Maternal Mortality and Morbidity

What are maternal mortality and morbidity?

Maternal mortality and morbidity are important ways to measure the health of a community.

Maternal mortality represents not just the loss of a person’s life, but the impact of that loss on her family and community. Severe maternal morbidities (serious birth complications, or “near-misses”) can be traumatizing for birthing people and their families, have lasting health consequences, and be extremely expensive.

Though maternal health in the United States has improved over the past century, recent increases in maternal deaths and significant racial disparities in maternal health show a need for systematic improvements in the care and support pregnant and postpartum people receive.

Maternal mortality can have several definitions, depending on the data source. In Maternal Mortality Review, a pregnancy-associated death is a death during or within one year of the end of pregnancy, regardless of the cause. A pregnancy-related death is a death during or within one year of pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. The Wisconsin MMRT reviews all Wisconsin resident pregnancy-associated deaths to determine whether the death was pregnancy-related. Visit Review to Action for more information on definitions.

One way to measure the rate of maternal mortality is the pregnancy-related mortality ratio (PRMR) or the ratio of pregnancy-related deaths to live births. According to Wisconsin, P-03226 (PDF) and national data, in 2011-2015 the PRMR in Wisconsin was 7.2 deaths per 100,000 live births, compared to the U.S. ratio of 17.2 deaths per 100,000 live births.*

Though Wisconsin regularly reports a lower PRMR than the nation, the PRMR for non-Hispanic Black people is much closer to the national rate. In 2011-2015, the PRMR for non-Hispanic Black birthing people was nearly 2.5 times the PRMR, P-03226 (PDF) for non-Hispanic White birthing people in Wisconsin (15.7 and 6.5 deaths per 100,000 live births, respectively), a decrease from the previous report (PDF), which reported a PRMR five times higher for non-Hispanic Black birthing people.

It is important to note that while the racial disparity in maternal mortality appears to have improved in Wisconsin, the recent increase in pregnancy-related overdoses (PDF) in the non-Hispanic white population may be masking the persistent disparity for non-Hispanic Black birthing people. While rates of pregnancy-related overdose deaths have increased for the non-Hispanic white population, rates of pregnancy-related death have remained high for the non-Hispanic Black population. We know non-Hispanic Black birthing people experience both interpersonal racism and the effects of systemic racism, which can have serious impacts on their birth and health outcomes.

*Please note that the methodologies used for calculating Wisconsin and national PRMRs are different. The Wisconsin PRMR is calculated using Maternal Mortality Review definitions and the national PRMR is calculated using Pregnancy Mortality Surveillance System definitions.

Maternal deaths make up only a small portion of the serious health issues people experience during and after pregnancy. Severe maternal morbidities (SMM) with serious birth complications or "near misses” are much more common. SMM includes complications resulting from or made worse by pregnancy, such as hemorrhage, kidney failure, and eclampsia. National data suggest that the SMM is increasing across the country, possibly due to the impacts of systemic racism and pre-pregnancy health conditions.

In Wisconsin, hundreds of birthing people experience one or more severe maternal morbidities during a delivery hospitalization each year. In 2022, more than one out of every 150 delivery hospitalizations resulted in at least one SMM, with a statewide rate of 70 per 10,000 delivery hospitalizations. SMM rates were highest for birthing people younger than 20 or over 40 years of age, non-Hispanic Black birthing people, and people enrolled in BadgerCare.

The most common categories of SMM in Wisconsin included hemorrhage, kidney complications, and respiratory complications.

In order to address these critical issues, the Wisconsin Department of Health Services supports the investigation of maternal deaths through the Wisconsin MMRT. The MMRT is part of Wisconsin’s broader effort to use comprehensive fatality reviews, such as Child Death Review (CDR) and Fetal and Infant Mortality Review (FIMR), to inform public health prevention.

The Wisconsin MMRT is a multi-disciplinary team that reviews all deaths that occur during or within one year of pregnancy. The MMRT determines whether the death was related to pregnancy, identifies contributing factors, and creates recommendations for prevention.

These investigations and other research have identified a number of ways to reduce maternal mortality and morbidity in Wisconsin, including:

Regionalized systems of perinatal care, which ensures that the highest risk pregnant people and infants receive care in facilities well-equipped to manage them. The Wisconsin Association for Perinatal Care (WAPC) leads a self-assessment process to help hospitals identify their level of perinatal care and makes these designations available to the public. Learn more about the self-assessment process.
A statewide Perinatal Quality Collaborative, which was established in 2015, to advance evidence-based practices and quality improvement initiatives related to the care of pregnant and postpartum people.
The Maternal Mortality Review Impact Team, which is a new team of maternal health experts from around the state working to move MMRT recommendations to action. Please stay tuned for more information as this is a new initiative.

The following publications provide more information on maternal mortality and morbidity in Wisconsin:

Questions about the data? Email DHSMMR@dhs.wisconsin.gov.

HEAR HER®

Women know their own bodies better than anyone and can often tell when something does not feel right

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Women who are pregnant or postpartum need our support. Partners, friends, family, coworkers, and providers—anyone who supports pregnant and postpartum women—can all help just by listening when she tells you something doesn’t feel right. Acting quickly could help save her life. Learn about the urgent warning signs and other life-saving information.

Wisconsin’s Maternal Mortality Review Team at the Department of Health Services is working with CDC (Centers for Disease Control and Prevention) to promote the Hear Her campaign, which supports our commitment to healthy pregnancies and deliveries for every woman. Visit the CDC’s Hear Her campaign website to hear compelling stories from women, get ideas for developing social media and doing other promotions to get out this important message.

Learn more: CDC Maternal Mortality

Hear Her® is a registered trademark of the U.S. Department of Health and Human Services (HHS). Use of these marks by the Wisconsin Department of Health Services does not imply endorsement by HHS and CDC.

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For more information email DHSMMR@dhs.wisconsin.gov.

What are maternal mortality and morbidity?