Here’s something hard to believe: more women in the United States die today from complications of pregnancy and childbirth than 20 years ago. And more than 50,000 women nearly die each year because they experienced a life-threatening event during childbirth, pregnancy or as a new mother. Maternal deaths, declining even in the poorest countries, have been on the rise in the U.S.

The problem is even more troubling when we look closely at who is dying: Black women are three to four times more likely to die from a pregnancy or childbirth related complication than white women — a stubborn fact that hasn’t changed in decades. Racial disparities in maternal health are wider than in many other areas of women’s health, including breast cancer and heart disease. They are persistent and insidious.

What is going on?

While many point to socioeconomic factors, including poverty, access to transportation, affordable housing or health insurance, these alone do not fully explain this disparity in maternal health outcomes.

There are clear signs that structural racism is a driving force perpetuating these unacceptable disparities. For example, last year researchers at Columbia University conducted focus groups with women from communities of color who revealed that few have a relationship with a provider they trust during childbirth. And some women expressed that oftentimes “decisions are not our own” and they do not feel heard or respected.

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Addressing the implicit racial bias behind these women’s accounts is crucial to improve health care and ensure dignity. It will take decades to change the deep-rooted, negative dynamic between many communities of color and health care providers. But an important step toward narrowing racial disparities in maternal health is deceptively simple:

We need to listen to women.

We need to share their stories.

And we need to act on what we hear.

While we may understand the clinical reasons why women are dying, we have not taken the time to listen to the stories of those who survived. Health care providers and hospitals play a vital role in improving the quality of maternal health care, but there is no substitute for hearing directly from a woman, her family and community about what happens during pregnancy, childbirth and the early days and weeks of motherhood when most deaths occur.

Women must play an integral role in efforts to improve maternity care. Asking women about their experiences will shed much-needed light on their interactions with maternity care providers and identify opportunities for systemic change to prevent future tragedies.

The MoMMA’s Voices Coalition is a promising effort to capture the traumatic experiences of women who nearly died during pregnancy and childbirth. This grassroots movement has started harnessing the powerful stories of survivors to advocate for policy and institutional changes in the way that maternity care is delivered and women are treated.

Here is what we know. The challenges women confront extend beyond hospital walls. Access to transportation, childcare, nutritious food and safe housing are critical — and women across the country often face barriers to getting this critical support.

We need a holistic approach to help end maternal deaths, which is what prompted Merck for Mothers to launch the Safer Childbirth Cities initiative. Through this $10 million effort, cities with high rates of maternal mortality and racial disparities will receive grants to develop and implement creative, multi-sector solutions to save women’s lives, improve maternal health and narrow disparities. At the core of this initiative is asking, listening and responding to women’s stories to help bridge the gap between hospitals and communities.

It’s our hope that equipped with what we hear and what we learn, cities around the country will be able to take action to provide the high quality, respectful care that millions of American women deserve.

Reverse is a short film that tells the story of a young daughter and the many challenges she faces on her journey to motherhood. Despite good parenting, good education and a good job, surviving giving birth is far from a given.

Dr. Mary-Ann Etiebet is the Lead and Executive Director of Merck for Mothers, Merck’s 10-year, $500 million initiative to help create a world where no woman dies while giving life. Merck for Mothers is known as MSD for Mothers outside the United States and Canada.