Most Maternal Deaths Are Preventable. Why Aren’t We Preventing Them?
By: Diana Peña Gonzalez, MPH, MCHES, EdD(c)
The United States has some of the worst maternal health outcomes of any high-income country. Researchers comparing global maternal health data have found that the U.S. consistently lags behind its peers.
That fact alone should stop us in our tracks.
What’s even harder to accept is this: most of these deaths do not have to happen.
According to the Centers for Disease Control and Prevention, more than 80% of pregnancy-related deaths in the United States are preventable. When maternal mortality review committees, clinicians, and public health researchers examine what went wrong, the pattern is strikingly consistent. The problem is not a lack of medical technology. It is not that providers do not know what to do. And it is not simply patient “non-compliance.”
The most consistent contributor is something far more basic and far more fixable.
Poor communication.
Not communication in a vague or interpersonal sense. Real, concrete breakdowns that directly affect safety. Birthing people are not being listened to. Symptoms are dismissed. Instructions are unclear or rushed. Warning signs are not reviewed. People are sent home confused, afraid, or unsure of what to do next.
These are not isolated mistakes. They reflect a deeper issue in the organization and delivery of maternal care.
This is not a patient problem. It’s a system design problem.
What “Poor Communication” Actually Looks Like
When we talk about communication failures in maternal health, we are not talking about bedside manner. This is not about whether someone sounded kind enough.
It is about whether people received information they could actually understand and use, especially during moments of stress, pain, fear, or grief.
Poor communication can look like:
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Being told something is “normal” without an explanation of what that means
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Leaving a visit unsure which symptoms require urgent care
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Hearing technical language with no check for understanding
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Being given instructions too quickly, or only once
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Providers speaking to patients instead of with them
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No clear invitation to ask questions, or a setting where it feels unsafe to ask
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Emotional distress interfering with the ability to process information
These moments matter because pregnancy, birth, miscarriage, and postpartum care are emotionally charged experiences. Health literacy research has shown that stress and fear can significantly reduce a person’s ability to process information in the moment, even among highly educated individuals.
In those moments, clarity is not a courtesy.
It’s a safety issue.
Yet many health care processes speed up at exactly the moment when birthing people need the system to slow down.
Why Marginalized Communities Are Harmed the Most
Maternal harm does not happen evenly across communities.
Data from the CDC and national policy organizations show that maternal morbidity and mortality are significantly higher among Black, Indigenous, and rural birthing people, even when income and education are taken into account.
This is not because of individual behavior or lack of effort. It reflects what happens when communication failures occur inside systems already shaped by inequity.
Many communities face maternal health challenges compounded by:
When symptoms are ignored, pain is minimized, or concerns are treated as exaggeration, harm becomes predictable rather than accidental.
Communication failures do not produce equal outcomes. They reinforce patterns that already exist.
The System Behind the Silence
To understand why communication breaks down so often, we must look beyond individual interactions.
The U.S. maternal health system is rooted in a Western biomedical model that prioritizes:
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Process over relationship
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Technical and compliance-focused fixes, such as documentation, over clarity
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Efficiency over understanding
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Risk management over trust-building
Health policy scholars and clinicians have long noted that this model rewards speed, standardization, and defensibility. Emotional needs, cultural context, and social realities are often treated as secondary, even though they directly affect comprehension, decision-making, and follow-through.
This is not about blaming clinicians.
Most health care professionals are doing their best within systems that:
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Limit visit time
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Provide little formal training in communication
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Treat emotional support as secondary, even when conversations are deeply personal and high-stress
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Reward documentation and efficiency more than patient understanding
When communication fails at scale, it is not a personality issue. It is a design issue.
Trust Isn’t Optional
Building trust is often treated as a “nice to have,” rather than a core part of the care plan. In maternal health, trust directly affects whether people feel safe speaking up, asking questions, and getting help when something feels wrong.
Trust influences whether people:
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Share symptoms early instead of waiting
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Follow care instructions
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Return for help when something feels wrong
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Believe their concerns will be taken seriously
Public health and communication research consistently shows that clear explanations, active listening, and confirmation of understanding are associated with stronger trust, better adherence, and improved health outcomes.
Trust is not shaped solely by individual interactions. It is shaped by systems, by policies, training, time constraints, and organizational culture.
If we want to reduce preventable maternal harm, trust cannot be optional.
What Actually Prevents Maternal Harm
If communication failures are one of the most consistent drivers of preventable maternal harm, then prevention must focus on how systems communicate, not on blaming patients for what they did or did not understand.
Evidence-informed practices that reduce harm include:
Using plain language as a safety strategy
Plain language is not “dumbing things down.” It is communicating clearly enough that people can act. In maternal care, plain language reduces confusion, fear, and error — especially in high-stress moments.
Making teach-back standard practice
Teach-back allows providers to check whether they explained the plan clearly by asking patients to repeat it in their own words. If the plan cannot be repeated back, it is a signal to explain it differently.
Creating time and space for questions
Silence does not equal comprehension. Systems should explicitly invite questions and normalize uncertainty.
Practicing trauma-informed communication
Fear, grief, and prior negative health care experiences shape how people hear information. Trauma-informed communication recognizes that emotional safety is part of clinical safety.
Building cultural humility and bias awareness into care
This must be an ongoing organizational expectation, not a one-time training, to meaningfully improve communication and trust.
Supporting team-based and midwifery-inclusive care models
Relationship-based models consistently support clearer communication, greater trust, and better patient experiences.
Creating policies that support continuity of care
Many preventable harms occur when postpartum care ends too early or when care is fragmented. Extending coverage and strengthening continuity reduces avoidable complications after delivery.
These are not abstract ideals. They are concrete design choices.
Re-Centering Dignity
Maternal health is not only about preventing medical complications. It is also about being listened to, being understood, and being treated with dignity.
Preventable maternal harm is not inevitable. It is not random. And it is not the result of patients failing to do the right thing.
It’s a communication failure, shaped by training, incentives, policies, and the structure of care.
If we want better outcomes, we must stop treating listening as optional and clarity as a bonus.
We prevent harm when we build systems that make it easier for birthing people to understand their care, speak up about what they feel, and trust that their concerns will be taken seriously.
Because in maternal health, clear communication isn’t a bonus.
It’s lifesaving.
About the Author:
Diana Peña Gonzalez, is the Health Literacy Education Director at the Institute for Healthcare Advancement. She helps health professionals and organizations create clearer, more respectful communication that supports equity, trust, and better outcomes.
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