Source: OECD Health Data, 2020.Showing data for
2005 and
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, women
in the United States are vulnerable
to poor maternal health outcomes.

Where in the US are mothers* vulnerable?

The US 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
Reproductive healthcare
Physical health
Mental health and substance abuse
General healthcare
Socioeconomic determinants
Physical environment
Hover to see MVI and state maternal mortality ratio (MMR)The MVI assigns each county a relative maternal vulnerability score (where 0 = the least vulnerable and 100 = the most)
Maternal Vulnerability
Very High
Very Low
Sources: United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics, 2020. Natality public-use data 2007-2019 and Underlying Cause of Death, 1999-2018. Accessed on CDC WONDER Online Database 11/25/2020. MMRs were calculated using 2015-2019 data.

Why are mothers vulnerable?

What are the drivers of maternal vulnerability in each US 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.

Dallas, TexasThe MVI assigns each county a relative maternal vulnerability score (where 0 = the least vulnerable and 100 = the most.)
* 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). Click here for more detailed information.How do mothers in Dallas county fare compared to
other mothers throughout Texas?
Overall MVI Score
Reproductive healthcare
Physical health
Mental health and substance abuse
General healthcare
Socioeconomic determinants
Physical environment

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.

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 US, White women are consistently more likely than Black or American Indian/Alaska Native women to live in areas that are conducive to good maternal health.

Black and American Indian/Alaska Native women are 2-4 times more likely to die from pregnancy-related causes in the US than White women.

Structural racism impacts maternal vulnerability as well: Nationally, Black and American Indian/Alaska Native women face vulnerability scores 10-12 points higher than those of their White counterparts.

US pregnancy-related deaths per 100,000 live births, 2014-2017*Black42American Indian or Alaska Native28Asian American or Pacific Islander14White13Hispanic or Latino12
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, 2020. Pregnancy-Related Mortality Ratio by Race/Ethnicity: 2014-2017.
*All groups except ‘Hispanic/Latino’ are ‘Non-Hispanic’.
Average MVI score by race and ethnicityBlack52American Indian or Alaska Native50Hispanic or Latino42White40Pacific Islander29Asian28
Hispanic or Latino ethnicity includes births to mothers of all races with Hispanic origin and overlaps with the races in this bar chart. Races refer to both Hispanic and non-Hispanic members where applicable.

There are significant differences in vulnerability for women 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 women and Black women is in the Midwest.

Toggle to view by race and ethnicity
Hispanic or Latino
Pacific Islander
American Indian or Alaska Native (AIAN)
How manywomen1 million5 million10 million

Stay informed

Join us in building better maternal health, reducing racial disparities for mothers of color, and improving the United States’ dire maternal mortality rate. Join Surgo in bringing precision to global health as we strive to build better maternal health, pandemic response, and more.Sign up for our email newsletter to learn more about our mission and receive important updates on our work.

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
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.
Methods and Limitations
The MVI covers 50 US states and the District of Columbia. The index is a relative metric that ranks the vulnerability of US geographic units against each other and is not an absolute measure of vulnerability. Because the index relies on datasets available for the whole US, 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 US The geographic levels used to calculate and map the index might mask more granular inequities in exposure to unfavorable environments for maternal outcomes. To access the data or learn more about the methods, please get in touch at 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.