Pregnancy-related deaths in the United States rose sharply during the COVID-19 pandemic, surging more than 60 percent. While overall rates have stabilized, Black mothers remain at higher risk, especially in the later postpartum period, according to new research published in Obstetrics & Gynecology. As Black Maternal Health Week highlights persistent inequities, the findings show recovery has not been equal across populations.

The Michigan Medicine study points to a clear divide in post-pandemic recovery. Early pregnancy death rates have returned to pre-pandemic levels, but later postpartum deaths remain elevated, and Black women continue to experience disproportionately higher rates.

Researchers say the data highlights an urgent need to better understand what is driving these differences and how to close the gap in outcomes.

“We saw a dramatic increase in pregnancy-related deaths during the COVID-19 pandemic, but the recovery has not been equal across all groups,” said senior author Lindsay Admon, M.D., M.Sc., an associate professor of obstetrics and gynecology at the University of Michigan Medical School and obstetrician-gynecologist at U-M Health Von Voigtlander Women’s Hospital.

“We need to better understand what’s driving these differences so we can develop solutions that reduce maternal deaths and improve outcomes for everyone.”

Pandemic-Era Surge and Uneven Recovery

The United States has long had the highest maternal mortality rate among peer nations, and the pandemic intensified that trend.

Maternal deaths, defined as those occurring during pregnancy or within 42 days after, increased from approximately 20 deaths per 100,000 live births in 2019 to 33 in 2021, a rise of more than 60 percent.

Between 2018 and 2024, the U.S. recorded 8,298 pregnancy-related deaths.

Much of the increase was linked to COVID-19–associated deaths. Early pregnancy deaths rose by 7.5 per 100,000 live births, while later pregnancy deaths increased by 3.7 per 100,000.

By 2023 to 2024, early pregnancy death rates had returned to pre-pandemic levels. However, later postpartum deaths have not followed this trend, highlighting ongoing risk beyond delivery.

Disparities Persist for Black Mothers

Despite some overall improvements, this recovery has not been evenly distributed across groups.

The largest increases were seen among non-Hispanic Black women, American Indian or Alaska Native mothers, and birthing people ages 40 to 49. Rates for Black mothers remained higher than those for other groups for both early and late pregnancy-related deaths.

“Our findings show that COVID-19–related deaths drove much of the increase during the pandemic,” Admon said. “They also highlight persistent racial disparities in maternal deaths. While progress has been made, more work is needed, especially to reduce later postpartum deaths and improve outcomes for Black mothers.”

Why This Matters During Black Maternal Health Week

The findings align with the focus of Black Maternal Health Week, which highlights gaps in care and the need to improve outcomes for Black mothers.

For nurses and frontline clinicians, the data reinforces a critical reality. Risk does not end at discharge. The postpartum period, particularly beyond the early weeks, remains a vulnerable time that requires continued monitoring and access to care.

The persistence of disparities also points to broader structural and policy challenges that extend beyond the clinical setting.

Policy and Practice Implications

Researchers emphasize the need to examine how policy decisions, such as Medicaid coverage extensions, insurance eligibility rules, and funding for maternal health programs, have directly influenced maternal outcomes during and after the pandemic.

This includes evaluating pandemic-era measures, such as extended Medicaid coverage beyond 60 days postpartum, policies that facilitate access to postpartum care, and initiatives that improve care coordination. Assessing these allows policymakers to understand which actions most effectively reduce maternal mortality in high-risk populations.

“There is an urgent need to understand how both pandemic and post-pandemic policies have affected maternal health,” Admon said. “This work can help guide public health and policy efforts to reduce pregnancy-related deaths and improve health equity for mothers, children, and families.”