Mortality rates for pregnant women and new mothers, already higher in the US than in many other nations, worsened during the pandemic. Much of the increase can be attributed to causes other than difficulties during pregnancy, including drug overdoses, homicides, and car accidents, research shows. The study was published Friday in JAMA Network Open, the New York Times reports. “It is really heartbreaking to see,” said Jeffrey T. Howard, a University of Texas associate professor who was the study’s lead author. “We are failing these women as a society and failing their children,” he added.

Black and Native American women are at the greatest risk. Native American women were 3.5 times as likely to die during and after pregnancy than white women, the study found, while Black women died at nearly twice the rate white women did. From pregnancy complications alone, the death rate of Black women was 2.8 times that of white women. Native American women also were five times as likely as white women to die in a car accident, three times as likely to die of a drug overdose or homicide, and four times as likely to die of suicide.

The researchers analyzed thousands of death certificates from 2019 and 2020. Deaths from nearly all causes, including pregnancy complications, rose in 2020. “There is definitely a problem in our country for women who are either pregnant or in the postpartum period, who are vulnerable and under a lot of stress,” Howard said. The pandemic hit Native Americans especially hard; their average life expectancy dropped 6½ years, to 65, and it’s been falling overall in the US, as well. Howard expects the trends to hold, though the Centers for Disease Control and Prevention says 80% of maternal deaths could be prevented. (Read more maternal health stories.)