Despite having the most expensive systemof maternity care in the world, outcomesfor birthing people in the USA are worsethan other high-income nations. Critically, US outcomes also reflect deep andpersistent racial and ethnic health disparities. The maternal mortality rate (deathsoccurring within 42 days of pregnancyper 100000 live births) in the USA was23.8 in 2020, the highest of all comparable countries.1–5 Non-Hispanic black(NHB) and Native American individualsare two to three times more likely todie during or after childbirth comparedwith those who are non-Hispanic white(NHW).2 6 In contrast, maternal mortalityoutcomes for Hispanic and Asian/PacificIslanders are generally comparable withthose of NHW individuals,7 though someresearch findings suggest health disparities among specific subgroups.8 9 NHBand Native Americans also experiencehigher rates of severe maternal morbidity(SMM), resulting in significant shortterm or long-term consequences to theirhealth.1 10 While mortality rates amongindustrialised countries are highest inthe USA, racial and ethnic disparities inoutcomes have also been noted in Brazil,Canada, the Netherlands and the UK.11 12