Maternal Mortality Begins Before Pregnancy
Evidence Explorer · Family Planning & Maternal Mortality

Maternal Mortality Begins Before Pregnancy

The most effective tool against maternal death may be the one used before a pregnancy ever begins. An interactive look at how family planning shapes maternal survival — and why the United States is the outlier.

Maternal mortality is measured as the number of maternal deaths per 100,000 live births. Between 2000 and 2020, sustained global investment drove the worldwide ratio down 34% — from 339 to 223 deaths per 100,000 live births. The United States moved the opposite direction, rising 77.9% over the same period, from 12 to 21 per 100,000.

Today the U.S. carries the highest maternal mortality ratio of any high-resource country, despite spending more on health care. The drivers are multiple, but one stands out as both powerful and preventable: limited access to family planning, in a country where 41.6% of pregnancies (2019) were unintended.

If a death happens during pregnancy, the chance to prevent it often existed before the pregnancy began.

Li and Peipert's 2026 review synthesizes the evidence on how family planning lowers maternal death along two pathways: a direct one — fewer total pregnancies means fewer opportunities to die — and an indirect one, by shifting pregnancies away from the highest-risk circumstances: the extremes of maternal age, high parity, short birth spacing, and unsafe abortion.

22.3
U.S. maternal deaths per 100,000 live births — highest among high-resource nations
2022
49.5
U.S. Black maternal mortality ratio — higher than every peer nation
2022
41.6%
Share of U.S. pregnancies that were unintended
2019
+77.9%
Rise in U.S. maternal mortality 2000–2020, while the global ratio fell 34%
2000–2020

Two pathways from family planning to survival

How preventing and timing pregnancies reduces maternal death
Direct effect

Fewer births, fewer deaths

Every pregnancy carries some risk of death. By preventing unintended pregnancies, modern contraception lowers the total number of pregnancies a person carries — and with it, the cumulative chance of a maternal death.

Indirect effect

Fewer high-risk pregnancies

Family planning shifts pregnancies away from the riskiest circumstances — very young or older mothers, high parity, short intervals between births, and unsafe abortion — each of which independently raises the risk of maternal death.

Open Explore the Evidence to compare countries and walk through each mechanism, or Study Findings to see the seven studies behind this review.

How the U.S. compares

Maternal deaths per 100,000 live births in selected high-resource countries, 2022
Peer nation United States & U.S. subgroups
The U.S. is the outlier. The U.S. overall ratio (22.3) exceeds every comparison country. The U.S. Black ratio (49.5) is more than triple the rate of most peer nations, and even the lowest U.S. subgroup — U.S. Asian (13.2) — sits near the top of the international range.
Figure 1, Li & Peipert, Am J Obstet Gynecol 2026. Data adapted from Gunja et al, Commonwealth Fund, 2024.

The indirect pathway, mechanism by mechanism

Select a risk factor to see how it raises maternal mortality — and how family planning addresses it

A published association

Modeling evidence on contraceptive prevalence and high-risk births

In Stover & Ross's population-level analysis, every 10% rise in contraceptive prevalence was associated with a 5.5% decrease in births carrying at least one risk factor (such as high parity or older maternal age). Across 1990–2005, rising contraceptive use was linked to an estimated 1.5 million fewer maternal deaths in the developing world.

Stover & Ross, Matern Child Health J 2010, as summarized in Li & Peipert, AJOG 2026. Figures are from population-level modeling, not individual prediction.

The evidence base

The review screened 9 articles and analyzed the 7 below, each examining family planning and the maternal mortality ratio.
Filter:
Primary publication — this tool
Li LY, Peipert JF. Family planning and maternal mortality. Am J Obstet Gynecol 2026 (July). doi:10.1016/j.ajog.2026.01.019
Expert Review / narrative review. All figures and study summaries in this tool are drawn directly from this publication and the sources it cites.
The seven studies reviewed
  1. Stover J, Ross J. How increased contraceptive use has reduced maternal mortality. Matern Child Health J 2010;14:687–95.
  2. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet 2012;380:111–25.
  3. Brown W, Ahmed S, Roche N, Sonneveldt E, Darmstadt GL. Impact of family planning programs in reducing high-risk births due to younger and older maternal age, short birth intervals, and high parity. Semin Perinatol 2015;39:338–44.
  4. Ganatra B, Faundes A. Role of birth spacing, family planning services, safe abortion services, and post-abortion care in reducing maternal mortality. Best Pract Res Clin Obstet Gynaecol 2016;36:145–55.
  5. Hawkins SS, Ghiani M, Harper S, Baum CF, Kaufman JS. Impact of state-level changes on maternal mortality: a population-based, quasi-experimental study. Am J Prev Med 2020;58:165–74.
  6. Verma N, Shainker SA. Maternal mortality, abortion access, and optimizing care in an increasingly restrictive United States: a review of the current climate. Semin Perinatol 2020;44:151269.
  7. Addante AN, Eisenberg DL, Valentine MC, Leonard J, Maddox KEJ, Hoofnagle MH. The association between state-level abortion restrictions and maternal mortality in the United States, 1995–2017. Contraception 2021;104(5):496–501.
Key data sources used in the figures and headline statistics
  1. Gunja MZ, Gumas ED, Masitha R, Zephyrin LC. Insights into the U.S. Maternal Mortality Crisis: An International Comparison. Commonwealth Fund; 2024. (country comparison chart)
  2. WHO, UNICEF, UNFPA, World Bank Group, UNDESA. Trends in maternal mortality 2000 to 2020. Geneva: World Health Organization; 2023. (global & U.S. trend figures)
  3. Bearak JM, Popinchalk A, Beavin C, et al. Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019. BMJ Glob Health 2022;7:e007151. (unintended pregnancy & abortion figures)
Every number shown in this tool traces to the publications above. Nothing is estimated or extrapolated beyond what these sources report.