Looking back, Jo Ann Allen wonders what she might have missed in the days leading up to her niece’s sudden death.

Monique Bacon was 17 and had given birth to a son weeks before. Allen, a nurse, took Bacon to her prenatal appointments. She said Bacon seemed fine — energetic and healthy.

So no one expected what happened at a Chatham, Ill., gas station in 1991. Bacon collapsed. Allen, summoned by a relative, arrived to see paramedics trying to resuscitate her. “It was devastating,” she recalled of her niece’s death, which was because of a heart-related problem. “She left a newborn.”

The Centers for Disease Control and Prevention estimates that every year, 700 U.S. women die within one year of giving birth as a result of related complications.

As other countries’ rates of maternal death decline, the U.S. is experiencing an alarming rise in maternal mortality — nearly four times worse than Canada, and five times worse than Australia. The nation’s numbers are more on par with Libya and Bahrain.

And black women are three to four times more likely to die from causes related to pregnancy, according to the CDC.

To help reverse this trend, Illinois Rep. Robin Kelly, who is co-chair of the Congressional Caucus on Black Women and Girls, introduced a bill that would expand Medicaid coverage, establish emergency obstetric protocols, encourage training and create federal collection of data. “Having a baby in 2018, you shouldn’t lose your life from that,” Kelly said.

A February CDC review of nine states concluded that of the 680 women who died during pregnancy or within one year of delivery, about 60 percent of their deaths could have been prevented. Nearly half of the deaths were because of hemorrhage, heart issues or infections.

In April, the American College of Obstetricians and Gynecologists recommended a “fourth trimester” of care, beginning within three weeks of giving birth. The Black Mamas Matter Alliance has urged an improved response to obstetric emergencies, ensuring women understand warning signs for complications and requiring providers to have bias training.

“It’s not easy to pinpoint to one thing,” said Shannon Lightner, deputy director of the Health Department’s Office of Women’s Health and Family Services. “There’s so many other things going on that interplay in a black woman’s life. If black women are more likely to be in poverty, if black women are more likely to be on Medicaid, if black women are more likely to have transportation barriers, all of those things are going to be playing a role.”

The CDC said both patient and provider factors contribute to deaths. Dr. Nicole Williams, founder of the Gynecology Institute of Chicago, said the medical community needs to focus on monitoring mothers as much as they do infants. “We are very good at keeping babies alive, but we don’t think as much about moms,” she said. “After a woman has a baby, that’s probably her most vulnerable time.”

One way to reach moms is to visit them. And some pilot programs are offering free home visits for every new mom.

Allen has spent the decades since her niece died working as an instructor at the University of Illinois at Chicago’s College of Nursing. She said, “The same problems that existed when I started 40 years ago are the same problems that we’re seeing now.”

When she speaks to new parents, she emphasizes that the family should pay attention to the mother’s health — and not just the next day but weeks and months later. She emphasizes warning signs. Headaches. Dizziness. Nausea. Pain that medication doesn’t help.

She said, “So many times the mothers forget about themselves because they’re so worried about taking care of their baby.”