Skip Navigation LinksPregnancy-Related-Mortality

Top Menu
Left Menu

Maternal, Child & Adolescent Health Division

CA-PMSS FactsheetPregnancy-Related Mortality: 2020–2022

The California Pregnancy Mortality Surveillance System (CA-PMSS) provides accurate and timely information on California's pregnancy-related mortality — a key measure of population health. CA-PMSS defines pregnancy-related deaths as deaths during pregnancy or within one year of the end of pregnancy from causes directly related to or worsened by pregnancy or its management, excluding accidental or incidental causes (suicide, homicide, drug overdose, or other injury). In 2020-2022, California had 1.26 million births and 232 pregnancy-related deaths.

preview of latest fact sheet  

By the Numbers

Pregnancy-related mortality ratio was 15 deaths per 100,000 live births in 2022 

Pregnancy-Related Mortality in 2022

In 2022, California's rate of pregnancy-related deaths decreased to 15.0 deaths for every 100,000 live births — down from rates of 21.6 in  2021 and 18.6 in 2020 during the COVID-19 peak. 

  • Before the COVID-19 pandemic, the rates were 12.8 in 2019 and 16.1 in 2018.
COVID-19 current leading cause of pregnancy related death 

Leading Causes in 2020-2022

The leading causes of pregnancy-related mortality were COVID-19, hemorrhage (HEM), cardiovascular disease (CVD), pulmonary embolism (PE), other infections (INF), amniotic fluid embolism (AFE), and hypertensive disorders of pregnancy (HDP).

Number of deaths
  • COVID-19, 58
  • HEM, 41
  • CVD, 40
  • PE, 20
  • INF, 19
  • AFE, 18
  • HDP, 11
205% increase in pregnancy-related deaths from infection 
  • Infection – including COVID-19 and other causes – became the leading cause of pregnancy-related deaths in 2020 –2022.
  • 1 in 4 pregnancy-related deaths was due to COVID-19 in 2020-2022.
  • In 2020-2022, deaths due to infection had surpassed all other causes, including hemorrhage (3.3 deaths per 100,000 live births) and cardiovascular disease (3.2).
  • The mortality rate for infection-related causes rose significantly to 6.1 deaths per 100,000 live births, up from 2.0 in 2017-2019.

Timing of Death

In 2020-2022, 60% of pregnancy-related deaths in California occurred after delivery.

  • This is a shift from 2017-2019 which saw the day of delivery as the leading timepoint.
  • Postpartum deaths that occurred 7-42 days after pregnancy made up the largest share in 2020-2022, accounting for 27.6% of deaths.

60% of all pregnancy-related deaths occurred in the postpartum period.


  • Pregnancy
    • During Pregnancy, 18.1%
  • Delivery/Birth
    • Day of Delivery, 22.4%
  • After-birth/Postpartum
    • 1-6 days postpartum, 19.8%
    • 7-42 days postpartum, 27.6%
    • 43-365 days postpartum, 12.1%

There was regional variation in the rates of pregnancy-related deaths, and these differences grew between 2017-2019 and 2020-2022.

  • The Southern Central Valley region had the highest mortality rate at 27.2 deaths per 100,000 births, up from 17.2 in 2017-2019.
  • Other high-burden regions were Northeastern and Northern Central Valley (24.5, up from 16.6 in 2017-2019) and Southern Inland (22.0, up from 13.7 in 2017-2019).
  • Los Angeles-Santa Barbara-Ventura and North and Mid-Coastal had smaller increases or stayed the same.


  • Orange, San Diego, Imperial: 10.8
  • North and Mid-Coastal, 16.1
  • Los Angeles, Santa Barbara, Ventura, 16.6
  • Northeastern and Northern 24.5
  • Southern Inland, 22.0
  • Southern Central Valley, 27.2

*Regions are grouped based on the Regional Perinatal Programs of California, which divide the state by hospital referral patterns to support coordinated maternal and infant care.
Source:go.cdph.ca.gov/RPPC.

7.4 times higher rate of pregnancy related deaths for those with Obese Class III BMI 

Disparities by Pre-Pregnancy BMI

  • Pregnancy-related mortality increased significantly with higher body mass index (BMI).
  • In 2020-2022, people with Obese Class III (BMI ≥40) had the highest mortality rate at 87.7 deaths per 100,000 live births. This was 2.1 times higher than the rate seen in 2017-2019 (42.0).
  • People with under/normal weight (BMI <25) had the lowest rate of 11.1 in 2020-2022, though up from 8.8 in 2017-2019.
  • The disparity between the highest and lowest BMI groups increased
    • from a 4.8-fold difference in 2017-2019 (42.0 vs. 8.8 deaths per 100,000 live births)
    • to a 7.4-fold difference in 2020-2022 (87.7 vs. 11.1).
5.2 times higher rate of pregnancy related deaths among birthing people aged 40 years and older 

Disparities by Age

  • Pregnancy-related mortality increased with age and was higher among birthing people 40 years and older.
  • In 2020-2022, those aged 40 years and older had a mortality rate of 49.6 deaths per 100,000 live births. This was an increase from 2017-2019 when the rate was 34.1. It was
    • 5.2 times higher than the rate for those 20-24 years (9.6) and
    • 2.9 times higher than the rate for those 30-34 years (17.3).
5.2 times higher rate of pregnancy related deaths for those who did not complete high school 

Disparities by Education Level

  • Pregnancy-related mortality rates by education widened between 2017-2019 and 2020-2022.
  • Birthing people who did not complete high school had a mortality rate of 45.9 per 100,000 in 2020-2022. This rate was
    • 1.8 times higher than the rate in 2017-2019 (25.7) and
    • 5.2 times higher than the rate for college graduates (8.8).
  • The pregnancy-related mortality rate for college graduates decreased from 10.1 in 2017-2019 to 8.8 in 2020-2022.
3.9 times higher rate of pregnancy related deaths when living in the least healthy community conditions 

Disparities by Community Conditions

  • The disparity increased for pregnancy-related deaths of birthing people living in the least healthy communities* and healthiest communities in 2020-2022.
  • The rate for those living in the least healthy communities increased during the COVID-19 pandemic, from 15.7 deaths per 100,000 live births in 2017-2019 to 33.6 in 2020-2022, compared to 7.7 and 8.6 for the healthiest communities.
  • The rate for those living in the healthiest communities did not change significantly from 2017-2019 to 2020-2022.
3.1 to 4 times higher rate of pregnancy related deaths for Black birthing people 

Disparities by Race and Ethnicity

  • Black birthing people continued to face the highest pregnancyrelated mortality rate, at 56.5 per 100,000 live births. This was
    • 3.1 times higher than Hispanic (18.4),
    • 3.8 times higher than White (15.0), and
    • 4.0 times higher than Asian birthing people (14.2).

In comparison, during 2017-2019, the rate for Black birthing people was 3.4 to 4.3 times higher than those of other racial and ethnic groups.

3.1 times higher rate of pregnancy related deaths with Medi-Cal health coverage  

Disparities by Health Insurance Coverage

  • The gap in pregnancy-related deaths between people with Medi- Cal and those with private insurance grew wider from 2017-2019 to 2020-2022.
  • For people with Medi-Cal, the rate rose significantly, from 17.5 deaths per 100,000 live births in 2017-2019 to 28.9 in 2020-2022.
  • In contrast, the rate for people with private insurance was 9.4 in 2020-2022 and stayed about the same as it was in 2017-2019.
  • The pregnancy-related mortality rate for birthing people with Medi-Cal was 3.1 times higher than the rate for those with private insurance in 2020-2022.

* Community conditions were measured using the Healthy Places Index.​​

 
Page Last Updated :