This year, maternal health advocates got the heartening news that the death rate of women in childbirth was declining worldwide, while the rate of child survival was improving ahead of earlier projections. But while the epidemic of maternal and child mortality in poor countries seems to have ebbed--in part thanks to Washington's international assistance--there's been no such progress in some communities closer to home. Recent data on women in New York reveals the vast racial and economic health gaps that still plague the "developed" world. The mortality statistics don't seem so alarming on their own--about 266 pregnancy-associated deaths from 2001 to 2005 across New York City. But an in-depth study of long-term trends exposes disturbing patterns of racial disparity that underscore other community health problems. Health officials found that of the 161 mothers who died of pregnancy-related causes between 2001 and 2005, Black women were seven times more likely to die than white women. The death rates for Asian and Latina women were twice as high compared to whites. While some affluent neighborhoods like Manhattan's Chelsea were untouched by maternal mortality, the highest death rates were in enclaves associated with low-income communities of color, like Bed-Stuy, Crown Heights, and Jamaica. New York City's average maternal mortality rate was nearly double the national rate during this period. Similarly, New York State ranked fourth worst in the nation based on recent federal data. Aside from race, mortality patterns tracked various health factors that disproportionately impact women of color. About half the mothers were obese, which may partially explain why Black women are especially at risk of pregnancy-related death. Maternal mortality was four times higher for women lacking health insurance. And there are still more lingering questions on environmental factors like stress, pollution and deep poverty. One of the more chilling findings relates to another category of deaths among pregnant women, reports the New York Times:

In addition to the 161 women whose deaths were directly related to pregnancy, the city looked at another 105 women whose deaths were indirectly related to their pregnancies. Homicide accounted for more than a fifth of these deaths, suggesting that the stress of pregnancy may be related to domestic violence. Black women were five times as likely to be murdered as white women, and Hispanic women were more than twice as likely to be killed as white women.

An earlier study on violence against women in New York City found that "Women in younger age groups, black and Hispanic women and those living in neighborhoods with very low median household income were at increased risk for fatal and non-fatal [intimate partner violence]." Poor women of color aren't just more vulnerable to illness or injury; their bodies are in many cases targets of systematic brutality, which could lay hidden until their wombs end up as collateral damage in the emergency room. According to the Times, the city's study shows that "while factors like obesity, poverty and race were strongly correlated with maternal mortality, it was not possible to say that those factors actually caused the deaths." True, it's always difficult to separate correlation and causality in women besieged by multiple health crises. But whatever the exact cause, the statistical links speak to inequalities that we seldom discuss in our communities. One thing we can say for certain is that in the world's greatest metropolis, pregnant women are dying needlessly--for reasons that seem like they should belong to another, less fortunate society. But instead, it's happening right next door. Image: Detail from Harlem Hospital WPA mural: Charles Alston, Modern Medicine, oil on canvas, 1940.