Women in the United States face a higher likelihood of suffering pregnancy-related death and their babies dying compared with women in the world’s wealthiest countries, says an annual report published by Save the Children reported on Time.com.

According to the findings, the United States ranked 33rd of 179 countries surveyed, a slide down of two spots from last year. (Researchers used the latest available data on political status, economics, education, children’s well-being and maternal health as indicators.)

In the areas of maternal health and children’s well-being, America ranked No. 61 and No. 42, respectively. What’s more, the United States ranked 89th in terms of women’s political status, defined as women’s participation in national government.

Scandinavian countries—Norway, Finland, Iceland, Denmark and Sweden—dominated the top 5 ranks. The bottom 5 countries for moms were all in Africa. Among them were Sierra Leone (which tied with Haiti), Guinea-Bissau, Chad, Côte d’Ivoire and Gambia.

Among the 25 capital cities of wealthy countries surveyed, Washington, D.C., had the highest rate of infant mortality, with 7.9 deaths per 1,000 births as of 2012. In Detroit the rate of newborns dying was even higher, at 12.4, and in Cleveland it was 14.1. Overall, the United States had an infant mortality rate of 6.9 deaths per 1,000 live births—comparable to that in nations such as Bosnia, Serbia and Macedonia.

Researchers said that high premature birth rates, insufficient prenatal care, a lack of education, poverty and race likely contributed to the surprisingly high numbers in America.

For more information about racial health inequities in the United States, click here.