Introducing the US Maternal Vulnerability Index

The first national, community-level index that shows where and why mothers are vulnerable to poor health, and helps combat US maternal mortality and bridge the racial maternal health gap

When it comes to a mother’s health and survival, the United States fares worst among high-income countries, and what’s been even less carefully explored is the degree to which a woman’s environment contributes to her risk of pregnancy-related death or other poor health outcomes.

That’s why we created the Maternal Vulnerability Index (MVI): the first county-level, national-scale, freely available data tool to help identify precisely where and why mothers and birthing people in the United States are vulnerable to poor health outcomes. The MVI offers the opportunity to explore important environmental and contextual factors affecting maternal health and develop more precise, localized solutions.

The MVI ranks US counties and states in terms of vulnerability to poor pregnancy outcomes, offering each geography a relative maternal vulnerability score (on a scale of 0–100, where a higher score indicates greater vulnerability to adverse maternal outcomes). It ranks counties and states on six themes: reproductive healthcare, physical health, mental health and substance abuse, general healthcare, socioeconomic determinants, and physical environment. The six themes reflect 43 county- and state-level indicators associated with maternal health outcomes.

Using data from the MVI, we conducted an analysis of the current state of maternal vulnerability across the United States. Our ensuing report, Getting Hyperlocal to Improve Outcomes & Achieve Racial Equity in Maternal Health: The US Maternal Vulnerability Index, identified three key findings:

1. Overall maternal vulnerability is highest in the South, Midwest, and for rural communities, but there are pockets of concern across the US. Rural areas, the South, and the Midwest have particularly high concentrations of counties where pregnant women and mothers are exposed to harmful neighborhood conditions across MVI themes. The average woman of reproductive age lives under higher vulnerability conditions in the South than in any other region.
2. Each county has a unique maternal vulnerability profile, with the majority of counties vulnerable in at least one dimension. Most counties are vulnerable in at least one dimension, even if their overall vulnerability score is low. In fact, 59% of US counties score “Very High” on at least one theme. For more detailed summaries of how counties fare across the six themes, download the full report.
3. Black and American Indian and Alaska Native (AIAN) women of reproductive age are more likely to live under conditions that are not conducive to good maternal health — a sign of structural racism. Individual characteristics like age, income, and education cannot fully explain why these women experience such high risk from pregnancies: for example, the most educated Black women are still more likely to die from pregnancy-related causes than the least educated White women, according to the CDC. One driver of these disparities is structural racism, which affects maternal health outcomes by limiting access to health-promoting factors leading to worse maternal health conditions for women of color. One key pathway through which structural racism exerts its influence is residential racial segregation. The MVI shows that relative to the US average, Black and AIAN women of reproductive age are 1.6 and 2.6 times more likely to live under conditions not conducive to good maternal health, respectively.

From the MVI, we understand that mothers of different races are unequally exposed to conditions that are harmful for maternal health based on where they live. However, preliminary analysis of the relationship between vulnerability and maternal health outcomes suggests we’ll need to look beyond county-level factors to fully explain persistent racial disparities in maternal outcomes.

For instance, not only do mothers of color tend to live in poorer neighborhoods within their counties; but they might also face differential treatment when interacting with the health system due to interpersonal racism; and systemic inequities might make them more prone to chronic conditions.

We publicly launched the MVI on October 20, 2021, at a virtual panel discussion moderated by our Co-Founder and CEO Dr. Sema Sgaier and featuring panelists:

• Christy Turlington Burns, Founder of Every Mother Counts;
• Dr. Ololade “Lola” Okito, MD, 2 Neonatologist, Children’s National;
• Dr. Mary-Ann Etiebet, MD, Lead, Merck for Mothers; and
• Michele Blackwell, Public Policy Manager, Uber.

To learn more, you can:

• Watch the recording of our virtual event, Closing the Racial Maternal Health Gap with Better Data;
• Explore the Maternal Vulnerability Index; and
• Download our report, Getting Hyperlocal to Improve Outcomes & Achieve Racial Equity in Maternal Health: The US Maternal Vulnerability Index.