According to the World Health Organization, 2.8 million people die per year from diseases related to being overweight or obese. The WHO also states that “In all WHO regions women were more likely to be obese than men.” This is a global problem, but also uniquely a women’s problem, especially as the weight of pregnant mothers can cause complications in pregnancy.

The United States is not exempt from this matter. In 2015, the Maternal Mortality Ratio in the United States was 14 in 100,000, and that number is increasing. In other words, despite our status as a world economic leader, the U.S. is 46th in the world for maternal mortality (The World Bank). With our nation’s wealth and our growing access to affordable healthcare, we should be doing more for our own mothers, right?

It turns out that maternal mortality in the United States is not always a matter of wealth. As Kelly Wallace reports:

A range of experts made clear to me that there isn’t any one factor to explain the increase, but a number of issues, including obesity-related complications such as hypertension and diabetes, the dramatic increase in the number of cesarean section births, a lack of access to affordable, quality health care and more women giving birth at older ages.

Record-keeping also contributes to the change, as it is now included as a box on the U.S. death certificate that most states use.

Of these issues, it’s likely that obesity contributes to this issue the most. An overweight or obese woman may already have to cope with heart disease or other complications from her weight; the “’demands of pregnancy,’” according to associate professor of nursing Elise Turner, put too much stress on the body already, and furthermore, African-American women are over 300% more likely to die from pregnancies than white women. Kristof and WuDunn discuss this in their chapter seven, “Why Do Women Die in Childbirth?”: according to some limited data, African-America women are more likely to have anthropoid pelvises – an elongated pelvis shape that is “more likely to result in obstructed labor.”

How do you combat such a multi-faceted problem? Wallace’s CNN article seems to be a bit contradictory. On one hand, Dr. Michael Brodman, a chairman of the OBGYN department in a New York hospital network, says, “’We didn’t specifically have protocols for dealing with obese patients. We didn’t treat them differently and in reality, you have to treat them differently.’” The same logic would follow for women with different pelvis shapes – they, too, should be treated differently. Paradoxically, Brodman has been part of programs that seek to standardize OBGYN care, since states or even individual hospitals often have different practices in pregnancy and delivery. (These programs include the American Congress of Obstetrics and Gynecologists’ Safe Mother Initiative and the National Partnership of Maternal Safety.) Hopefully standardized maternal care does not replace individualized maternal care, because certainly we need both.

While individualized care may greatly help our rate of maternal mortality, our obesity epidemic is another beast we have yet to tackle. There is a Campaign to End Obesity, which advocates for policy changes and provides information about the American obesity epidemic. But there is a thin line here, too: how do we recognize that obesity is a problem, but treat overweight people as equal people – not as failures or, sometimes worse, as products?

The Obesity Action Coalition has a great brochure that highlights some of the ways that the obese are discriminated against in the workplace and in their social lives. The brochure states that the overweight individual should try to practice positive self-talk, and healthcare professionals should become more sensitive about the issue and encourage patients to discuss their weight in a healthy way.

However, while it encourages individuals to “decid[e] how to best handle” stigmatizing situations “to achieve positive emotional health and to help prevent additional stigma from occurring” (p 11), it does not provide actionable steps for, say, loved ones of overweight individuals to better recognize their own hurtful words and actions. By focusing only on the individual’s response, are we directing attention to the wrong place?

Ultimately, our school lunch initiative and current healthcare system is failing, especially as healthcare providers are often insensitive about the overweight woman’s issues. The public’s response to obesity is often one of disgust, which does nothing to help the problem. I hope we can tackle this issue better in the future, but unfortunately it seems that we are a long way away from finding the line between action and shame.