42 is Missouri’s national ranking when it comes to maternal mortality rates at 32 deaths per 100,000 births. To put this in even sharper perspective, Missouri trails Romania in maternal mortality. While most of the developed world has experienced a decline in maternal and infant mortality, the United States, including Missouri, remains stubbornly stuck and has even experienced an uptick in deaths from 2016-2018. Missouri’s mortality rate for African-American moms skyrockets to 65 per 100,000 births, a rate that is double the state rate. In addition to health, we must examine the underlying causes of maternal health disparity, including systemic racism that puts black mothers and babies at risk. The importance of good health before, during and after pregnancy is key to improving maternal health outcomes. Leading causes of maternal death include excessive bleeding, high blood pressure, heart disease, and blood clots. Rising rates of obesity and poor overall health contribute to these outcomes. Missouri also has very high rates of tobacco use among pregnant women at 15.3%, more than double the national average of 7.2%. This speaks only to the worst outcome and does not account for morbidity, near misses.