The United States is one of the most resource-rich healthcare system in the world, yet maternal mortality continues to rise. Today, women in the United States are more likely to die from a pregnancy-related cause than women in any other high-income country. The National Center for Health Statistics reported that in 2023, the United States recorded 18.6 maternal deaths per 100,000 live births.(1) For Black women, the maternal mortality rate in 2023 was alarming, at 50.3 deaths per 100,000 live births, more than three times the rate for white women (14.5) and significantly greater than the rates for Hispanic (12.4) and Asian (10.7) women.(1)
As a physician leader who cares for women with cardiovascular disease in pregnancy, I contend that such statistics are not just public health information — they are indicators of system failure. Therefore, we must elevate maternal health to the center of strategic decision-making in health systems. Then and only then will we see focused leadership, equitable resource allocation, and structural transformation move from data collection to lives saved.
Maternal health outcomes are a barometer for system quality. From my vantage point, they reflect how well a health system coordinates care, addresses chronic conditions, and closes equity gaps. Too often, maternal health is siloed into Obstetrics and Gynecology or relegated to public health campaigns. But the reality is that maternal health is not a niche concern. As stated earlier, it is a comprehensive indicator of a system’s ability to deliver coordinated, equitable, and preventive care. It is crucial to point out that a health system that fails mothers during their most vulnerable period cannot claim to be high performing.
We can all agree that pregnancy and postpartum care impact nearly every area of health. This includes managing chronic conditions such as hypertension and diabetes, as well as behavioral health, community health, and emergency response. Therefore, poor maternal outcomes can reflect how effectively systems work together
In my world of cardio-obstetrics, a preventable postpartum hypertension readmission doesn’t just indicate an uncontrolled blood pressure issue; it reflects potential failures in communication among care teams, staffing, access, protocols during labor and delivery, and immediate postpartum follow-up.
Ultimately, maternal health is not just about reducing mortality. It’s about closing the health equity gap that undermines trust in the U.S. health system. It’s about bringing to light racial and socioeconomic disparities, revealing that Black, indigenous, and rural mothers face significantly worse outcomes, even when adjusting for social factors.
Beyond the clinical and moral imperatives, maternal health should clearly be a strategic priority. We must recognize that leaders who fail to acknowledge this are missing an opportunity to align with core organizational priorities.
It is critically important to note that health system leaders face increasing pressure to provide equitable, high-quality care while managing costs and retaining talent. Maternal health sits at the intersection of all these challenges:
First, there is the workforce. Most U.S. health systems are experiencing attrition and burnout. This job dissatisfaction and related retention issues have significantly affected nursing and allied health staff, who often are the frontline for maternal care. So prioritizing staff satisfaction for retention can impact the workforce.
Secondly, there is a high cost associated with poor maternal outcomes. Complications during maternal prenatal care and delivery can lead to longer hospital stay, avoidable readmissions, and long-term health burden in women as well as their infants. This cost can ripple across systems. Therefore, investing in maternal health initiatives such as prenatal care bundles, doula support, and immediate postpartum follow-up can reduce cost while improving maternal outcomes.
Next, it is important for systems to recognize that maternal health is the grassroots of population health. For me, this means that a healthy pregnancy will set the stage for a healthy infant, appropriate child development, family stability, and chronic disease prevention. Investing appropriately in better maternal outcome for a health system yields multigenerational returns — an important strategic goal every healthcare executive should prioritize.
Lastly, building community trust and boosting the health system’s reputation are crucial. Forming a robust and sustainable health system strategy in maternal care can build credibility and trust with the community that system serves. In an era where community engagement is central to trust building, focusing on maternal health provides a tangible, visible area for strategic partnership with community-based organizations and community leaders.
It is important to include maternal health in your strategic dashboards. Track and measure maternal outcomes such as wound infection rates or readmission. Disaggregate the data by race, ethnicity, language, and geography (down to zip codes). Listen to the lived experience of birthing professionals in your community to optimize care based on evidence-based protocols and best practices. Continue to reassess policies in place that can foster disparities. Implement policies to expand access, such as doula, midwifery, and postpartum care. Commit to making maternal health a system-wide focus.
To healthcare leaders, maternal health is not about reacting to the data presented — it is about setting the agenda to develop a safe healthcare zone for our mothers. We cannot build equitable, high-quality health systems while maternal outcomes lag. It is time for physician leaders to challenge outdated assumptions, break down care silos, and create strategic plans where maternal health is embedded as a priority and not an optional proposal.
In the end, change starts when these strategies not only improve maternal health, but reinforce U.S. health systems’ commitment to health equity, healthcare quality, value-based care, and trust.
Reference
Hoyert DL, Gregory. ECW. Health E-Stat 100.Maternal Mortality Rates in the United States, 2023. National Center for Health Statistics, 2024. www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023.htm