Written collaboratively by Saving Mothers Interns Sarah Ricklan (MS1, NYU School of Medicine) & Isa Cuervo (MS4, Weill Cornell Medicine)
The United States maternal mortality rate was ranked 46th globally in 2015.  Let’s put some numbers to that. In the U.S., the rate hovered between 16 – 19 deaths per 100,000 live births from 2011 to 2015. Meanwhile, most other developed nations saw rates in the single digits – for reference, the UK (9), Canada (7), Germany (6), Japan (5) and Australia (6). 
New York State in particular has a high maternal mortality rate – we rank 30th among the other 50 states. In 2016, the United States had a maternal mortality rate of 19.9 per 100,000 live births. During the same time period, NY state had a rate of 20.9 maternal deaths. More specifically, the New York City rate of maternal mortality in 2015 was 22.6 per 100,000 live births. And of the five boroughs, the Bronx had the highest maternal mortality rate at 26 deaths per 100,000 live births. 
What are the causes of death? According to the Maternal Mortality Review, the top causes of pregnancy-related death in New York State include pulmonary embolism (29%), hemorrhage (17.7%), infection (14.5%), and cardiomyopathy (11.3%).  Of note, these causes of death were not distributed evenly across racial groups: black women had a higher number of deaths from embolism, while white women from hemorrhage. In terms of weight, half of the women who died of embolism, infection, and cardiomyopathy were obese or overweight. 
Social factors affect maternal mortality in NY state, as well. Over the years of 2011 to 2015, the maternal mortality rate for black women in NY state was 53 per 100,000 live births.  This rate is 4x higher than for white women (13.5 deaths per 100,000 live births). With respect to insurance, in NY State between 2013 to 2016, 56.3% of women who died of pregnancy-related causes were on Medicaid. 
Since its founding in 2009, Saving Mothers mission has been dedicated to eradicating preventable maternal deaths and reducing the burden maternal morbidity due to birth‐related complications in developing countries. The maternal mortality rates in the countries that we have projects are dramatically higher than what we have in the United States, ranging anywhere from 88 to 510 deaths per 100,000 live births.(i) Despite this, we cannot stand by in the face of the dramatic maternal health disparities occurring in our own home state and city. Saving Mothers led an obesity in pregnancy program for 5 years in East Harlem and the Bronx . The Lifestyle Modification Program (LMP) served a largely medicaid population and we found that minimizing weight gain in pregnancy was possible, easily adopted and decreased pregnancy related complications. In 2019, Saving Mothers will be launching a New York City based program that is community-based and focused on addressing these disparities.
Notes & Citations:
(i) The maternal mortality rate per 100, 000 live births in Guatemala is 88, in the Dominican Republic is 92, in Uganda is 343 and in Kenya is 510.
 WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division. Trends in Maternal Mortality: 1990 to 2015. Geneva, World Health Organization, 2015
 America’s Health Rankings, 2016
 New York State Maternal Mortality Review Team, 2017
 America’s Health Rankings, 2018a
 (Statewide Planning and Research Cooperative System (SPARCS), 2016)
 Explore Maternal Mortality in New York | 2016 Health of Women and Children Report. 2017
 Shirazian, Taraneh, et al. “The lifestyle modification project: Limiting pregnancy weight gain in obese women.” The Journal of Maternal-Fetal & Neonatal Medicine 29.1 (2016): 80-84.