Source: OECD Health Data, 2020.Showing data for
2005 and
2018.
To solve a complex problem like maternal mortality,
we must better understand why mothers—especially those of
color—are dying at higher rates.

The Maternal Vulnerability Index (MVI) identifies not only where,
but why, mothers in the United States are vulnerable to poor
maternal health outcomes.

We also have a zip code and census tract granular level MVI, please reach out to mvi@surgoventures.org if you’d like to partner with us.

Where in the U.S. are mothers* vulnerable?

The U.S. Maternal Vulnerability Index is the first county-level, national-scale, open source tool to identify where and why mothers in the United States are vulnerable to poor health outcomes. Six MVI themes reflect 43 indicators associated with maternal health outcomes. Explore themes and overall vulnerability below.

*Although we use the term ‘mothers’ here and in our materials, we recognize that not everyone who carries a pregnancy refers to themselves this way, and we respect the diversity of all birthing people.
Overall MVI
Hover to see MVI and state Maternal Mortality Ratio (MMR)
Filter by:
Reproductive
healthcare
Physical
health
Mental health &
substance abuse
General
healthcare
Socioeconomic
determinants
Physical
environment
States
Counties
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Maternal Vulnerability
Very High
High
Moderate
Low
Very Low
County Comparison
*Click two counties on the map to compare them here
White Population
0%
100%
Percent of women of reproductive age population that is White
The MVI assigns each county a relative maternal vulnerability score (where 0 = the least vulnerable and 100 = the most)
Sources: United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics, 2021. Natality public-use data 2007-2020 and Underlying Cause of Death, 1999-2020. Accessed on CDC WONDER Online Database 10/26/2020. MMRs were calculated using 2016-2020 data.

Why are mothers vulnerable?

What are the drivers of maternal vulnerability in each U.S. county or state? They can include a range of factors across the personal, clinical, and environmental context in which mothers live, work, carry pregnancies, deliver, and raise their children. With a deeper understanding of the “why” behind poor outcomes, we can better target policies and interventions to mothers who need them most. Explore the six MVI themes of vulnerability below.

The MVI assigns each county a relative maternal vulnerability score (where 0 = the least vulnerable and 100 = the most.)
Dallas, Texas
How do mothers in Dallas county fare compared to other mothers throughout Texas?
On average, women in Dallas county are more vulnerable to adverse maternal health outcomes due to county-level conditions than the average woman in the state of Texas.
Dallas is most vulnerable due to

Socioeconomic determinants

.
Socioeconomic determinants of health include educational attainment, poverty and food insecurity, and social support.
Overall MVI
Score
Reproductive
healthcare
Physical
health
Mental health &
substance abuse
General
healthcare
Socioeconomic
determinants
Physical
environment
*State average in this section is a population-weighted average of county-level MVI scores, and therefore may not match the state-level MVI scores in the maps above (which are calculated with state-level data).

Learn More

The Impact of Racism

Although some regions of the United States have low overall maternal vulnerability, this can obscure large inequities. In any region of the U.S., White mothers are consistently more likely than Black or American Indian/Alaska Native mothers to live in areas that are conducive to good maternal health.

U.S. pregnancy-related deaths per 100,000 live births, 2016-2018*Black41American Indian/Alaska Native26Asian or Pacific Islander14White14Hispanic/Latino11
Average MVI score by race and ethnicityBlack52American Indian/Alaska Native50Hispanic/Latino42White40Pacific Islander29Asian28
Black and American Indian/Alaska Native mothers are 2-4 times more likely to die from pregnancy-related causes in the U.S. than White mothers.
Structural racism impacts maternal vulnerability as well—nationally, Black and American Indian/Alaska Native mothers face vulnerability scores 11-13 points higher than those of their White counterparts.
Source: Pregnancy Mortality Surveillance System, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, 2021. Pregnancy-Related Mortality Ratio by Race/Ethnicity: 2016-2018.*All groups except ‘Hispanic/Latino’ are ‘Non-Hispanic’.

There are significant differences in vulnerability for mothers of color across regions, with the South having by far the highest levels of vulnerability. Racial inequity in vulnerability differs across regions too. For example, although there is inequity between Black and White maternal mortality rates in all regions, the largest gap between White mothers and Black mothers is in the Midwest.

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American Indian or Alaska Native (AIAN)
Asian
Black
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Additional Resources
November 11, 2021 | Opinion
What We See in the Shameful Trends on U.S. Maternal Health
November 2020 | Case Study
Getting More Mothers to Deliver their Babies in Hospitals
November 2020 | Case Study
Building a Maternal Vulnerability Index for the United States
November 2020 | Case Study
Rides for Pregnant Moms to Give Babies a Healthier Start
November 2020 | Case Study
Antenatal Care During the COVID-19 Pandemic

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Credits

Research: This work was made possible by everyone at Surgo Ventures, especially (in alphabetical order): Pulkit Agarwal; Marjorie Berman, MPH; Jordan Downey, MPH; Bettina Hammer; Bethany Hardy; Talia Satchu; Dr. Sema K.Sgaier, PhD; Dr. Peter Smittenaar, PhD; Dr. Nick Stewart, PhD; Staci Sutermaster, MSPH; and Dr. Valerie C. Valerio, PhD.

Design and visualization: Daisy Chung, The Beauty Shop
Web development: Paolo Corti
Grant funding:

This publication is based on research funded in part by the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.

Additionally, we are grateful to the following experts for their feedback on this initiative (in alphabetical order): Dr. William Callaghan, MD, MPH; Dr. Mariam Claeson, MD, MPH; Dr. David Goodman, PhD, MS; Dr. Michael Kramer, PhD, MS; and Dr. Lydia Ogden, PhD, MPP, MA.
Data Methods and Limitations
The MVI covers 50 U.S. states and the District of Columbia. The index is a relative metric that ranks the vulnerability of U.S. geographic units against each other and is not an absolute measure of vulnerability. Because the index relies on datasets available for the whole U.S., it may not include all the factors associated with adverse maternal health. In addition, the index might not capture state-specific programs that seek to improve maternal health and/or disparities in outcomes. Though the influence of individual themes on vulnerability may vary by geography, a single weighting scheme was used to calculate the index across the U.S. The geographic levels used to calculate and map the index might mask more granular inequities in exposure to unfavorable environments for maternal outcomes. For more details, please writes to mvi@surgoventures.org. Finally, robust data on birth outcomes as they pertain to the birthing individuals are limited and are generally based on information collected for purposes other than public health surveillance.
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