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The United States continues to grapple with a maternal health crisis characterized by significant racial and ethnic disparities in morbidity and mortality. Maternal mortality rates here are at least double (and sometimes triple) those of most other high-income countries, according to a 2024 Commonwealth Fund report. The Centers for Disease Control and Prevention (CDC) estimates that 80% of U.S. maternal deaths are preventable.

Recent data show some improvement in mortality and morbidity but persistent disparities in who is at greatest risk. Pregnancy-related deaths in 2023 decreased to 18.6 deaths per 100,000 live births from a rate of 22.3 the year before, according to the National Center for Health Statistics. Yet the maternal mortality rate for Black women and American Indian and Alaska Native women continues to be more than three times that of White women.

Federal changes threaten efforts to improve care and disparities 

As nurses and other maternal health providers work to address the complex underlying causes of these disparities, their efforts have been challenged in recent months by rapid and unprecedented federal funding and infrastructure cuts. The Trump administration has suspended Title X family planning and preventive health services funding, initiated widespread layoffs of federal health agency staff, and removed public data essential to public and maternal health care. Expected cuts to Medicaid and the National Institutes of Health’s budget—which is anticipated to be cut nearly in half, eliminating centers and institutes focused on nursing research, global health research, and minority health and health disparities—will directly impact efforts to improve maternal health, especially among those most at risk.

The American College of Nurse-Midwives (ACNM) responded to the freezing of about a quarter of Title X grants with a statement that read in part:

“This abrupt action not only threatens the stability of essential reproductive health services but also disproportionately harms the communities that midwives are committed to serving, many of whom already face significant barriers to care.”

Title X funding

The only federal program of its kind, Title X provides health care access to people with low income and those facing barriers to care, such as systemic and structural discrimination. Almost 4,000 clinics nationwide, including more than three-quarters of Planned Parenthood’s affiliates, receive this funding, serving nearly 3 million patients, according to KFF.

If the government permanently withholds the frozen Title X funds, more than 830,000 people wouldn’t have access to care this year, according to the Guttmacher Institute. A recently filed lawsuit over the funding freeze says people living in at least seven states—California, Hawaii, Maine, Mississippi, Missouri, Montana, and Utah—no longer have access to Title X–funded services.

Unavailable data

The Centers for Disease Control and Prevention’s (CDC’s) Pregnancy Risk Assessment Monitoring System (PRAMS) dataset has been unavailable since April 1, when all members of the PRAMS team and most of the Division of Reproductive Health at the CDC were placed on leave, which is expected to be permanent. Based on annual survey responses by those who’ve given birth, PRAMS has collected vital information about maternal health for almost 40 years, allowing researchers and providers to monitor trends and make improvements in patient care and maternal and infant health. The future of this public database is unknown.

Safety net concerns

There is also concern about potential Medicaid cuts, which would significantly impact prenatal and postpartum care nationally. Medicaid is the largest single payer of maternity care, financing more than 40% of U.S. births. Additionally, with more than half of maternal deaths occurring in the year after giving birth, extending Medicaid coverage to a year postpartum—which most states have opted to do—is an important strategy to improve maternal health.

“We’ve acknowledged over the last decade, as we’ve seen these abysmal maternal health numbers that disproportionately affect Black and Brown families in our country, that a lot of it is systemic racism,” says Emily McGahey, DM, MSN, CNM, FACNM, clinical director of the Pittsburgh-based Midwife Center and a member of the ACNM’s board of directors. “Not only the implicit bias of providers and our health system, but also systemic inequities.”

The frozen federal funds and potential cuts in programs that provide essential support to women and their families, she says, will lead to “ripple effects through communities that lead to poorer maternal health outcomes.”

By Corinne McSpedon, senior editor. (A more in-depth version of this article will appear in AJN’s July issue.)