Mental health conditions, overwhelmingly tied to substance use disorder, are now the leading cause of pregnancy-related deaths in Tennessee, according to a new state review. The latest numbers show a slight dip in overall maternal deaths between 2022 and 2023, yet the state still sits well above the national average and nowhere near where health officials say it should be.
Counts Dip, But Most Deaths Did Not Have To Happen
The Maternal Mortality Review Committee recorded 96 pregnancy-associated deaths in 2023, a small drop from 100 in 2022. Pregnancy-related death rates fell to roughly 41 per 100,000 live births in 2023. The committee determined that about three in four pregnancy-related deaths in 2023 were preventable, according to the Tennessee Department of Health. The review focuses on trends from 2021 through 2023 and tracks how the pandemic and overdose patterns have shaped recent outcomes.
Mental Health And Substance Use Take The Top Spot
Mental health conditions were the top underlying cause of pregnancy-related deaths from 2021 to 2023, accounting for 27% of those deaths, and most of those cases were tied to substance use. Substance use disorder represented 81% of deaths attributed to mental health conditions and 22% of all pregnancy-related deaths, as reported by WVLT. Many of these deaths occurred after delivery, with the largest share happening 43 days to one year postpartum, a period that often sees less consistent medical follow-up.
State Rate Still Above U.S. Average
Using the international definition of maternal mortality, the report lists Tennessee’s rate at about 28 deaths per 100,000 live births in 2023, higher than the national figure. The Centers for Disease Control and Prevention reported a U.S. maternal mortality rate of 18.6 deaths per 100,000 live births in 2023, a comparison that puts Tennessee’s situation in sharp relief. Health officials note that the steep rise during the pandemic, followed by recent declines, tracks with national patterns, yet Tennessee continues to face persistent gaps.
Hot Spots And Racial Disparities
The review flags clear geographic and racial inequities. From 2017 through 2023, Madison County recorded a pregnancy-associated mortality rate of about 212 per 100,000 live births, Shelby County 162, and Knox County 157. Non-Hispanic Black women experienced the highest pregnancy-related mortality between 2021 and 2023, with roughly 116 deaths per 100,000 live births, or about 2.7 times the rate of non-Hispanic White women, as described by WVLT. Local advocates say the numbers highlight long-standing gaps in continuous care and addiction services that hit some communities far harder than others.
Recommendations Target Treatment, Harm Reduction And Access
The Maternal Mortality Review Committee outlined a series of concrete recommendations, including better clinical recognition of hypertensive and cardiovascular conditions, expanded screening and treatment for mental health and substance use disorders, broader harm reduction strategies such as naloxone access, trauma-informed care, and stronger postpartum supports. The report also urges action on social drivers like housing, transportation, and insurance coverage, problems that previous reporting has linked to worse outcomes for TennCare enrollees, according to Tennessee Lookout. Whether lawmakers and agencies turn those recommendations into funding and policy changes will determine if the recent declines continue or stall out.
For families, clinicians, and advocates across Tennessee, the report serves as both a roadmap and a warning. Much of the state’s maternal death toll is preventable, yet progress will hinge on sustained resources, consistent screening and treatment, and a sharper focus on the communities carrying the heaviest burden. The Maternal Health Task Force and the MMRC plan to keep reviewing cases and pressing partners to act on the recommendations in the months ahead.
