If you’re pregnant or trying to conceive, you might have noticed that maternal mortality rates in the U.S. have been getting a lot of attention lately. And for an important reason: The number of American women dying from pregnancy-related complications has more than doubled between 1987 and 2016, the latest year for which data is available. Between 2000 and 2017, rates worldwide have dropped by nearly 40 percent.

Before you get too freaked out, keep in mind that the overall numbers are still very, very low: The maternal mortality rate in the U.S. is around 17 out of every 100,000 births. Still, research shows that the majority of these deaths are preventable. So, what exactly is going wrong?

The answers are complex, of course. On the other hand, knowledge is power. The more information health care providers, women and their loved ones have about pregnancy-related complications and factors that affect maternal mortality, the more we can do to protect the health of new moms and moms-to-be.

Here’s a look at some of the most prominent factors affecting the higher maternal mortality rate in the U.S. — plus, what women can do to stay safe.

1. More moms-to-be have chronic diseases

The health of the population — including pregnant women and new moms — is changing. Chronic health problems like obesity, heart disease, high blood pressure and diabetes are more common than they used to be, and all of these can raise the risk for pregnancy-related complications. After all, pregnancy is like a natural endurance test. So, if the body is already experiencing other stressors, problems may be more likely to strike.

2. Women of color often don’t get the same treatment as white women

There’s a major disparity in how women of color are treated for pregnancy-related complications. Findings show that Black moms are roughly three times more likely to die in childbirth or of pregnancy-related complications than non-Hispanic white women, while Native American and Alaskan Native women are about two-and-a-half times more likely.

The reasons why are complicated. Women of color are more likely to have risk factors like diabetes, high blood pressure, late prenatal care and obesity. Poverty and a lack of access to health care increase the chances that these issues end up going untreated — and resulting in issues that could lead to maternal death.

Institutionalized racism plays a big part, too. When women of color with access to health care speak up about a concern, they’re more likely to be dismissed and ultimately go untreated. 

3. Women need more education about serious warning signs

Symptoms like very heavy bleeding, trouble breathing, chest pain or a bad headache are all red flags that could indicate a serious or life-threatening complication like postpartum hemorrhage or a heart condition. But reports show that not all women and their families are aware of these warning signs. That could make them less likely to seek the immediate medical care that they desperately need.  

4. We have work to do on mental health issues

Perinatal mood disorders affect up to 15 percent of U.S. women during pregnancy and the postpartum period. And while it’s scary to think about, suicide ideation occurs more in pregnant women and new moms than in the general population — especially during the late postpartum period (43 to 365 days after giving birth).

Hormones can have a major impact on mood, but there are plenty of other factors that need to be considered. Social isolation and lack of social support, racism, poverty and lack of access to insurance, transportation or health care providers all play a big role, experts say. 

5. Opioid addiction is a big problem

The use of opioids during pregnancy quadrupled from 1999 to 2014, mostly due to overprescribing practices, CDC data shows. (Up to 20 percent of pregnant women are prescribed opioids in some parts of the U.S.)

It’s no secret that drugs like oxycodone, hydrocodone and codeine can be highly addictive — and new moms who struggle with substance addiction are at a greater risk for overdosing. For instance, research shows drug-induced death is the most common cause of pregnancy-associated deaths in Utah, with 80 percent of the deaths occurring after a woman’s postpartum checkup. And some estimates show that up to 30 percent of maternal deaths nationwide could be due to overdose or suicide.

6. We have more barriers to quality care

Compared to countries with nationalized health care, our own fragmented system can be tougher to navigate. Even though the U.S. spends more than any other country on hospital-based care, many pregnant women or new moms with Medicaid or who don’t have health insurance are unable to access free or affordable care. That can set the stage for complications — and increase the risk of death by four-fold.

7. We don’t devote enough resources to maternal health 

Both federal-state grant programs and Medicaid devote significantly more funding and coverage to babies than to new moms. And while the U.S. is getting better at creating standards to reduce pregnancy-related complications, the vast majority of them focus specifically on infants. Compare that to the United Kingdom, where the National Health Service recently announced the rollout of a blood test for preeclampsia that can reduce maternal stroke, seizure and death rates by 20 percent. While California has a preeclampsia toolkit that’s made strides in improving maternal health, we don’t have something like that nationwide. 

8. Some other countries are more likely to look into what went wrong — and how it can be prevented next time

When a woman in the United Kingdom dies of a pregnancy-related complication, a national committee analyzes the details of her death — including reviewing her medical records, interviewing family members and even asking hospitals and health care providers to explain what went wrong. The information is compiled into a public report that’s used to improve care policies across the country.

Though some cases are reviewed in the U.S., not every maternal death gets this kind of deep dive. As of 2018, the most recent year for which data is available, only 45 states in the U.S. and the District of Columbia have a policy on the books for establishing Maternal Mortality Review Committees (this is up from 23 states in 2010).

9. Care is less likely to be coordinated among different providers

As chronic health conditions among U.S. pregnant women become more commonplace, their care may need to be managed by more specialists. And each of those specialists might keep their own health records for patients. That adds up to more chance for miscommunications among a woman’s care providers or important details falling through the cracks, potentially causing a woman to miss out on essential information about her health or treatments — or even mess up details about her care.

And the problem is more common than you might think: Coordination of care was found to be a dominant cause of death in a 2015 report on maternal mortality rates in Philadelphia, for instance.

10. Women may be misdiagnosed or get ineffective treatments

Take preeclampsia, for example. There’s no simple diagnostic test for the condition here in the U.S. So, some providers might not recognize the warning signs until it’s too late — resulting in dangerous delays in treatment. These kinds of problems may be less likely in places like the United Kingdom and Australia, thanks to the rollout of a new blood test that screens for preeclampsia risk factors. Slow or wrong diagnosis or inaccurate treatments — including the failure to have patients consult with a cardiologist — have been shown to impact maternal mortality rates, too. 

Thinking about our maternal mortality rates can be frightening — and frustrating. And while the problem doesn’t have an easy solution, there are steps that women and their loved ones can take to protect their health. Namely? Keep in touch with your doctor throughout your pregnancy and after giving birth to help head off potential problems before they become serious. Familiarize yourself with the late pregnancy and postpartum warning signs, too. And if you feel or notice anything unusual — speak up ASAP.