BETHEL, Alaska — The contractions were coming eight minutes apart, and Billie Jo Yupanik was breathing into them, her gaze down, hands cradling her abdomen.

Around her, other pregnant women padded around the open, airy rooms of the Yukon-Kuskokwim prematernal home, chatting on phones or grabbing coffee from the pot. They mostly smiled and nodded at Ms. Yupanik as they passed, but otherwise seemed to pay her little mind. Going into labor, after all, is hardly remarkable in this place.

Childbirth has become more dangerous for women across much of the United States over the last two decades; maternal death rates have doubled since the late 1980s, according to federal figures. Rural places — here in Alaska and across the lower 48 states — are among the hardest hit as vast distances, widespread poverty and fewer doctors make it harder to obtain access to health care. And Native populations are often on the very edge of that disparity: A baby born to an Alaska Native mother is four times as likely to die in the first year of life as a white baby.