Pregnancy trends show later maternal age and persistent inequities

Pregnancy trends show later maternal age and persistent inequities | Image Credit: © fotoduets - stock.adobe.com.

Women in high-income countries are increasingly delaying childbirth, with new research warning that this trend is associated with rising maternal health risks and persistent inequities. An international review, published in the Journal of Clinical Medicine and led by researchers at Flinders University, examined pregnancy and birth outcomes in Australia, the United States (US), and the United Kingdom (UK) over the past 2 decades.^1,2

“One of the most noticeable shifts is that women are having babies later in life,” said lead author Anya Arthurs, PhD, Flinders University. “The average age of first-time mothers has steadily increased, with many now starting their families aged 35 years or over, reflecting broader societal changes including career priorities, financial pressures, and improved access to contraception.”

Maternal age and complications

The review found that older mothers are more likely to access prenatal care but also experience higher rates of complications. “We’re seeing increased rates of gestational diabetes, high blood pressure, and caesarean sections among older mothers, which raises important questions about how maternity care systems are adapting,” Arthurs explained. Data show that in Australia, the average age of mothers increased from 28.9 years in 1998 to 31.1 years in 2021, while in the UK it rose to 30.9 years in 2022. In the US, the average age of first-time mothers reached 27.5 years in 2023.

Fertility and birth rates

Across all 3 countries, fertility rates have declined to below replacement levels. In 2022, the total fertility rate was 1.63 in Australia, 1.67 in the US, and 1.49 in the UK. Despite this decline, the number of births to Indigenous and minority women is increasing. The authors highlighted the significance of these demographic shifts for future healthcare planning.

Maternal mortality and disparities

Maternal mortality remains a key concern, particularly in the US, where the maternal mortality rate (MMR) was 32.9 per 100,000 live births in 2021, markedly higher than Australia (5.8) and the UK (13.4). Racial and ethnic disparities are prominent. “Maternal mortality remains a serious concern, especially in the US, where Black, Indigenous, and Hispanic women are far more likely to die during pregnancy or childbirth due to limited access to quality healthcare and systemic inequalities,” said Arthurs.

Indigenous women in Australia and migrant women in the UK also face worse outcomes. In Australia, First Nations women have an MMR 3 times that of non-Indigenous women. In the UK, Black women are nearly 4 times more likely to die during or after pregnancy compared with White women.

Pandemic effects and delivery practices

The COVID-19 pandemic further strained maternity care. In the UK, COVID-19 became a leading cause of maternal death between 2019 and 2021. The review also noted a rise in caesarean deliveries, particularly among older mothers and those delivering in private hospitals. While caesarean sections can be life-saving, the authors cautioned that rates exceeding 10–15% may reflect systemic rather than clinical drivers.

Improvements and ongoing challenges

Some positive trends were observed. Smoking during pregnancy has declined across all 3 countries, and breastfeeding rates are improving, particularly in Australia and the UK. However, disparities persist. “But younger mothers are still more likely to smoke, and the USA continues to lag in breastfeeding rates, partly due to the absence of a national paid maternity leave policy,” Arthurs said.

Policy recommendations

Senior author Professor Claire Roberts emphasized the need for policy reforms. “We’re calling for governments and health systems to take action by focusing on maternity care that is equitable, culturally safe and responsive to changing needs,” she said. Recommendations include adopting midwifery-led continuity of care, improving postpartum follow-up for women with gestational diabetes or hypertensive disorders, expanding culturally safe perinatal programs, and introducing universal paid parental leave in the US.

The authors also called for governments to address social determinants of health, including housing, income, and food security, and to establish an international maternal health equity task force to coordinate global efforts.

References:

1. Flinders University. Global study reveals alarming gaps in maternal health across Australia, USA, and UK. Euerkalert. August 26, 2025. Accessed September 2, 2025. https://www.eurekalert.org/news-releases/1096054
2. Arthurs AL, Harrison JK, Williamson JM, Roberts CT. Pregnancy and Birth Trends Across Australia, the United States of America and the United Kingdom. Journal of Clinical Medicine. 2025;14(16):5841-5841. doi:https://doi.org/10.3390/jcm14165841