Tashia Bishop’s journey into motherhood was never supposed to be marked by heartbreak. But as she sat before Pennsylvania lawmakers on October 2, 2025, sharing her painful testimony, her story echoed the experiences of countless women across the state—and the nation—struggling within a maternal and infant health system under siege from policy, stigma, and systemic neglect.
Bishop, a resident of Delaware County, recounted the trauma of two miscarriages, followed by the premature birth of her first son. She was in recovery from addiction, determined to do everything right for her baby. Yet, as she explained to the state policy committee, “I felt like the doctors and the hospital staff didn’t get to know me because of my drug history. I was put in a box and treated a certain way.” Her repeated concerns about her newborn’s breathing were brushed aside as the anxieties of a first-time mother. One night, after reading her son bedtime stories, she put him to sleep—not knowing he would not wake up the next morning. Months later, she learned he’d suffered from a genetic lung disorder and viral pneumonia. “Now that I have a second child, it’s hard for me to enjoy him 100% because I have a lot of fear that my second son will also pass away,” Bishop said.
Bishop’s story is not an outlier. According to the 2025 Pennsylvania Maternal Mortality Report, the state recorded a staggering pregnancy-related mortality rate of 97 deaths per 100,000 live births in 2021—translating to almost 130 women dying during pregnancy, delivery, or up to a year postpartum. Dr. Aasta Mehta, director of Reproductive, Adolescent, and Child Health at the Philadelphia Department of Public Health, told The Keystone, “When mothers and babies are dying, it reflects not only a failure of our health care delivery but also a reflection of our broader social, economic, and policy environment.”
The crisis is not evenly distributed. Black women in Pennsylvania die at more than double the rate of white women from pregnancy-related causes, a disparity mirrored nationwide. In 2023, a new report by The Commonwealth Fund found Black mothers in the U.S. suffered the highest maternal mortality rate at 50.3 deaths per 100,000 live births—more than twice the national average. American Indian/Alaska Native women and Native Hawaiian and Pacific Islanders also faced elevated risks. The situation for infants is equally grim: Pennsylvania’s 2022 infant mortality rate was 5.7 per 1,000 live births, with Black babies dying at more than twice the rate of white infants, primarily due to prematurity and low birthweight. Nationally, infant mortality remained steady at 5.6 deaths per 1,000 live births from 2022 to 2023, but Black, American Indian/Alaska Native, and Native Hawaiian and Pacific Islander infants had mortality rates of 7.4 deaths per 1,000 live births, according to The American Journal of Managed Care.
One of the most significant contributors to these alarming statistics is the prevalence of maternity care deserts. More than two million women of childbearing age in Pennsylvania live in areas with little or no maternity care, and about 12.4% must drive over 30 minutes to reach the nearest birthing hospital. Dr. Mehta warned, “This combination makes it unsustainable for hospitals, especially community hospitals, to continue providing labor and delivery services. The result is that families are forced to travel further for care, putting both mothers and infants at risk and concentrating demand on fewer remaining hospitals.”
The situation may soon worsen. The so-called “One Big Beautiful Bill” cuts federal Medicaid funding by roughly $1 trillion over the next decade, threatening the financial viability of rural hospitals. In Pennsylvania, about three million people (23% of the population) are covered by Medicaid—including over 737,000 in rural counties—and Medicaid pays for roughly 35% of births in the commonwealth. With reduced funding, hospitals may be forced to close maternity units, as has already happened in southeastern Pennsylvania due to low reimbursement rates and high liability costs.
Nationally, the U.S. maternal mortality rate remains stubbornly high compared to other wealthy countries. In 2023, the national rate was 18.6 deaths per 100,000 births, according to The Commonwealth Fund. Louisiana topped the list with 41.9 deaths per 100,000, while California had the lowest at 9.5. Although the maternal mortality rate dropped from 22.3 in 2022, it remains comparable to countries like Palestine and Chile, and far higher than most high-income nations. For children under five, the mortality rate was 6.7 deaths per 1,000 live births, with Mississippi at the top and Massachusetts at the bottom. The highest mortality rates for young children were seen among Black children, at 13.4 deaths per 1,000 live births.
Experts say effective policies can make a difference. Expanding the roles of midwives, ensuring safe abortion access, and providing postpartum home visits have led to marked improvements in some regions. In New Mexico and Chile, for instance, expanding midwife roles has contributed to significant drops in maternal deaths. Chile saw a 50% decrease since 2000. States that protected abortion access saw a 21% decrease in maternal mortality compared to those that restricted it. Ireland, which guarantees home visits from a midwife or public health nurse for months after birth, reported no maternal deaths in 2022. Medicaid reimbursement for home visiting services is now available in 28 states, offering a potential lifeline for at-risk mothers and infants.
Mental health and substance use disorders are another major factor driving maternal mortality. In Pennsylvania, mental health conditions accounted for about 47% of pregnancy-related deaths, with overdose and substance use disorder leading the way. Bishop, who was on methadone maintenance treatment during her pregnancy, described persistent stigma from healthcare providers. “When I started my prenatal appointments I was really looking forward to meeting my OB doctors and my maternity team, but my experience wasn’t what I expected,” she said. “I was drug tested at each visit and I knew my doctor didn’t approve of me being pregnant and on methadone even though it is a normal treatment for pregnant women who are in recovery. Methadone was helping to keep me clean during my pregnancy. I know that I was doing everything right.”
Dr. Mehta emphasized the urgent need to integrate behavioral health into routine perinatal care. “There are too few psychiatrists, therapists, and substance use disorder providers trained in the care of pregnant and postpartum people, particularly outside of major cities,” she said. To address these disparities, the PA Black Maternal Health Caucus introduced the PA MOMNIBUS 2.0 package in June 2025, aimed at reducing racial disparities and improving access to maternal and infant care. One bill, HB 1192, would create a pilot “mother’s treatment court” to support recovering mothers, but it remains stalled in committee.
Policy changes at the federal level loom large. The overturning of Roe v. Wade and recent Medicaid cuts are expected to worsen maternal and child mortality in states lacking abortion access or Medicaid coverage. The Commonwealth Fund report concluded, “Variations [in outcomes] highlight the need for federal protections to ensure consistent coverage, maternal and child health services, and quality of care regardless of state of residence, race and/or ethnicity, or economic background.”
The path forward, experts say, lies in expanding equitable access to care, investing in the maternal health workforce, strengthening data collection, and guaranteeing robust postpartum support. For families like Tashia Bishop’s, these changes cannot come soon enough. “I find it difficult to trust doctors and I worry about not being heard, not being believed,” Bishop said. Her story, and those of many others, serve as a stark reminder of the stakes for mothers and children—and the urgent need for action.
