Safe Motherhood

Promoting Health for Women

Before, During, and After Pregnancy

2008

AT A GLANCE

“The world looks to us for leadership in demonstrating how to achieve and sustain safe motherhood.

CDC’s work in safe motherhood is truly where science meets society.”

Wanda K. Jones, DrPH

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

Coordinating Center for Health Promotion

February 2008
Safe motherhood 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. 

The ideal results are pregnancy 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.

Addressing Maternal Mortality and Morbidity

Maternal death continues to be the international standard 

by which a nation’s commitment to women’s status and their 

health can be evaluated. It is the primary measure of whether 

women can expect to survive complications that arise during 

pregnancy, delivery, and the postpartum period.

In the United States in 2004, the rate of maternal mortality 

was 13.1 deaths per 100,000 live births, with great disparities 

in many racial and ethnic communities. The leading causes of 

pregnancy-related deaths in the United States are hemorrhage, 

blood clots, high blood pressure, infection, stroke, amniotic 

fluid in the bloodstream, and heart muscle disease.

However, mortality is not the only indicator of women’s 

health. In 2001, CDC began working with national and 

international groups to develop and implement programs for 

safe motherhood, including those designed to prevent illness, 

death, and disability among women of reproductive age.

Sustaining Progress to Prevent Deaths

In the United States, 1 to 2 women die each day of pregnancy 

complications. From 1900 to 1982, deaths from pregnancy 

complications in the United States declined sharply. Antibiotics, better obstetric procedures, and control of infections 

have helped to prevent many deaths over the past century.

Despite these advances, studies indicate that as many as half 

of all deaths from pregnancy complications could be prevented

if women had better access to health care, received better 

quality care, and made positive changes in their health and 

lifestyle habits. Some people believe that maternal deaths 

are a rare event. However, maternal mortality rates have not 

improved in recent years, and deaths continue to occur.

Racial, Ethnic, and Age Disparities

A woman’s race, ethnicity, country of birth, and age can be

associated with her risk of dying of pregnancy complications. 

These same factors may affect her ability to avoid unintended

pregnancy, have access to adequate medical care, or learn and 

successfully practice healthy behaviors. CDC continues to 

investigate these disparities and to make information available 

to health care providers, scientists, and the general public

to help eliminate these disparities.

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Safeguarding the Health of Mothers 

36.1

9.8 8.5

13.1

Deaths per 100,000 live births

Non-Hispanic White

Hispanic

Total U.S. Population

Non-Hispanic Black

0

5

10

15

20

25

30

35

40

Maternal Mortality Rates by Racial and Ethnic Group, United States, 2004

* Annual number of deaths during pregnancy or within 42 days after delivery, per 100,000 live births.

Source: CDC, National Center for Health Statistics and Division of Reproductive Health.
CDC is committed to ensuring that all people, especially 

those at greater risk for health disparities, will achieve their 

optimal lifespan with the best possible quality of health

in every stage of life. With agency-wide health protection 

goals that support healthy people in healthy places across all 

life stages, CDC is setting the agenda to enable people to 

enjoy a healthy life by delaying death and the onset of illness 

and disability by accelerating improvements in public health.

To better understand the burden of maternal complications 

and mortality and to decrease disparities, CDC’s Division 

of Reproductive Health supports national and state-based 

surveillance systems to monitor trends and investigate health 

issues; conducts epidemiologic, behavioral, demographic, and 

health services research; and works with partners to translate

research findings into health care practice, public health 

policy, and health promotion strategies.

Pregnancy Mortality Surveillance

System (PMSS)

CDC works with state health departments and other groups 

to identify and gather information on pregnancy-related 

deaths. With its partners, CDC collects data on women who 

died during or within 1 year of pregnancy. Data are used to 

describe conditions that lead to death, identify risk factors 

for pregnancy-related deaths, and identify disparities in death 

rates. All states, the District of Columbia, and New York City 

contribute data for this surveillance system. CDC recently 

used PMSS data to describe associations between violence and 

pregnancy-related deaths.

Maternal Mortality Review Committees

CDC provides technical assistance and expertise to help states 

establish maternal mortality review committees. CDC collaborated with the Health Resources and Services Administration,

the American College of Obstetrics and Gynecologists, the 

Association of Maternal and Child Health Programs, and 

representatives of several states to publish best practices for 

improving maternal mortality review processes and activities. 

CDC is currently working with its partners to update national 

and international recommendations for conducting reviews 

and using data from these reviews to improve safe motherhood

programs.

Pregnancy Risk Assessment Monitoring

System (PRAMS)

PRAMS provides information about women’s health and 

health behaviors before, during, and immediately after

pregnancy. Data are used to develop indicators of success

in improving the health of mothers and their infants. PRAMS 

data also are used by state officials, researchers, and program 

managers to guide decisions on maternal and child health 

programs, practices, policies, and resources. In some parts

of the United States, PRAMS data have been used to describe 

women’s ability to accept and use specific health recommendations, including those related to prenatal care, folic acid use, 

breastfeeding, HIV testing, and smoking cessation.

PRAMS recently expanded to include 37 states, New York 

City, and one tribal nation. PRAMS data represent approximately 75% of births in the nation, and most importantly, 

the experiences of the women who gave birth to these infants.

Maternal and Child Health Epidemiology

Program (MCH-EPI)

This program provides expertise and support to state and 

local health departments to help them conduct studies to 

improve public health practice and management. In fiscal 

year 2007, 8 MCH epidemiologists and 8 MCH fellows were 

working in public health agencies in 13 states.

Interactive Atlas of Reproductive Health

CDC publishes the Interactive Atlas of Reproductive Health, 

which presents indicators of reproductive health in a clear, 

accessible format. This online reference is designed to be used 

by professionals working in public health and health care

as well as by the general public.

The indicators include fertility, health risk factors, maternal 

health, and infant health. Periodic updates allow users

to compare information by age, race, ethnicity, risk, and

geographic location. The atlas is available at http://www.cdc.

gov/reproductivehealth/GISAtlas/index.htm.

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CDC’s Role in Safe Motherhood 

DE

MA

MD

NYC

NJ

RI

VT

PRAMS projects

*

Participating PRAMS Projects, 2007

* Collaborative project with the State of South Dakota and the 

Yankton Sioux Tribe.
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Preconception Health

In 2006, CDC released a report with guidelines on how 

health care providers can support women’s efforts to achieve 

and maintain optimal health before, during, and beyond their 

reproductive lives, regardless of decisions to bear children. 

These guidelines are intended to help providers prevent death, 

disease, and disability among their patients. The findings

in this report are based on reviews of evidence by experts

in medicine and public health. CDC is working with its

partners to expand the acceptance and use of these findings 

and guidelines into everyday practice and health care policy.

We also are working to identify how society, economics,

genetics, geography, and other factors influence women’s 

health before, during, and after their reproductive years.

The Burden of Infertility

Safe motherhood embraces the concerns of women who have 

attempted to conceive naturally without success. In 1996, 

CDC published its first report on assisted reproductive technology (ART), called Assisted Reproductive Technology Success 

Rates. This report provided a national overview of outcomes 

at U.S. fertility clinics. CDC has published 10 ART reports 

over the years, and we continue to monitor trends in the use 

of ART services and maternal and infant health outcomes. 

CDC hopes to expand these efforts in the future to respond 

to a growing demand for information on how to overcome

infertility in women and men. In 2008, CDC plans to convene a panel of experts to discuss the public health burden

of infertility on families and communities.

Chronic Diseases and Reproductive Health

An important component of safe motherhood is improving 

outcomes for women who have or will develop chronic diseases

such as diabetes or heart disease during their reproductive 

years. Recent PRAMS surveys have included questions about 

diagnosis of diabetes during pregnancy. Women with diabetes 

must take the disease into account when choosing a contraceptive method or preparing for pregnancy. In the future, 

CDC plans to devote more attention to gestational diabetes, 

which is a strong predictor of future type 2 diabetes in many 

women during and after their reproductive years. CDC also 

will work with its partners to better understand genetic, metabolic, and other factors that can lead to infertility in women 

and men. These data and evidence could lead to important 

breakthroughs for U.S. families.

Emerging Threats and Safe Motherhood

CDC recognizes that new threats to safe motherhood have 

emerged in this century. These threats include man-made and 

natural disasters, as well as emerging infectious diseases.

Fortunately, many CDC reproductive health professionals

have experience working in emergency settings and complex

medical situations. For example, in 2005, CDC staff helped

in the aftermath of Hurricane Katrina, when obstetric services 

were shut down or relocated in some areas. In 2006, CDC

staff provided scientific and other assistance in Puerto Rico

to help assess the impact of dengue fever on pregnant women. 

CDC will draw on this experience to help prepare public 

health professionals for the next emergency, whether it is a 

threat of monkeypox, anthrax exposure, or natural disaster.

HIV Prevention and Care

CDC’s Division of Reproductive Health will continue its

pioneering work into understanding the burden of HIV 

infection on the reproductive lives of women and men. These 

efforts will require continued support that delivers evidence 

about new technologies and strategies to protect those who 

are not infected. At the same time, important investments 

need to be made to help people at high risk for infection and 

women who need to use anti-retroviral drugs before and

during their pregnancy. CDC will continue to be involved

in microbicide research and other new technologies, reviewing 

guidelines for contraceptives for people using anti-retroviral 

drugs and evaluating outcomes of new technologies for HIV 

prevention.

CDC’s Investment in the Health of Women

CDC will continue to invest resources to ensure safe motherhood for all U.S. women and to overcome disparities in reproductive health. Ongoing activities and research seek answers 

to questions about differences in health status, risks, and

outcomes related to race, ethnicity, age, geography, and other 

demographic factors. CDC continues to invest in using the 

behavioral sciences to understand disparities that create

or provide protection from health risks. CDC will continue

to work with partners to address urgent issues related to safe 

motherhood, including depression, premature labor and delivery, teenage pregnancy, and reproductive health and violence. 

We also will work to prevent negative outcomes of pregnancy, 

including miscarriage, stillbirth, and the sudden, unexpected 

death of infants.

For more information, please contact the Centers for Disease Control and Prevention

 National Center for Chronic Disease Prevention and Health Promotion

4770 Buford Highway NE, Mail Stop K-93, Atlanta, GA 30341-3717

Telephone: 770-488-5200 • E-mail: ccdinfo@cdc.gov • Web: http://www.cdc.gov/reproductivehealth

CS114854

Future Directions for Safe Motherhood Programs