Maternal mortality 2020-2022

Data brief: Maternal mortality UK 2020-22
January 2024

Main points

• There was a statistically non-significant increase in the overall maternal death rate in the UK between 2019-21 and 2020-22. A statistically non-significant increase also occurred when deaths due to COVID-19 were excluded.
• Compared to 2017-19, the last complete triennium, there was a statistically significant increase in the overall maternal death rate in the UK in 2020-22. This increase remained statistically significant when deaths due to COVID-19 were excluded.
• Thrombosis and thromboembolism was the leading cause of maternal death in the UK in 2020-22 during or up to six weeks after the end of pregnancy. COVID-19 was the second most common cause of maternal death followed by cardiac disease and mental health-related causes.
• There remains an almost three-fold difference in maternal mortality rates amongst women from Black ethnic backgrounds compared to White women. The maternal mortality rate for Black women has decreased from 2019-21 but not statistically significantly so. The apparent disparity has decreased largely due to an increase in the maternal mortality rate amongst White women. As in 2019-21 there remains an almost two-fold difference amongst women from Asian ethnic backgrounds compared to White women.
• Women living in the most deprived areas have a maternal mortality rate more than twice as high as women living in the least deprived areas. This disparity is statistically unchanged from 2019-2021.

Maternal mortality rates UK 2020-2022

1. Overall 293 women died in 2020-22 during pregnancy or within 42 days of the end of pregnancy in the UK. The deaths of 21 women were classified as coincidental. Thus, in this triennium 272 women died from direct and indirect causes, classified using ICD-MM (World Health Organisation 2012), among 2,028,543 maternities, a maternal death rate of 13.41 per 100,000 maternities (95% CI 11.86-15.10). This compares to the rate of 11.66 per 100,000 maternities (95% CI 10.23-13.23) in 2019-21 (rate ratio (RR) 1.15, 95% CI 0.96-1.37, p=0.114) and a rate of 8.79 per 100,000 maternities (95% CI 7.58-10.12) in 2017-2019, the last complete triennium (RR 1.53, 95% CI 1.26-1.85, p<0.001) (Figure 1).
2. Thirty-eight of the women who died between March 2020 and December 2022 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 2020-22 would be 11.54 per 100,000 maternities (95% CI 10.10-13.11), higher than the corresponding rate for 2019-21 (10.06 (95% CI 8.74-11.53)) but not statistically significantly so (RR 1.15, 95%CI 0.95-1.39, p=0.152). The maternal death rate for 2020-22 remains significantly higher than the rate in 2017-2019 (RR 1.31, 95% CI 1.08 – 1.60, p=0.005) even when COVID-19 deaths are excluded (Figure 1).

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Causes of maternal deaths UK 2020-2022

1. Thrombosis and thromboembolism was the leading cause of maternal death in the UK in 2020-22.
2. The second most common cause of maternal death in 2020-22 was COVID-19. This figure includes only women who died from complications of COVID-19 and excludes women who were known to have COVID-19 at the time of their deaths but died from other causes. Rates of maternal death due to COVID-19 were lower than in 2019-21 but not significantly so (RR 0.75, 95% CI 0.46-1.24, p=0.232). From 2021 to 2022, there was a significant reduction in the maternal mortality rate attributable to COVID-19 (RR 0.22, 95% CI 0.06-0.58, p<0.001) (Figure 2).
3. After thrombosis and thromboembolism, the next most common direct causes of maternal death were suicide and sepsis due to pregnancy-related infections, which were responsible for the same number of deaths (Figure 2).
4. After COVID-19, the next leading indirect causes of maternal deaths in 2020-22 were cardiac disease and neurological conditions (Figure 2).

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Maternal mortality amongst different population groups in England 2020-2022

1. The risk of maternal death in 2020-22 was statistically significantly almost three times higher among women from Black ethnic minority backgrounds compared with White women (RR 2.81, 95% CI 1.81-4.22); the mortality rate for women from Black ethnic backgrounds is lower, but not statistically significantly so, than the rate in 2019-21 (RR 0.91, 95% CI 0.52-1.59, p=0.728) (Figure 3).
2. Women from Asian backgrounds also continued to be at higher risk than White women (RR 1.67, 95% CI 1.00-2.88); the mortality rate for women from Asian ethnic backgrounds is higher, but not statistically significantly so, than the rate in 2019-21 (RR 1.14, 95% CI 0.71-1.86, p=0.563) (Figure 3).

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3. Women living in the 20% most deprived areas continue to have the highest maternal mortality rates, more than twice as high as the maternal mortality rate of women living in the 20% least deprived areas (RR 2.25, 95% CI 1.41-3.73); this disparity is higher, but not statistically significantly so, than the disparity in 2019-21 (Figure 4).

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The availability of denominator data from national datasets 2022

• The total number of maternities for 2022, used to calculate overall mortality rates and rate ratios, was available for England and Wales on 17 August 2023 from the Office of National Statistics, for Scotland on 20 July 2023 from National Records of Scotland, and for Northern Ireland on 26 October 2023 from the Northern Ireland Statistics and Research Agency.
• These datasets from National Records Scotland and Northern Ireland Statistics and Research Agency also contain age-specific maternities used to calculate mortality rates and rate ratios for different age groups. For England and Wales, these data, along with denominator data on the place of delivery and multiple pregnancies, has a provisional release date of March 2024. As such, the age-specific mortality rates cannot be calculated for inclusion in this data brief.
• Hospital Episode Statistics NHS maternity data from England, accessible through NHS Digital, is used to calculate mortality rates and rate ratios for specific ethnic and socio-economic groups; for 2022 maternities these data were available on 7 December 2023.