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Maternal mortality is on the rise in Canada, according to Statistics Canada. The rate per 100,000 live births has risen from 5.98 in 2014 to 12.58 in 2024. But the real trend remains a mystery because the country lacks the capacity to capture the numbers accurately nationwide.

“If you’re trying to solve a problem, you have to have good data to begin with, and Canada has a real issue with that,” Lynn Murphy-Kaulbeck, MD, maternal fetal medicine specialist and president of the Society of Obstetricians and Gynaecologists of Canada, told Medscape News Canada. “Are we going up? Are we going down? Are we staying the same? I don’t know. [But since] the current data that we have are trending upward, that’s enough to say we need to look at this.” Rising mortality is also consistent with the trend of giving birth at older ages and with more comorbidities.

Most of the developed world has established robust maternal mortality surveillance systems and confidential inquiries years or even decades ago to collect good data. Canada has no such system.

Why Is Canada Lagging Behind?

Myriad issues contribute to the lack of a national strategy to monitor maternal mortality. The fact that healthcare is under the authority of the provinces, rather than the federal government, always complicates nationwide initiatives. The conditions under which patients give birth also vary widely across the country, from urban centers to remote locations. Even the definition of maternal mortality varies from province to province. The coroner’s report for some deaths (say, from intimate partner violence or suicide) may not even record the fact that a birth had taken place in previous weeks or months.

But Murphy-Kaulbeck points to the lack of prioritization of women’s health as a major factor. “I don’t think government policymakers really put the resources [needed toward] delivery of care to women. It’s not seen as a priority. I’ve been doing this for over 20 years, and I can tell you, sitting at the tables and pounding, beating the drum, trying to get things to happen, was incredibly frustrating.” Research into the management of women’s health issues also is inadequately funded, she added.

“We need to be very honest and upfront [about the fact that] maternal mortality disproportionately affects Indigenous, marginalized immigrants, [and people of] lower socioeconomic status,” she added.

This sentiment was echoed by Jon Barrett, MD, PhD, chair of the Department of Obstetrics and Gynecology at McMaster University in Hamilton, Ontario. “The Canadian healthcare system does not see women’s health and women dying as a priority, so they don’t fund the inquiries,” he told Medscape News Canada. “The organizations we have are either ignored or impotent. I sit on the Ontario Coroner’s Committee, which reviews all maternal deaths year after year. We make recommendations about systems that should be introduced into hospitals…but they’re completely ignored….Women are dying unnecessarily in Canada every day from lessons learned that are not shared because we haven’t done the work.”

Because maternal deaths remain rare, officials may be deprioritizing the question. But maternal deaths are the tip of the iceberg, with severe morbidity hiding just under the surface, said Murphy-Kaulbeck and Barrett. Severe morbidity rates as high as 1.6% have been recorded.

Making Changes Today

The first step to making meaningful changes, said Murphy-Kaulbeck, is for the decision-makers to recognize the problem. The next is to implement a robust, national surveillance system encompassing all 10 provinces and three territories with a confidential inquiry system into each death to explore its antecedents and implement preventive measures. A model already exists: Barrett identified Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK as the gold standard that Canada should follow.

Canada has already taken steps forward. Rohan D’Souza, MD, PhD, associate professor of obstetrics and gynecology at McMaster University, is heading the Canadian Obstetric Survey System (CanOSS), a nationwide collaboration of experts in maternal and postpartum care to capture pregnancy-related morbidity and mortality data. They will start with Ontario — the province with proportionally the largest number of births — focusing on one outcome at a time. This effort will be piloted in October 2026, and the first outcome in focus will be hemorrhage. The plan is to have a nationwide surveillance system with multiple outcomes up and running within a few years.

D’Souza expressed greater optimism about funding for a national system than either Barrett or Murphy-Kaulbeck. “We will be doing cost-effectiveness and budget impact analysis [as part of the pilot project] to demonstrate that for even the small amount of money that is invested in the system, this will be the yield, not only in terms of clinical benefits, lives saved, and healthcare costs reduced but also in terms of government expenditure and funding. Once we’re able to demonstrate that, I feel confident that we will be able to convince the provincial government to invest in this and keep it sustainable.”

While Barrett held that legislation should mandate the reporting of maternal mortality and severe morbidity, D’Souza argued that this step is not necessary if trust can be built among all stakeholders to report voluntarily. Maternal morbidity and mortality carry a stigma that can make healthcare workers reluctant to reveal what went wrong, for fear of recrimination. D’Souza and his team have been working to build trust within Ontario and across the country, and he is optimistic about their success. “This is not a witch hunt,” he said. “This is about improving our health system. It’s about understanding what the gaps are, what the delays are, what led to them, and how to fix that problem. It’s not about naming and shaming anybody.”

D’Souza is also optimistic about the impact CanOSS will have. Leading causes of maternal death in Canada include hemorrhage, sepsis, and preeclampsia. In countries that have implemented similar surveillance systems, these outcomes have been all but eliminated. There is every reason to expect that the same will happen in Canada, he said.

The experts agreed that efforts to improve outcomes should not wait until a national surveillance system is up and running. The time to implement better continuity of care for women in the postpartum period and to prioritize obstetric care and women’s health is now, especially for marginalized groups and those in rural and remote settings, they said. This prioritization requires a collaborative, multidisciplinary approach that welcomes professionals such as midwives to help fill in gaps in care. It also requires that large academic centers actively support remote or rural hospitals, where the local staff may never have experienced a rare, life-threatening event. Ultimately, the way forward is through collaboration across disciplines, distances, hospital systems, and provincial or territorial borders.

Murphy-Kaulbeck, Barrett, and D’Souza reported having no relevant financial relationships.