Safe Motherhood:

Preventing Pregnancy-Related Illness and Death

AT-A-GLANCE

2000

“We as a nation must do all we can to ensure that all mothers are safe and healthy before, during, and

after pregnancy. Every year, nearly 1,000 of our sisters and daughters die and hundreds of thousands

of others experience medical complications from pregnancy. Death and serious illnesses due to

pregnancy and childbirth shouldn’t be part of the picture in the United States.”

Wanda K. Jones, Dr PH

Deputy Assistant Secretary for Health (Women’s Health)

Director, Office on Women’s Health, U.S. Public Health Service

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention



DE

MA

NH

RI

Maternal Deaths,* United States, 1987–1996

*Deaths during or within 42 days after pregnancy, per 100,000 live births.

Source: CDC, National Center for Health Statistics.

Revised May 2000
2

Safe Motherhood: Preventing Pregnancy-Related Illness and Death

Approximately 6 million American women become

pregnant each year, and over 10,000 give birth each

day. Safe motherhood is a vital social and economic

investment. It begins before conception with proper

nutrition and a healthy lifestyle. It continues with

appropriate prenatal care, the prevention of

complications when possible, and the early and

effective treatment of any complications that do

occur. It ends with a labor at term without

unnecessary interventions, the delivery of a healthy

infant, and a healthy postpartum period in a positive

environment that supports the physical and emotional

needs of the woman, infant, and family.

Pregnancy-Related Deaths—No Decline

in Almost 20 Years

A pregnancy-related death is one that occurs during

pregnancy or within 1 year after a pregnancy and is

caused by pregnancy-related complications. Each day

in the United States, between two and three women

die of pregnancy-related causes. Although the risk of

dying of pregnancy-related complications has

decreased dramatically in the United States over the

past 50 years, this risk has not declined since 1982.

Over half of all pregnancy-related deaths could be

prevented through improved health care access,

improved quality of care, and changes in health and

lifestyle habits.

The risk of death due to pregnancy varies greatly

among women of different racial and ethnic groups.

In particular, black women are four times more likely

and Hispanic women are 1.7 times more likely than

white women to die of pregnancy-related

complications.

Deaths Only Part of the Picture

Of the 4 million women who give birth in the United

States each year, at least 30% have a pregnancyrelated complication before, during, or after delivery.

These complications can cause long-term health

problems even when they do not result in death.

Childbirth is the most common reason for hospitalization in the United States, and pregnancies with

complications lead to more costly hospitalizations. In

the United States, hospitalizations for pregnancyrelated complications occurring before—not during or

after—delivery account for more than 2 million

hospital days of care each year at a cost of more than

$1 billion annually.

*Deaths during or within 42 days after pregnancy, per 100,000

live births.

Source: CDC, National Center for Health Statistics.

0

5

10

15

20

25

30

35

40

Maternal Deaths* Among Black and White

Women, United States, 1973–1997

The leading causes of pregnancy-related deaths in

the United States are

• Hemorrhage.

• Embolism (a blockage in the bloodstream).

• Pregnancy-induced hypertension.

• Sepsis/infection.

• Anesthesia complications.

• Cardiomyopathy (heart muscle disease).

Some of the most common complications of

pregnancy are

• Miscarriage.

• Ectopic pregnancy.

• Excessive vomiting.

• Diabetes.

• Hemorrhage.

• Infection.

• Pregnancy-induced hypertension.

• Premature labor.

• Need for a surgical (caesarean) delivery.
3

CDC’s National Leadership

Supporting State-Based Programs

With fiscal year 2000 funds of about $8 million, CDC

will work with states and health partners to translate

science into quality care to reduce pregnancy-related

complications and deaths. CDC also assists states in

determining which women may be at increased risk for

pregnancy-related complications and what types of

interventions can decrease these risks. By answering

such questions, states can implement research-based

prevention programs to make motherhood safer.

Examples of CDC assistance include the following:

The Pregnancy Risk Assessment Monitoring System

(PRAMS). CDC and state health departments use

PRAMS to collect state-specific,

population-based data on maternal

attitudes and experiences before, during,

and immediately after pregnancy. These

data can be used to identify groups of women at high

risk for health problems, to monitor changes in health

status, and to measure progress towards goals in

improving the health of mothers and infants.

Maternal and Child Health Epidemiology Program

(MCHEP). Through MCHEP, CDC and the Health

Resources and Services Administration (HRSA)

support state and local health departments in

collecting and analyzing information to assess and

protect the health of mothers and infants. Seven

states, the District of Columbia, and CityMatCH (an

organization in Omaha, Nebraska, that assists

maternal and child health programs in U.S. cities)

have MCHEP-sponsored epidemiologists. MCHEP

provides financial support for six additional programs,

and several other states receive technical assistance

but no direct resources. In addition, the annual MCH

Epidemiology Conference offers training opportunities

and information to professionals in the field.

Monitoring Safe Motherhood: An Essential

National Strategy

Data from safe motherhood monitoring are critical for

improving health-promotion programs for pregnant

women, mothers, and infants. Priorities for safe

motherhood monitoring include identifying and

investigating all pregnancy-related deaths and

gathering information on complications of pregnancy

and their causes. CDC uses these data to

• Identify risk factors for maternal illness and death.

• Examine racial disparities in pregnancy-related

death rates.

• Define the burden of disease in the population as a

whole and in groups of women at higher risk.

• Explore ways to assist women at risk for domestic

violence.

CDC’s ongoing Pregnancy Mortality Surveillance

System works with states to monitor pregnancyrelated deaths and to identify risk factors for

pregnancy-related deaths from specific causes.

PRAMS and MCHEP Participants, 1999–2000
4

For more information or additional copies of this document, please contact the

Centers for Disease Control and Prevention,

National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K–23,

4770 Buford Highway NE, Atlanta, GA 30341-3717, (770) 488-5187.

ccdinfo@cdc.gov

http://www.cdc.gov/nccdphp/drh

Strengthening the Science Base

CDC is analyzing national and state data to learn

more about maternal illness during labor and delivery,

define trends in surgical deliveries, and identify the

factors involved when a woman dies or almost dies of

pregnancy-related causes. CDC has research under

way to expand on the following innovative activities:

• Understanding racial and ethnic differences in

pregnancy-related deaths. One of the greatest

racial gaps in public health is the fourfold greater

risk of pregnancy-related death among black

women than among white women. CDC uses

national data to analyze the prevalence of death

due to pregnancy-related complications among

women of different races. Results are being used to

target risk factors for these complications among

black and Hispanic women.

• Understanding the risks of domestic violence

among pregnant women. Each year, up to 300,000

pregnant women in the United States are victims

of domestic violence; violence is more common

among pregnant women than many conditions for

which they are routinely screened. CDC provides

assistance to projects that focus on the risk of

domestic violence among pregnant women and

new mothers. In both Alaska and Georgia, for

example, PRAMS data identified a high prevalence

of domestic violence among new mothers; this

information was used to institute recommendations

for prenatal screening for domestic violence.

• Evaluating changes in health care for pregnant

women. In response to changes in many U.S.

health care delivery systems and in current medical

practices, CDC and its partners are investigating

better ways to monitor pregnancy-related illness.

Projects include

✓ Examining pregnancy-related illness among

Medicaid recipients in Tennessee.

✓ Examining the prevalence of vaginal birth after

caesarean section in Georgia.

✓ Characterizing the treatment of ectopic

pregnancies in an HMO in California.

• Limiting illness from infections. CDC is exploring

factors associated with bacterial vaginosis, which

can lead to ectopic pregnancy, premature labor,

and uterine infections after pregnancy. CDC will

also study the association of douching with

premature delivery and the design of culturally

appropriate interventions to inform women about

potential risks.

Expanding Communication and Education

Using various methods to disseminate new knowledge,

CDC continues to expand communications activities

that focus on

• Ways to make motherhood safer.

• The importance of prenatal care.

• Effective prevention strategies for health care

providers to decrease illness and possible death

among women during pregnancy.

In addition, CDC builds coalitions with federal,

university, state, and health care partners to share

knowledge on making motherhood safer. In 1999,

CDC sponsored a national conference to explore ways

to better understand the magnitude and causes of

pregnancy-related illnesses and complications. Also in

1999, responding to requests from health departments

for information and technical assistance, CDC and its

partners developed Strategies for the Identification and

Review of Pregnancy-Related Deaths in the United States

with the goal of helping states find ways to reduce

these deaths.

Building on Accomplishments

Currently, CDC has limited resources to support

prevention research and public education on safe

motherhood. CDC has developed a 3-year action plan

that calls for partnering with federal agencies, states,

nonprofit organizations, and community-based groups

to address maternal health issues. Working with

HRSA, CDC is also preparing the maternal health

portion of Healthy People 2010, which provides

national goals for safe motherhood in the next decade.