The U.S. spends the most on health of any nation on earth — and loses more mothers than any of its rich-country peers.
For over a century the U.S. has tracked how many mothers and infants die around childbirth, and the recent picture is a stark outlier: despite the highest health spending in the world, American maternal and infant mortality rank among the worst of the wealthy nations, and Black mothers die at roughly three times the rate of white mothers. This traces the long-run data, why the U.S. diverges from its peers, where the racial and geographic gaps are widest, and what the evidence says would close them.
Maternal deaths vs peers
≈3×
18.6 per 100k (2023) — highest of any rich nation (CDC/OECD)
Black vs white maternal death
3.5×
50.3 vs 14.5 per 100k, 2023 (CDC/NCHS)
Infant deaths per 1,000, 2023
5.6
32nd of 38 OECD · vs 4.2 OECD avg (CDC/OECD)
Maternal deaths preventable
>80%
≈4 in 5 pregnancy-related deaths (CDC MMRC)
Maternal deaths per 100k, 1915→now
608→19
a 97% fall, then a modern plateau (NCHS)
A century of collapse — then a stall
The United States has counted how many mothers and infants die around childbirth since 1915, the first year of standardized national data. What it recorded was one of the great public-health achievements in human history: maternal mortality fell from 608 deaths per 100,000 births in 1915 to single digits by 1980, and infant mortality from about 100 per 1,000 to under 7. Clean water, aseptic childbirth, antibiotics, blood banking, vaccines, and later neonatal intensive care each took a bite out of what had been routine tragedy.
Then progress stalled. Infant mortality flattened after 2000 and rose in 2022 for the first time in two decades. Measured maternal mortality climbed sharply after 2018 — partly because a new death-certificate "pregnancy checkbox" counts more deaths, but not only that. On the modern, like-for-like method the U.S. still loses more mothers than any comparable nation. The two eras below are drawn separately because they are not measured the same way; the shape that matters is the century-long fall and the recent plateau.
U.S. infant mortality · 1915 — 2025NCHS
Deaths before age one, per 1,000 live births. Note the 1918 influenza notch (100.9) and the 2022 uptick to 5.6 — the first significant rise in 20 years. The last two points, 2024 and 2025, are PROVISIONAL: NCHS publishes final annual rates about two years in arrears, so these are 12-month-ending provisional rates. Where the two overlap they agree — provisional Q4 2023 is 5.63 against a final 5.6. Source: NCHS (final 1915–2023; provisional 2024–25, data.cdc.gov jqwm-z2g9).
U.S. maternal mortality · 1915 — 2023NCHS
Maternal deaths per 100,000 live births. Orange = historic national series; yellow = modern pregnancy-checkbox era (2018+), which measures more deaths and is not directly comparable to the historic line. Even so, the 2021 COVID peak (32.9) and the 2023 level (18.6) sit far above every peer nation. Source: NCHS.
Aseptic, attended childbirth
In 1915 most U.S. births happened at home, often without a trained attendant, and puerperal (childbed) fever — a preventable bacterial infection — killed tens of thousands of women a year. The shift to hospital delivery, hand-washing and aseptic technique, and trained obstetric care through the 1930s–40s attacked the single largest cause of maternal death. Maternal mortality fell from 608 per 100,000 in 1915 to 83 by 1950.
Antibiotics & safe blood transfusion
Sulfa drugs (late 1930s) and penicillin (mid-1940s) made puerperal sepsis survivable for the first time; safe blood banking and transfusion tackled hemorrhage, the other great killer. These two advances alone drove the steepest single stretch of the maternal-mortality decline, roughly 1935–1950.
Clean water, milk & vaccines (infants)
The infant collapse — 100 deaths per 1,000 in 1915 to under 30 by 1950 — came mostly before high-tech medicine, from municipal water filtration and chlorination, milk pasteurization, sewage systems, and the vaccines that stopped diphtheria, pertussis, and measles from killing babies. Structural public health, not hospitals, did most of the early work.
Neonatal intensive care
After mid-century the infant frontier shifted to the newborn period. Neonatal intensive-care units, surfactant therapy for premature lungs (1990), maternal steroids, and better management of low birthweight pushed the rate from 26 per 1,000 in 1960 to under 7 by 2000 — the gains that modern medicine, rather than sanitation, delivered.
Family planning & prenatal care
Contraception, spacing of births, and the spread of routine prenatal care lowered the number of high-risk pregnancies and caught complications earlier. Medicaid (1965) extended coverage of prenatal and delivery care to low-income mothers, financing a large share of U.S. births ever since.
Then the progress stalled
Both curves flattened around 2000 and maternal deaths rose. Part of the measured maternal increase after 2018 is better counting (the death-certificate "pregnancy checkbox"), but even on the modern, like-for-like method the U.S. sits far above every comparable nation — the plateau, not just the measurement, is real.