from immigration enforcement and replacing it with a directive that gives U.S. Immigration and Customs Enforcement (ICE) authority to take enforcement action in these spaces undermines safety for all Americans. The fear of ICE officials in hospitals and health care settings has led to patients canceling appointments, including sexual and reproductive health services.57 Avoiding or delaying care can have devastating impacts on patients’ health. Barriers to care already exist for immigrant communities, and the militarization of the U.S. border and the threat of ICE at health care facilities create additional intentional but unnecessary barriers to health care.

Immigrants face higher rates of poverty, with 14 percent of Black immigrants living below the poverty line, and are less likely to have health insurance coverage.58 Currently, immigrants must wait five years before they are eligible to enroll in federal health care programs, including Medicaid and the Children’s Health Insurance Program (CHIP). There are also additional restrictions that prevent undocumented immigrants from purchasing health insurance through the Affordable Care Act marketplace. Lack of health insurance means people of color, including immigrants, face significant barriers to accessing prenatal care. Consequently, the percentage of Black and Latina women with delayed or no prenatal care continues to be about two times that of white women.59 Access to health care should not be contingent on a person’s immigration status. It is imperative to acknowledge health care as a human right and create pathways for all people to access high-quality care.

Attacks on Access to Mifepristone and Misoprostol

The ongoing state and federal attacks on access to mifepristone and misoprostol will have far-reaching impacts on maternal health. Mifepristone and misoprostol are known for being two medications used in medication abortion. These essential medications are also necessary for use in miscarriage management, treating postpartum hemorrhage, managing fibroids and endometriosis, and other gynecological procedures.60

There are federal efforts attempting to roll back FDA approval of mifepristone in the hopes of making it more difficult for patients to access this essential medication.61 Actors at the state-level are also trying to make these medications inaccessible. This includes listing mifepristone and misoprostol as Schedule IV drugs, classifying them as controlled substances subject to stricter regulations.62

Louisiana was the first state to make mifepristone and misoprostol a controlled substance. As a result, hospitals run drills to practice accessing these medications quickly from where they are stored. Previously, mifepristone and misoprostol were once stored on medical carts for use in emergency scenarios.63

Other states are attempting to regulate and even prevent the availability and distribution of mifepristone and medication in their states.64 Making these medications difficult to access harms providers’ ability to care for patients and will inevitably harm maternal health.

Immediate Policy Opportunities

The challenges to improving maternal health in the current environment are numerous, but so are the policy opportunities for facing these challenges. Most immediately, policymakers must actively work to stop legislation that would ultimately exacerbate the maternal health crisis by being outspoken in their opposition to legislation, administrative action, and executive orders that are targeted toward reducing health care access and that would negatively affect maternal health experiences and outcomes for all people.

Below are other immediate opportunities for action to protect access to care and work to improve maternal health care experiences and outcomes.

Maintain and Expand Medicaid Coverage

The importance of Medicaid coverage of maternal health cannot be adequately emphasized. Without a fully functioning Medicaid program, access to perinatal care will decline drastically. Policymakers must protect Medicaid, oppose any funding cuts, and actively work to support Medicaid by developing new incentives for the remaining states to expand Medicaid.65

Strengthening Medicare and Medicaid funding would allow hospitals to continue to apply for federal funds to create and implement health care quality improvement plans that support health system upgrades, help develop clinical guidelines adjustments, enable staff and workflow improvements, and coordinate related billing and coding improvements.66

Improve Health Insurance Coverage

Beyond Medicaid, there is a need to build on the Affordable Care Act (ACA) to expand federal financial assistance for individuals to purchase private insurance through the Health Insurance Marketplace. Legislators have an opportunity to create a pathway for states to offer public options for all residents regardless of their income. The ultimate goal is to achieve universal coverage and guarantee access to health care for everyone, regardless of their income, immigration status, state of residence, or other factors.

Congress can improve access to comprehensive maternal health services by establishing a federal floor on the benefits, providers, services, and duration of coverage. This standard should also be extended to plans not subject to the ACA’s Essential Health Benefits requirement.

Insurance plans could improve access by covering a robust set of providers, including nonphysician providers and a broad range of perinatal workers. Congress can establish a minimum federal standard that includes but is not limited to midwives, doulas, lactation consultants, and OB-GYNs within certain geographic, time, and distance standards.

Expand Physical Access to High-Quality Maternity Care

Amidst ongoing hospital closures, more birthing options are needed. Birthing centers have emerged as a proven way to fill gaps in access to high-quality maternity care.67 In particular, community-based birthing centers are equipped to provide the holistic care that Black women need, but face unnecessary barriers to accessing funding to stay open and grow their services. Streamlining access to funding for community-based birthing centers can help fill gaps in care caused by hospital, clinic, and labor and delivery unit closures, and provide alternative options even where hospital-based care is available.68

Protect and Expand the Maternal Care Workforce

Health care workforce shortages are an immediate and ongoing threat to positive maternal health outcomes and wellbeing. In the past, federal funding has helped grow the health care workforce through a variety of programs.69 These programs must be protected and expanded, and special attention is needed to promote access to care in rural areas. Providers operating in maternity care deserts could benefit from infrastructural support, technical assistance, and educational resources to help reach communities with higher perinatal risks.

To address the specific need for culturally competent and congruent care, policymakers must invest in historically Black colleges and universities (HBCUs). Investing in HBCUs is imperative to create a diverse talent pipeline for medical education, create a psychologically safe and culturally inclusive health care workforce, and make progress toward health care equity.70 Creating and expanding funding streams dedicated to growing a midwifery pipeline are also critically important. For example, the Title VIII Advanced Nursing Education Workforce Program funds nurse-midwifery programs to award scholarships to students.71

To meet the need for maternal mental health care, policymakers can also equip frontline providers (OBs, family physicians, midwives, doulas, and community health workers) with the training and tools to deliver trauma-informed, culturally responsive, and stigma-free screening and referrals.

Collect and Analyze Data

Without reliable data, decisionmakers are unable to take meaningful action that will yield positive results for all people. Policymakers must immediately restore public health data surveillance systems and defend funding for existing data collection programs. Data gathered by states must be sent to the U.S. Department of Health and Human Services (HHS) and duly analyzed.

Defend Access to Mifepristone and Misoprostol

How medications are used should be left in the realm of qualified professionals. Mifepristone and misoprostol are necessary for a variety of medical interventions, and must not be subject to the whims of politicians. Given their safety, FDA-approval, and broad use, these medications must be depoliticized and decriminalized. Lawmakers must continue to reinforce the safety and efficacy of these medications, and continue to challenge restrictions on mifepristone as medically unnecessary and harmful to providing essential health care.

Review Legislative Options

Over the past several years, a variety of bills seeking to improve maternal health have been introduced in the House and Senate. The following is a list of legislation related to the issues discussed above, many of which have been crafted in collaboration with maternal health experts. This list is not exhaustive and certainly does not address the broad range of possibilities to improve maternal health experiences and outcomes in the United States, but they are worth noting.

Bills introduced in the 119th Congress include:

  • Preventing Maternal Deaths Act (H.R.1909)—This bill would strengthen and expand federal support for Maternal Mortality Review Committees (MMRCs).
  • Mamas and Babies in Underserved Communities Act of 2025 (H.R.1966)—This bill authorizes the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, to award grants to expand and improve maternal health care services.
  • Rural Obstetrics Readiness Act (S.380/H.R.1254)—This bill seeks to address the shortage of rural obstetricians.
  • The PREEMIE Reauthorization Act (H.R.1197)—This bill is the only federal legislation dedicated to the research, prevention, and treatment of preterm birth.

Bills introduced previously in Congress include:

Data

  • Data to Save Moms Act (S.1599/H.R.3320)—This bill expands data collection and research on maternal morbidity and mortality among minority populations.
  • NIH IMPROVE Act (S.4147/H.R.8037)—This bill would continue funding the Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative through the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and for other purposes.

Health Care Coverage

  • MOMMIES Act (S.3090/H.R.6004)—This bill establishes a series of programs and requirements under Medicaid and the Children’s Health Insurance Program (CHIP) relating to maternal health.
  • Healthy Moms and Babies Act (S.948/H.R.4605)—This bill would amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP.
  • Healthy MOM Act (S.3509/H.R.6716)—This bill would amend title XXVII of the Public Health Service Act to provide for a special enrollment period for pregnant women.
  • Mamas First Act (S.4304/H.R.8317)—This bill would amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services provided by doulas and midwives.
  • Impact to Save Moms Act (S.1797/H.R.3346)—This bill requires the Centers for Medicare and Medicaid Services (CMS) to establish the Perinatal Care Alternative Payment Model Demonstration Project to allow states to test payment models for maternity care, including postpartum care, under Medicaid and the Children’s Health Insurance Program (CHIP).

Workforce and Access

  • Perinatal Workforce Act (S.1710/H.R.3523)—This bill establishes grants for eligible education programs to grow and diversify the perinatal workforce for nurses, physician assistants, and other specified health workers, and otherwise addresses issues related to the maternal health workforce and care delivery models.
  • Keeping Obstetrics Local Act (S.5236)—This bill would amend titles XIX and XXI of the Social Security Act to enhance financial support for rural and safety net hospitals providing maternity, labor, and delivery services to vulnerable populations.

Substance Use and Mental Health

  • Moms Matter Act (S.1602/H.R.3312)—This bill establishes two grant programs to address maternal mental health conditions and substance use disorders, with a focus on racial and ethnic minority groups.
  • Promoting Maternal and Child Health Through Substance Use Prevention Act (S.3370)—This bill reauthorizes the program on prenatal and postnatal health of the Centers for Disease Control and Prevention.

Equity

  • CARE for Moms Act (S.2846/H.R.5568)—This bill would improve federal efforts for the prevention of maternal mortality.
  • Social Determinants for Moms Act (S.1594/H.R.3322)—This bill directs various federal departments to address social determinants of maternal health.
  • Kira Johnson Act (S.2239/H.R.3310)—This bill establishes grants to improve maternal health outcomes for racial and ethnic minority groups and other underserved populations.

Progress Is Possible

Each of these recommendations requires strong leadership and an unwavering commitment to doing what is necessary to improve maternal health experiences and outcomes. Without dedicated and consistent action from policymakers, women in the United States will continue to suffer from poor maternal health outcomes. Fortunately, there are clear actions that stakeholders and policymakers can take even during turbulent political times.

Beyond existing legislation, there are detailed policy agendas (listed below) that, when fully implemented, are likely to yield the desired positive impact that pregnant and birthing people need. Notably, BMMA has produced a comprehensive agenda outlining specific policy recommendations across structural determinants of health, workforce development, health care, research and data, criminalization, and community leadership.

Progress is possible and it is imperative. Without intentional action toward a better future, health and wellbeing in the United States will continue to lag and decline. Despite these murky political times, the vision for maternal health remains clear and it is achievable with appropriate leadership.

Resources

Maternal Health Policy Agendas

From the Black Maternal Health Federal Policy Collective

Additional Resources

Notes

  1. Munira Z. Gunja, Evan D. Gumas, Relebohile Masitha, Laurie C. Zephyrin, “Insights into the U.S. Maternal Mortality Crisis: An International Comparison,” The Commonwealth Fund, June 4, 2024, https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison
  2. Munira Z. Gunja, Evan D. Gumas, Reginald D. Williams II, “U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes,” The Commonwealth Fund, January 31, 2023, https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
  3. Roger Severino, “Department of Health and human Services,” https://static.project2025.org/2025_MandateForLeadership_CHAPTER-14.pdf https://www.guttmacher.org/fact-sheet/how-project-2025-seeks-obliterate-srhr
  4. Munira Z. Gunja, Evan D. Gumas, Relebohile Masitha, Laurie C. Zephyrin, “Insights into the U.S. Maternal Mortality Crisis: An International Comparison,” The Commonwealth Fund, June 4, 2024, https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison
  5. Donna L. Hoyert, “Maternal Mortality Rates in the United States, 2023,” U.S. Centers for Disease Control and Prevention, February 2025, https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/Estat-maternal-mortality.pdf
  6. “Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 38 U.S. States, 2020,” U.S. Centers for Disease Control and Prevention, May 28, 2024, https://www.cdc.gov/maternal-mortality/php/data-research/index.html
  7. Rebecca Britt, Joy Burkhard, Caitlin Murphy, “Maternal Mental Health Provider Shortages & Population Risk Report,” Policy Center for Maternal Mental Health, November 17, 2023, https://policycentermmh.org/maternal-mental-health-provider-shortages-population-risk-report/
  8. “Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 38 U.S. States, 2020,” U.S. Centers for Disease Control and Prevention, May 28, 2024, https://www.cdc.gov/maternal-mortality/php/data-research/index.html
  9. Eugene Declercq, Laurie C. Zephyrin, “Severe Maternal Morbidity in the United States:  A Primer,” The Commonwealth Fund, October 28, 2021, https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer
  10. Dorothy A. Fink, Deborah Kilday, Zhun Cao, Kelly Larson, Adrienne Smith, et al., “Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021,” June 1, 2023, https://pubmed.ncbi.nlm.nih.gov/37347486/
  11. Renee Montagne, “For Every Woman Who Dies In Childbirth In The U.S., 70 More Come Close,” NPR, May 10, 2018, https://www.npr.org/2018/05/10/607782992/for-every-woman-who-dies-in-childbirth-in-the-u-s-70-more-come-close
  12. Tiffany E. Byrd, Lucy A. Ingram, Nkechi Okpara, “Examination of maternal near-miss experiences in the hospital setting among Black women in the United States,” National Library of Medicine, November 2, 2022, https://pmc.ncbi.nlm.nih.gov/articles/PMC9638691/
  13. “Births – Method of Delivery,” National Center for Health Statistics, April 9, 2024, https://www.cdc.gov/nchs/fastats/delivery.htm
  14. Stephanie A. Leonard, Elliott K. Main, Suzan L. Carmichael, “The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity,” BMC Pregnancy and Childbirth, January 9, 2019, https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-2169-3
  15. Andrea Rice, “Black Women Are 25% More Likely to Have a C-Section Than White Women,” Healthline, September 13, 2024, https://www.healthline.com/health-news/c-section-rates-among-black-women#What-are-the-risks-of-C-sections
  16. “Nowhere to Go: Maternity Care Deserts Across the US,” 2024, https://www.marchofdimes.org/maternity-care-deserts-report#:~:text=Where%20you%20live%20matters%20when,and%20150%2C000%20births%20in%202022.
  17. Andrea Sonenberg, Diana J. Mason, “Maternity Care Deserts in the US,” Jama Health Forum, January 12, 2023, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2800629
  18. “Status of State Medicaid Expansion Decisions,” KFF, February 12, 2025, https://www.kff.org/status-of-state-medicaid-expansion-decisions/
  19. Erica L. Eliason, “Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality,” Women’s Health Issues, June 2020, https://www.sciencedirect.com/science/article/abs/pii/S1049386720300050
  20. Chintan B. Bhatt, Conseulo M. Beck-Sagué, “Medicaid Expansion and Infant Mortality in the United States,” PubMed Central, April 2018, https://pmc.ncbi.nlm.nih.gov/articles/PMC5844390/
  21. Laurie C. Zephyrin, Kay Johnson, Akeiisa Coleman, Rachel Nuzum, “State Options for Extending Medicaid Postpartum Coverage,” The Commonwealth Fund, August 11, 2021, https://www.commonwealthfund.org/blog/2021/state-options-extending-medicaid-postpartum-coverage
  22. “2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health,” Centers for Medicare and Medicaid Services, May 2024, https://www.medicaid.gov/medicaid/benefits/downloads/2024-maternal-health-at-a-glance.pdf; “Births Financed by Medicaid,” KFF, 2023, https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
  23. “Equitable Payment Rates for Maternity and Surgical Care,” The American College of Obstetricians and Gynecologists, 2025, https://www.acog.org/advocacy/policy-priorities/equitable-payment-rates-for-maternity-and-surgical-care
  24. Laura Harker, Breanna Sharer, “Medicaid Expansion: Frequently Asked Questions,” Center on Budget and Policy Priorities, June 14, 2024, https://www.cbpp.org/sites/default/files/6-16-21health_series3-18-24.pdf
  25. “Medicaid Postpartum Coverage Extension Tracker,” KFF, January 17, 2025, https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/
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