U.S. Ranks Worst Developed Country for Maternal Health

A woman in the United States faces a one in 1,800 risk of maternal death, according to an annual report by the charity Save the Children, the worst of any developed country in the world. What’s more, they’re more than 10 times as likely to die from a cause related to pregnancy as those in Belarus, Poland and Austria.

The State of the World’s Mothers 2015 report, a global index that ranks the best and worst places to be a mother based on the latest available data on indicators like political status, economics, education, children’s well-being and maternal health, ranks the U.S. at No. 33 of 179 surveyed countries—down two spots from last year.

The U.S. ranked No. 42 on children’s well-being, No. 61 on maternal health and No. 89 for political status—or the participation of women in national government. Among the other statistics, the report finds that an American child under the age of 5 is nearly just as likely to die (6.9 per 1,000 live births) as one in Bosnia and Herzegovina, Serbia, Slovakia or Macedonia.

Of the 25 capital cities of wealthy countries surveyed, the report finds Washington, D.C., had the highest rate of infant mortality (7.9 deaths per 1,000 live births as of 2012). In comparison, cities like Stockholm and Oslo had rates below 2.0. Washington’s rate fell in 2013, to 6.6, but a number of major American cities have had rates much higher. In 2011, Detroit’s rate was reported at 12.4, and in Cleveland, it was 14.1.

Prematurity was considered a major factor in the Detroit rate, but others included insufficient prenatal care, a dearth of education and poverty. Save the Children found race to be a factor, too.

The national average for deaths per live births in the U.S. is 6.1 per 1,000, but the report finds it’s much higher for unwed, poor and young black mothers. As one example, a black mom in San Francisco is six times more likely than a white one to lose her baby before its first birthday.

The overall top 10 included Norway, Finland, Iceland, Denmark, Sweden, the Netherlands, Spain, Germany, Australia and Belgium. The bottom 10 were Haiti and Sierra Leone (tied), Guinea-Bissau, Chad, Côte d’Ivoire, Gambia, Niger, Mali, Central African Republic, the Democratic Republic of Congo and Somalia.

Read the full report here.

Write to Eliana Dockterman at eliana.dockterman@time.com.