The United States is experiencing a maternal and fetal health crisis.

We have the highest rate of maternal and infant mortality in the developed world, including a disproportionately high rate among Black women and children.

U.S. women are more likely to suffer a pregnancy-related death today than in the 1990s. The risks are even greater for women of color. Black women are at least three times more likely than white women to die as a result of pregnancy. In Illinois, their risk is six times higher. In New York City, their risk is twelve times higher.

Babies are suffering, too.

There’s a racial disparity in maternal and infant health

According to the CDC, Black infants are twice as likely to die from pregnancy-related complications as those born to non-Latinx white mothers. Black babies are more likely to be born preterm and are twice as likely to die in their first year of life.

Dr. James Collins is the medical director at the neonatal ICU at Chicago’s Lurie Children’s Hospital and a professor of pediatrics at Northwestern University. He has dedicated his career to understanding racial disparities and birth outcomes.

“We’ve always hypothesized that living in the U.S. as an underserved minority is not good for your health, as measured by preterm birth rates,” Dr. Collins tells Motherly in an exclusive interview. “We’ve come to realize that racism is a chronic stressor for African American women. There have been a number of studies that have shown that it is a risk factor for preterm birth.”

As an example, Dr. Collins cited a study that was conducted in California. It found that African American women that worried about racial discrimination had a two-fold greater risk of having a preterm infant, compared to women that didn’t have chronic worry about racial discrimination.

“We’ve also looked at the concept of structural racism,” says Dr. Collins. “I think it’s a bigger risk factor. It’s insidious, it’s more difficult to measure.” Dr. Collins’s team obtained data that looked at approximately 300 shootings of unarmed black people over a five-year period. His team found that the areas where those shootings occurred also had higher rates of racial disparities in preterm births, on average, than those that had no killings or very few killings.

It comes down to structural and systemic racism

“We’ve also done studies looking at redlining and we found that’s associated with increased risk of preterm birth,” says Dr. Collins. Redlining refers to the practice of racial discrimination in mortgage lending that happened in the 1930s. It shaped how American communities grew—and still affects them today.

“We know in most metropolitan areas, the geographic separation of races is almost complete, largely due to the historical context of redlining,” explaines Dr. Collins. “African Americans are more likely to live in low-income neighborhoods their entire lives. Whites are more likely to live in higher-income neighborhoods their entire lives. Clearly, in both groups, if you happen to live in a poor neighborhood, that is a risk factor for poor outcomes. But because African Americans have such a higher prevalence in those neighborhoods, it disproportionately contributes to their poor outcomes. So, neighborhood poverty, which is in a large part related to redlining and structural racism, is another contributing factor to the poor outcomes for African American women compared to white women.”

“Equitable health care is a right, not a privilege.”

More recently, Dr. Collins’s research has focused on the role of fathers. In one study, his team compared a gap in health outcomes between U.S.-born Black women and foreign-born Black women, as well as the gap between U.S.-born Black women and U.S.-born white women.

Dr. Collins says that access to prenatal care and the mother’s education levels were found to have an impact on preterm birth rates. “But what really had the biggest impact was dad acknowledgment on the birth certificate, which is a pretty weak marker for involvement,” says Dr. Collins. “But it had a bigger association than even maternal education. So, if dad was not acknowledged, that was a major risk factor for poor outcomes.”

His team then focused on fathers’ specific education levels—and what that meant for their children. They found that a father’s education level impacted preterm birth rates.

“If dad’s education went up, preterm birth rates went down,” he explaines. “But U.S.-born Black women had a higher percentage of dads who didn’t complete high school, they had a lower percentage of dads who didn’t graduate college, so we were able to do some fancy statistical modeling and found that dads’ education attainment explained a greater proportion of the disparities than even moms’ education,” he says.

The study found that a father’s education mattered three times as much as the mother’s education when it comes to preterm birth rates.

March of Dimes, the leading non-profit in the fight for the health of moms and babies, funded the study.

“The findings from Dr. Collin’s research shed light on factors that impact higher preterm birth rates among Black moms and babies in the United States,” says Dr. Rahul Gupta, Chief Medical & Health Officer for March of Dimes. It’s “a strong reminder that more must be done.”

“Equitable health care is a right, not a privilege,” he adds. “For more than 80 years, March of Dimes has been helping lead this fight. We have a choice. We can either make a change or see more death and health challenges facing our nation’s moms and babies, especially women and babies of color.”

And let’s be clear: This is a fight. We do have a choice. Black women in other developed nations don’t face the same type of risks during pregnancy and birth. Their babies are more likely to survive birth and into childhood.

Many of Dr. Collins’s studies identified something researchers call “modifiable characteristics;” that is, things that can be changed for a better outcome. The problem is that they’re not quick or easy fixes. They require major investments: in time, money, and government and social accountability.

Take the study about fathers’ education, for example. It’s not enough to simply say that Black moms and Black babies will have better health outcomes if fathers are able to pursue higher education.

“I think the role where fathers are is a result of structural racism,” says Dr. Collins. “African American men are less likely to go to college and they’re more likely to be in jail. Their neighborhoods are more likely to have high unemployment rates. So, all that stuff, structural racism is at the top of the stream. There’s major systemic things that have to be changed,” he adds.

We need to invest in children and families

We know birth outcomes for Black moms and babies are worse in areas where there are a high number of shootings of unarmed Black men; in low-income, redlined neighborhoods; when Black fathers lack equal access to education; and when moms experience chronic worry about racial discrimination.

These are all symptoms of systemic racism. And they’re killing families.

Read more: Having more Black doctors and midwives could be the key to reducing Black maternal mortality rates

As Dr. Gupta says, we can choose to fight. We can demand public policies and legislation that address income, housing, racial, medical, and education inequalities. We can donate to organizations that are dedicated to improving the quality of life for all Americans. We can elect public officials who will use the power of their office to protect moms and babies.

There is no quick fix—which is why we must demand change now.

“This is a massive problem that really goes back generations and to correct it, is going to take generations,” says Dr. Collins.

And this impacts everyone.

We know that America has the highest rate of maternal mortality in the developed world. If we were to take African American women out of our statistics and only consider outcomes involving white moms, we’d still be in the same ranking: dead last.

“It’s just mindboggling. I think we tend to forget that,” says Dr. Collins.

“We need to invest more in children and families, young families. But it affects us all.”

We need to invest in our children. We need to invest in our families. And we need to do it now.