Many people think of dying during or after childbirth as something confined to history. They assume that, at least in the United States, our medical knowledge and practice regarding a procedure as common as childbirth would be effective in 2018. Unfortunately, that is not the case. According to a new report, the U.S. is the most dangerous place to give birth in the developed world. 

Following a four-year investigation, USA Today published a report on the state of maternal care and mortality in America, and the results were startling: Around 700 people die during or after childbirth each year, while more than 50,000 mothers are severely injured. It is estimated that around half of these deaths were preventable.

The reason for this, the report found, is that doctors are nurses are ignoring warning signs and neglecting to provide the proper treatment for treatable complications like excess bleeding during childbirth. And this negligence isn’t confined to small, rural community hospitals: It’s also a problem in larger urban hospitals with state-of-the-art facilities.

While other countries in the developed world — like Canada, Japan, England, Germany and France — have all seen a decrease in maternal mortality rates over the past two decades, the rates of maternal death in the U.S. has steadily increased. 

The only exception to this trend in the U.S. is California, where the maternal death rate has fallen by half thanks to hospitals adopting maternity and childbirth practices endorsed by leading medical organizations, USA Today reports.

More: Yes, It’s Possible to Have Prenatal Depression Too

So, how do the other states rank? The most dangerous state to give birth in is Louisiana, where the maternal death rate is 58.1 per 100,000 births. The next-most dangerous states for people giving birth are Georgia, Illinois, Arkansas, New Jersey, Missouri and Texas — all of which had between 30 and 39 maternal deaths per 100,000 births. Alaska, Vermont and New Hampshire did not make data on their maternal death rates available to USA Today and were not included in the rankings. 

The report includes stories of individuals who have had complications during childbirth — some of which resulted in death. More information and the full results of the investigation are available on USA Today.

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