The shameful secret is out: Although the number of women who die in childbirth globally has fallen in recent decades, the rates in the U.S. have gone up. Since 1987 maternal mortality has doubled in the U.S. Now approximately 800 maternal deaths occur every year. One of the most striking takeaways from examining the data is racial disparity: Black women are three to four times more likely to die from pregnancy-related conditions such as cardiac issues and hemorrhage and to bear the brunt of serious complications as well. That risk is equally shared by all black women regardless of income, education or geographical location. In other words, the factors that typically protect people during pregnancy are not protective for black women.

Fortunately, most of these deaths are considered preventable, and therefore, much more can be done to stop them. First, everyone—from doctors to the media to the public—needs to stop blaming women for their own deaths. Instead we should focus on better understanding the underlying contributing factors. These include a lack of data; not educating patients about signs and symptoms—and not believing them when they speak up; errors made by health care providers; and poor communication among different health care teams. Finally, studies have shown that interventions such as wider access to midwifery, group prenatal care, and social and doula support are effective in improving maternal health outcomes.

Progress has been slow and uneven. Deaths from hemorrhage, for example, have been reduced by half in some states because of standardized tool kits for care. And California has led in the pursuit of understanding root causes of maternal mortality. Still, structural racism is proving to be an intractable force.