The United States has slipped on an index that measures the best and worst places in the world for mothers — hurt by infant-mortality and maternal-death rates that stand in stark contrast to the nation's wealth.
"In some United States cities, urban child survival gaps between rich and poor are greater than those found in developing countries," according to the report by the non-profit Save the Children.
The U.S. ranked No. 33 on the Mother's Index this year, two slots down from last year. The rate of women who die from childbirth or pregnancy is 1 in 1,800 — 10 times worse than a woman in Belarus. Nearly 7 in 1,000 children die before their fifth birthday, on par with Serbia.
In Washington, D.C., the infant mortality rate is higher than any capital of a wealthy nation — even though at 6.6 deaths per 1,000 births, it's the lowest it's ever been. By contrast, Sweden's rate was below 2.0.
And within the district, the risk depended in large part on where the baby lived. In one of the poorest neighborhoods, the infants were 10 times as likely to die before their first birthday than in the richest.
Race was also a factor. "In many U.S. cities, poor, unmarried and young African-American mothers are losing their babies at much higher rates than the U.S. average," the report found. In San Francisco, for instance, a black mother is six times more likely than a white mom to lose her baby.
Globally, the ground found that the urban poor in developing countries are often worse off than their rural counterparts, because of water, sanitation and health care deficiencies. "In most countries the poorest urban children are at least twice as likely to die as the richest urban children before they reach their fifth birthday," the authors wrote.
The country ranked last on the Mothers Index, at No. 179, was Somalia, where the mortality rate for children under 5 is a staggering 145 per 1,000 live births.