"But we have a rather poorly developed system of good primary care and prenatal care," she continues. "And our problem is connecting the prenatal care with the delivery site, making sure the information about a patient travels with that patient when they go into labor and go to the hospital. So we can deal with the high-tech and the crisis. Our problem is we're not focusing upstream on the prevention and the primary care, and the developing countries are just the opposite."

Maternal mortality in America is particularly high in New York City, where extremes of wealth and poverty abound, says Deborah Kaplan, who oversees the Bureau of Maternal, Infant and Reproductive Health for New York City's health department. The department analyzed the causes of 161 maternal deaths in New York between 2001 and 2005. The study found that half the women who died were obese and that 56 percent had a chronic illness, such as high blood pressure, heart disease or asthma. Black women were seven times more likely to suffer a pregnancy-related death compared to white women.

"And we think the issue for black women is they are more likely to be obese and have chronic illnesses, like high blood pressure, which put you at higher risk for complications during pregnancy," says Kaplan. "Black women, who are more likely to be uninsured, are living in communities where there is limited access to the healthy foods and exercise and activity that is necessary from childhood on to reduce the likelihood of obesity and chronic illnesses."