Inequalities in Severe Maternal Morbidity and Mortality in High-Income Countries: Patterns, Drivers, and Pathways to Action.

Inequalities in severe maternal morbidity (SMM) and mortality in high-income countries are persistent, socially patterned, and evident across multiple dimensions, including socioeconomic deprivation, race and ethnicity, and migration status. These inequalities are not fully explained by individual clinical risk factors but arise from the interaction of structural disadvantage, intermediate social conditions, and health systems. Many determinants of risk are established before pregnancy; however, variation in access to care, quality of care, and responsiveness to symptoms during pregnancy and childbirth can either mitigate or exacerbate vulnerability. Identifying social and structural determinants, ensuring equitable access to care, providing culturally responsive care, and promoting timely, unbiased clinical decision making are essential components of clinician efforts to reduce inequalities in SMM and mortality.