The U.S. maternity care system fails to provide many childbearing people and newborns with equitable, respectful, safe, effective, and affordable care. Proven care models rectify these shortcomings.

More people die per capita as a result of pregnancy and childbirth in this country than in any other high-income country. These terrible birth outcomes and unconscionable racial and ethnic inequities are driven by many separate yet interrelated factors and we must continue the ongoing work to transform our maternity care system. Nevertheless, we already know what to do to make concrete progress and achieve healthier mothers and babies now.

We encourage decisionmakers to increase access to midwifery care, community birth settings (birth centers, home birth), doula support, and services of community-led and -based perinatal health worker groups. We must not accept the status quo of inequitable and expensive care that perpetuates avoidable harm. Concrete progress is within reach if decisionmakers are willing to act.

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Editor's note: We recognize and respect that pregnant, birthing, postpartum, and parenting people have a range of gender identities, and do not always identify as “women” or “mothers.” In recognition of the diversity of identities, this report uses both gendered terms such as “women” or “mothers” and gender-neutral terms such as “people,” “pregnant people,” and “birthing persons.”