American women are 50% more likely to die in childbirth than their mothers

What do Serena Williams and Beyoncé have in common?

Both are global superstars and phenomenally successful in their chosen careers. Both are also mothers, who’ve spoken publicly about the life-threatening complications they experienced during pregnancy and childbirth.

These high-profile cases highlight risks faced by women around the world during pregnancy and labour. The World Health Organisation estimates that around 830 women die from pregnancy- or childbirth-related complications every day and has called the rate of global maternal mortality “unacceptably high.”

Furthermore, while the maternal-death rate has fallen in most developed nations and has improved in many developing ones, it has risen in the US.

In 2015, more than 26 deaths were recorded per 100,000 pregnant women, up from 17 in 1990. That means American women today are 50% more likely to die in childbirth than their own mothers.

As hard-hitting as that statistic is, the number is low compared to developing regions, with Nigeria and India accounting for around one-third of all maternal deaths worldwide in 2015. And it is set against a backdrop of broad global improvement, with the maternal mortality ratio dropping by nearly 44% in the past 25 years.

“The public image of maternal death is a woman who has a medical emergency like a hemorrhage while in labor,” Neel Shah, assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School wrote in a blog post. “However, very few deaths counted in maternal-mortality statistics occur during childbirth. Rather, four out of five of these deaths happen in the weeks and months before or after birth.”

It’s not just about medical failures but also represents “eroding social support” for women and a lack of timely care, she said. A study published in Health Affairs showed access to obstetric services in rural US counties has fallen, with 9% losing all their hospital obstetric services in the 10 years to 2014. It also showed an additional 45% of rural US counties had no hospital obstetric services at all during the same period.

The US also lags its industrialized counterparts in the World Economic Forum’s Gender Gap Report, ranking 49th out of 144 countries, compared with Canada at 16th and France at 11th. It also ranked 82nd out of 144 in the subcategory that measures the differences between women’s and men’s health.

Singer Beyoncé suffered from preeclampsia during her first pregnancy. Tennis ace Serena Williams has written about the “slew of health complications” she faced after giving birth to her daughter, and has said she was “lucky to have survived.” Williams used her experience to call for better care for mothers and newborn babies.

“This is not just a challenge in the United States,” Williams wrote in an article for CNN. “Thousands of women struggle to give birth in the poorest countries. When they have complications like mine, there are often no drugs, health facilities or doctors to save them. Before they even bring a new life into this world, the cards are already stacked against them.”

A report from nine US states on maternal mortality estimated that more than 60% of pregnancy-related deaths were preventable. Nearly half of all of the deaths were caused by hemorrhage, cardiovascular and coronary conditions, cardiomyopathy or infection, the report said.

The report also identified almost 200 recommendations for reducing deaths, including improving training and ensuring policies and procedures are followed. It also advocated improving access to care, communication and assessment, diagnosis and treatment decisions.

Williams said she wanted to see governments, businesses and health-care providers do more. Harvard’s Neel Shah said policymakers can improve tracking and recording of maternal mortality, so that failures can be corrected more swiftly.

“We need to listen to moms. And we need to support them,” Shah said. “If rising maternal mortality is fundamentally a failure of social support, we all need to step up: birth partners, grandparents, friends, neighbors, professional colleagues — all of us.”