June 12, 2026 | The Society of Obstetricians and Gynaecologists of Canada
Op-ed by Dr. Elisabeth Codsi and Dr. Isabelle Malhamé
Distributed by the Society of Obstetricians and Gynaecologists of Canada (SOGC)
In recent weeks, various media outlets have related the findings of an article published in the Lancet about global maternal mortality. This article reported an 18 per cent increase in maternal mortality in Canada, and multiple journalists have tried to extrapolate a reason for this alarming statistic. Unfortunately, the answer to this question is unknown. The reality is that we do not even know if there is an increase in maternal mortality in Canada because we do not know our true maternal mortality rate and we fear that it is higher than that reported by the Lancet.
Health care delivery in Canada is provincial and territorial domain, but many provinces and territories lack an integrated and systematic maternal mortality surveillance system. Efforts such as linking birth and death certificates to identify maternal deaths are a start. However, this method does not identify deaths occurring in the first half of pregnancy. In the province of Quebec, physicians are required by law to declare any maternal death occurring during or within 42 days of pregnancy. Although this initiative allows coroners to better investigate maternal deaths, it fails to capture late maternal deaths, which now account for a majority of mortality events. The current system also relies on physicians’ knowledge of a patient’s pregnancy status, which may be variable.
Data sharing between and within provincial health care systems is also challenging, as laws governing specific provinces prevent sharing de-aggregated data involving a small number of patients in order to protect confidentiality. Importantly, current national estimates leave out the province of Quebec, which does not contribute to datasets utilized to estimate national maternal mortality rates. For all these reasons, Canada has not yet been able to adequately and precisely report its maternal mortality rate. However, we know that such a report is possible.
The above-mentioned problems are hurdles that can certainly be overcome if provinces come together in a concerted effort. Countries such as the U.K. have greatly improved maternal mortality surveillance and have been able to create thorough reports to guide national guidelines and improve health care through confidential enquiries. The status quo in Canada is not sustainable. We need reliable data to guide practice changes that can have a tangible impact on the health of mothers in Canada.
Maternal mortality, however, is only the tip of the iceberg. Improvements in pregnancy and post-pregnancy care require a thorough assessment of severe maternal morbidity, which are the serious complications that precede maternal mortality. Such complications are 85-100 times more frequent than pregnancy-related deaths, and their incidence is increasing in Canada. Importantly, up to 75 per cent of severe maternal morbidity events are preventable, which means that we can and must do better for the health and wellness of pregnant women.
We need to know what mothers are dying from, why they become critically ill, and what we can do to improve their care. We must learn collectively and prevent severe maternal morbidity and mortality going forward in Canada.
As of now, most initiatives to prevent maternal mortality and improve maternal health have focused on obstetrical complications such as hypertensive disorders of pregnancy and postpartum hemorrhage. However, several reports have shown that late maternal deaths account for the majority of maternal mortality and are typically due to indirect causes, such as cardiovascular or mental health problems. While many initiatives are anchored in obstetric delivery services, late maternal deaths highlight limitations of health care systems as a whole. It is a moral imperative and a collective responsibility to integrate post-pregnancy considerations across all health sectors.
Our message is simple: no woman in Canada should die during or after pregnancy without having a complete and thorough inquiry and the result of this inquiry should be used to guide and improve health care for all.
Dr. Elisabeth Codsi is a Maternal Fetal Medicine Specialist and Associate Professor at CHU Sainte-Justine Hospital and Université de Montréal. She is also a member of the Maternal Mortality Review Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and is past president of the Maternal Fetal Medicine Specialists of Quebec (MFMQ).
Dr. Isabelle Malhamé is an Obstetric Internist and Associate Professor at CHU Sainte-Justine and Université de Montréal, co-lead of the Canadian Obstetric Survey System Initiative and Principal Investigator on the Pan-Canadian Women’s Health Research Coalition. She is also a member of the Executive Leadership Committee of the North American Society of Obstetric Medicine and a member of the Society of Obstetricians and Gynaecologists of Canada (SOGC).
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Media inquiries:
Teresa Wright
Communications and Public Affairs Specialist
Society of Obstetricians and Gynaecologists of Canada
[email protected]