Roughly 700 people die from pregnancy-related complications in America every year, and most of them don’t have to.

A new report from the Centers for Disease Control shows just how bad the state of maternal health in the U.S. continues to be. Though our national system for collecting this kind of data is exceedingly poor, what little we have shows that mortality rates related to pregnancy haven’t improved at all in recent years. Right now, the CDC estimates that three out of every five maternal deaths is entirely preventable—we’re just not preventing them.

Here are the key takeaways from this most recent report:

Black and American Indian or Alaska Native women are the most likely to die

For every 100,000 live births in the U.S., 13 white mothers die. American Indian or Alaska Native mothers have a rate 2.5 times as high, at 32.5 deaths, and black mothers have the highest of all: 42.8, which is more than three times higher than that for Caucasians.

That disparity is due to many complicated factors, but Wanda Barfield, director of the Division of Reproductive Health for the CDC, sees four major areas. For one, “black and Native American women deliver at different and lower quality hospitals,” statistically speaking, she said on a press call this week. That step down in quality healthcare could spell worse outcomes for minority women. Another related issue is access to healthcare in the first place. Non-white mothers are more likely to have difficulty seeing top-notch physicians for a variety of reasons which range from lack of insurance to proximity to the providers themselves. The third reason is the issue of underlying conditions. Pregnancy can exacerbate some pre-existing health problems, especially heart conditions, which black women are more likely to have in the first place (a phenomenon that’s also tied to disparity in healthcare access).

And finally, Barfield says there’s the impact of structural racism and implicit bias on health, which helps drive all of the above. Both the long-term stress of living life in America as a non-white person (yes, this has an impact on physical health) and the increased likelihood that your physician won’t give you the best care make health a much bigger challenge for black and native women. Studies have shown that many medical professionals perceive black people as being in less pain than otherwise identical white patients, and are less likely to treat them for that pain, too. Research suggests that even middle-class black women have more trouble getting doctors to take their problems seriously than white women do.

The U.S. is way behind on maternal mortality

As a mother in America, you’re more likely to die from a complication from pregnancy or childbirth than in most other developed nations. Again, the reasons are varied and complex, but a 2018 report from the Commonwealth Fund identified a few key factors. For one, American women have generally poorer access to prenatal care than do women in countries with widely available insurance and healthcare. That means more potential mothers may skip care because of the cost, or simply aren’t able to go see quality physicians.

The U.S. also generally has higher rates of c-section, which is an operation that comes with its own risks, as well as higher rates of obesity, diabetes, and heart disease. All of those health problems can impact the likelihood of serious issues during pregnancy or childbirth.

One-third of maternal deaths happen well after childbirth

Just under a third of pregnancy-related deaths occur during pregnancy. Another third happen during delivery or in the following week. But that final third occurs anywhere from one week to one year after the birth, largely due to cardiomyopathy and other cardiovascular conditions. Emily Peterson, the lead author on the CDC report, explained on a press call that this group includes two distinct pools of people. One is those who already had a heart issue that pregnancy exacerbated, and the other is those who had no problem before giving birth but developed heart issues as a consequence of their pregnancy.

Regardless of when, how, or why these issues occur, however, CDC officials say the best thing physicians can do is help identify patients with chronic conditions before their lives are at risk.