Maternal mortality 2021-2023

Data brief: Maternal mortality UK 2021-23
January 2025

Main points

• There was a statistically non-significant decrease in the overall maternal death rate in the UK between 2020-22 and 2021-23. When deaths due to COVID-19 were excluded maternal death rates were similar between the two periods.
• Although maternal death rates have decreased since last year's report, they remain non-significantly higher than the last complete triennium of 2018-20. When deaths due to COVID-19 were excluded, rates remained higher in 2021-23 than 2018-2020.
• Thrombosis and thromboembolism was the leading cause of maternal death in the UK in 2021-23 during or up to six weeks after the end of pregnancy. Cardiac disease was the second most common cause of maternal death followed by COVID-19.
• Rates for late maternal deaths occurring between six weeks and one year after the end of pregnancy continued to increase and were significantly higher in 2021-23 compared to 2018-20. The leading causes of late maternal deaths in 2021-23 were mental-health related (34%) with deaths due to suicide or other psychiatric causes occurring in equal proportions.
• Inequalities in maternal mortality remained in 2021-23. Compared to women aged 20-24, women aged 35 or older were three times more likely to die. While the maternal mortality rate for women from Black ethnic backgrounds continued to decrease in 2021-23, there remained a two-fold difference in maternal mortality rates for Black women compared to White women. Asian women also had a slightly increased risk compared to White women. Women living in the most deprived areas continued to have a maternal mortality rate twice that of women living in the least deprived areas.

Maternal mortality rates UK 2021-2023

1. Overall, 281 women died in 2021-23 during pregnancy or within 42 days of the end of pregnancy in the UK. The deaths of 27 women were classified as coincidental. Thus in this triennium 254 women died from direct and indirect causes, classified using ICD-MM (World Health Organisation 2012), among 2,004,184 maternities, a maternal death rate of 12.67 per 100,000 maternities (95% CI 11.16-14.33). This compares to the rate of 13.56 per 100,000 maternities (95% CI 12.00-15.26) in 2020-22 (rate ratio (RR) 0.93, 95% CI 0.79-1.11, p=0.439) and a rate of 10.90 per 100,000 maternities (95% CI 9.53-12.40) in 2018-2020, the last complete triennium (RR 1.16, 95% CI 0.97-1.40, p=0.097) (Figure 1).
2. Twenty-nine of the women who died between January 2021 and December 2023 during or within 42 days of the end of pregnancy died from complications of COVID-19 infection. If these women's deaths attributable to COVID-19 are excluded, the maternal mortality rate for 2021-23 would be 11.23 per 100,000 maternities (95% CI 9.81-12.79), similar to the rate for 2020-22 (RR 0.96, 95%CI 0.80-1.16, p=0.669). The maternal death rate for 2021-23 remains non-significantly higher than the rate in 2018-20 (RR 1.07, 95% CI 0.89-1.30, p=0.460) when COVID-19 deaths are excluded (Figure 1).

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Causes of maternal deaths UK 2021-2023

1. As in 2020-22, thrombosis and thromboembolism remained the leading cause of maternal death in the UK in 2021-23. The second most common cause of maternal death in 2021-23 was cardiac disease, followed by COVID-19. Rates of maternal death due to COVID-19 continue to decline and are lower than in 2020-22, but not significantly so (RR 0.73, 95% CI 0.43-1.21, p=0.203) (Figure 2). There were no deaths due to COVID-19 in 2023.
2. Thrombosis and thromboembolism was the leading cause of direct maternal death occurring at a rate more than twice that that of any other direct cause. The next most common direct cause of maternal death was sepsis due to pregnancy-related infections followed by suicide, obstetric haemorrhage and deaths in early pregnancy, which were all responsible for the same number of deaths (Figure 2).
3. After cardiac disease and COVID-19, the next leading indirect cause of maternal deaths in 2021-23 was neurological conditions (Figure 2).

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Maternal mortality amongst different population groups in 2021-2023

1. In the UK, women aged 35-39 had significantly higher rates of maternal death compared to women aged 20-24 (RR 2.56, 95% CI 1.47-4.72) and the risk for women over 40 years of age was even greater (RR 4.80, 95% CI 2.56-9.37). The rate of maternal death for women aged 35 or older was three times that of women aged 20-24 in 2021-23 (RR 3.00, 95% CI 1.76-5.45).
2. For women in England, the risk of maternal death in 2020-22 was statistically significantly more than two times higher amongst women from Black ethnic minority backgrounds compared with White women (RR 2.31, 95% CI 1.46-3.52); the mortality rate for women from Black ethnic backgrounds is lower, but not statistically significantly so, than the rate in 2020-22 (RR 0.80, 95% CI 0.45-1.41, p=0.421) (Figure 3).
3. After year on year increases, the mortality rate for women from Asian backgrounds was non-significantly decreased in 2021-23 compared to the rate in 2020-22 (RR 0.83, 95% CI 0.52-1.33, p=0.414); Asian women continued to have a non-statistically significant higher risk of maternal mortality compared to White women (RR 1.37, 95% CI 0.93-1.98, p=0.092) (Figure 3).
4. Maternal mortality rates amongst women from mixed ethnic backgrounds continued to increase and were higher than those of Asian women in 2021-23; while not statistically significant, women from mixed ethnic backgrounds had an almost two-fold difference in maternal mortality compared to White women (RR 1.84, 95% CI 0.83-3.59, p=0.096), noting that low numbers of women from mixed ethnic backgrounds mean that this rate is subject to high levels of random variation (Figure 3).

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3. As in previous years, women living in the 20% most deprived areas of England continued to have the highest maternal mortality rates in 2021-23, nearly twice as high as the maternal mortality rate of women living in the 20% least deprived areas (RR 1.83, 95% CI 1.15-3.00).
4. While maternal mortality rates for women living in the most deprived areas were non-significantly decreased from 2020-22, mortality rates in nearly all other IMD quintiles, including the least deprived areas, continued to increase in 2021-23, which needs to be borne in mind when interpreting figures (Figure 4).

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