In 2023, Black women in the United States died from maternal causes at 50.3 deaths per 100,000 live births. The rate for white women was 14.5, a ratio of 3.5 to 1 (Donna Hoyert, NCHS Health E-Stat 100, 2024; PMID 39946528). That ratio is the widest Black-white gap in any of CDC's recent annual maternal mortality briefs.
The "three times" shorthand has held in public health copy for a decade. It is loose. The specific number moves from year to year, and the direction of movement matters more than the static label. When the gap widens, it is usually because something changed for white women. Black maternal mortality has held roughly flat.
The last four federal briefs, read side by side
CDC publishes an annual Health E-Stat with maternal mortality rates stratified by race and Hispanic origin. The numbers across the last four briefs tell a specific story.
In 2020 (a pandemic year, elevated across every group), the Black rate was 55.3 per 100,000 and the white rate was 19.1, a ratio of 2.9 (Hoyert, NCHS Health E-Stats, 2022). In 2022, the Black rate was 49.5 and the white rate was 19.0, a ratio of 2.6 (Hoyert, NCHS Health E-Stats, 2024). In 2023, the Black rate was 50.3 and the white rate was 14.5, a ratio of 3.5 (Hoyert, NCHS Health E-Stats 100, 2024; PMID 39946528).
The Black rate has moved between 49.5 and 55.3 across those four years. That spread is inside the margin of statistical uncertainty for a denominator of fewer than 260 Black deaths per year. The white rate moved from 19.1 to 19.0 to 14.5, a 24 percent drop between 2022 and 2023 alone. The 2023 brief itself confirms that directionally: CDC reported "rates decreased significantly for White non-Hispanic and Hispanic women" and did not report a significant decrease for Black women (PMID 39946528).
Put another way: the widest disparity in CDC's last four annual briefs is not a story about Black maternal mortality getting worse. It is a story about white maternal mortality getting better and Black maternal mortality staying where it was.
What the 2024 update says, and what it does not say
The most recent CDC brief covers 2024. Donna Hoyert, the NCHS statistician who has authored the federal maternal mortality E-Stats series, is again the lead author (Hoyert, NCHS Health E-Stat 113, 2024; PMID 41805296). The overall US maternal mortality rate dropped to 17.9 per 100,000, down from 18.6 in 2023. The abstract states the 2024 rates "were not statistically different from 2023 overall, by age, or by race and Hispanic-origin groups," and notes that "the maternal mortality rates for Black non-Hispanic women were greater than those for other race and Hispanic groups."
"Not statistically different" can read like good news. It is not. The phrase means the 2023 disparity carries into 2024 at the sample sizes CDC uses for annual briefs. A Black-white ratio in the range of 3.0 to 3.5 is consistent with every CDC maternal mortality report for the last decade; the 2024 data does not move it.
A note on specifics: CDC's 2024 Health E-Stat 113 PDF is the current authoritative source for the race-stratified numerical values. Secondary summaries have circulated with a 44.8 figure for Black non-Hispanic women and a 14.2 figure for white non-Hispanic women; we have not been able to confirm those specific rates against the primary document at the time of publication. We are treating the 2024 breakdown qualitatively per the CDC abstract until the primary table is independently verifiable.
"Three times" traces to PMSS, not to any single year
The "three times" framing has a specific origin, and it is not the annual Hoyert brief. CDC's Pregnancy Mortality Surveillance System (PMSS) reports a pregnancy-related mortality ratio (PRMR) covering deaths within one year of pregnancy, and the PRMR is consistently higher than the NVSS maternal mortality rate because the case definition is broader and the window is longer. Across the 2007 to 2019 PMSS tracking window, the Black-white PRMR ratio has held near three (CDC Pregnancy Mortality Surveillance System).
That is where "three times" comes from, and that is why the shorthand has survived year-by-year fluctuations in the annual NVSS brief. It is a longitudinal claim, not an annual fact. When a reader sees "three times" in a hospital patient pamphlet, a public health report, or a legislative committee statement, the number is usually faithful to PMSS and approximately faithful to NVSS averaged across years.
Greenwood's "three times" is about infants, not mothers
A frequent conflation: a 2020 PNAS paper by Brad Greenwood, Rachel Hardeman, and colleagues opens its abstract with the sentence "In the United States, Black newborns die at three times the rate of White newborns" (PMID 32817561). That figure is cited in the context of a study of physician-patient racial concordance in Florida hospitals. The study is about infant mortality, not maternal mortality. It reports that racial concordance reduced the infant mortality gap. It does not report a reduction in maternal mortality, and the abstract says so directly. A 2024 Borjas and VerBruggen replication of Greenwood reported the newborn-mortality effect became statistically insignificant once very-low birth weight was added as a covariate; our piece on the Greenwood-Borjas replication covers the mixed evidence in full (Physician racial concordance and Black newborn mortality: what the evidence actually says).
Devon Osei, PhD, MPH, blackhealth.org's health research lead, flagged this misattribution in our internal evidence memo on the maternal mortality ratio: the Greenwood infant figure gets quoted alongside NVSS maternal mortality data in ways that blur the two. They report different outcomes with different denominators. A hospital pamphlet or a press release that cites Greenwood to support a maternal mortality claim is citing the wrong paper.
What actually drives the 3.5 ratio
Virginia's April 2026 signing of four Momnibus Act II bills (coverage here) is one state-level policy response; whether it narrows the Black-white gap will take several years of NVSS data to read. The CDC maternal mortality rate covers death during pregnancy or within 42 days of termination of pregnancy. Most maternal deaths tracked through that window are attributable to cardiovascular conditions, hemorrhage, hypertensive disorders of pregnancy including preeclampsia and eclampsia, and infection. The Black-white gap for preeclampsia-related mortality, cardiomyopathy-related mortality, and hemorrhage-related mortality is larger than the overall ratio.
The 42-day cutoff matters. PMSS uses a 365-day window and captures deaths that happen after hospital discharge, in the postpartum year. The PMSS-NVSS gap is where most late postpartum deaths live. A mother who dies of peripartum cardiomyopathy at six months postpartum shows up in PMSS and does not show up in the NVSS annual brief. That structural feature of the NVSS counting rule is why the annual maternal mortality rate undercounts total pregnancy-related death, and it is why postpartum care extending beyond the six-week visit matters as a specific clinical concern.
What you can do
Three things you can take into a prenatal or postpartum appointment.
First, ask your obstetrics provider or hospital about its specific protocol for preeclampsia monitoring, hypertension treatment thresholds, and postpartum blood pressure follow-up. The three conditions CDC most consistently identifies as preventable drivers of maternal mortality are hypertensive disorders of pregnancy, hemorrhage, and cardiomyopathy. A hospital that uses standardized severe-hypertension treatment protocols and offers postpartum blood pressure cuffs at discharge has documented lower rates of the complications most tied to the Black-white gap.
Second, if you are in the postpartum year, ask what your care plan covers after the standard six-week visit. NVSS counts deaths through 42 days; PMSS counts them through 365. The gap between 42 and 365 days is where late postpartum deaths concentrate, particularly from cardiomyopathy and hypertension. A six-week visit followed by silence is the pattern most tied to preventable late maternal mortality.
Third, if you are searching for a prenatal provider, the Black Health directory lists obstetricians, midwives, and maternal-fetal medicine specialists with verified licenses and NPIs. Our piece on why a Black doctor can be hard to find covers the national supply numbers and the directory search workflow in more detail. The directory filters for Black clinicians and for clinicians with documented practice focus on Black maternal care. A directory search is a starting point, not a guarantee; the clinical protocol questions in the first two paragraphs of this section are what you use to evaluate any provider.
Citations
Hoyert DL. Maternal Mortality Rates in the United States, 2024. NCHS Health E-Stat 113. PMID 41805296. DOI 10.15620/cdc/174651.
Hoyert DL. Maternal Mortality Rates in the United States, 2023. NCHS Health E-Stat 100. PMID 39946528. DOI 10.15620/cdc/174577.
Hoyert DL. Maternal Mortality Rates in the United States, 2022. NCHS Health E-Stats. cdc.gov.
Hoyert DL. Maternal Mortality Rates in the United States, 2020. NCHS Health E-Stats. cdc.gov.
Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci USA. 2020;117(35):21194-21200. PMID 32817561.
CDC Division of Reproductive Health. Pregnancy Mortality Surveillance System. cdc.gov.
Malik Johnson is a senior staff writer covering Black health. Send tips to malik@blackhealth.org.
