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Women in the United States are twice as likely to die from causes related to pregnancy or childbirth than women in Canada, according to a survey published Thursday by the United Nations and the World Bank.

The U.S. was one of only 13 countries to have worse rates of maternal mortality in 2015 than in 1990, the World Health Organization study found.

Among those other 12 are North Korea, Zimbabwe and Venezuela.

Globally, maternal deaths have dropped by 44 per cent since 1990 – to an estimated 303,000 this year from 532,000.

“Over the past 25 years, a woman’s risk of dying from pregnancy-related causes has nearly halved. That’s real progress, although it is not enough. We know that we can virtually end these deaths by 2030 and this is what we are committing to work towards,” WHO Assistant Director-General Flavia Bustreo said in a statement.

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Maternal mortality is defined as a woman’s death during pregnancy, childbirth or within six weeks of giving birth.

While global trends are more positive, the United States average has slipped from 12 deaths to 18 per 100,000 live births over the past 25 years, while Canada’s remains around six where it was in 1990.

Jennifer, the CEO with the Society of Obstetricians and Gynaecologists of Canada, said chronic illness and other socio-economic levels are contributing factors to increased maternal mortality in the U.S.

“Chronic illnesses such as obesity ,diabetes, and cardiac disease sae are increasingly contributing to maternal mortality,” Blake said in an email. “Social determinants of health , access to care, poverty under housing and insecurity of food are basic conditions for good health that we all have to address.

“Violence and mental health are an important contributor in the developed world, and we know we have problems in Canada. Advancing maternal age is a risk that we are also watching closely, as older women may have more underlying health issues” Tweet This

Only nine countries hit the U.N. Millennium Development Goal of reducing maternal mortality by at least 75 per cent between 1990 and 2015. Those countries are Bhutan, Cabo Verde, Cambodia, Iran, Lao People’s Democratic Republic, Maldives, Mongolia, Rwanda and Timor-Leste.

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“Many countries with high maternal death rates will make little progress, or will fall behind, over the next 15 years if we don’t improve the current number of available midwives and other health workers with midwifery skills,” Babatunde Osotimehin, executive director of the U.N. Population Fund, said in a statement.