(NEW YORK) — Three of America’s top female athletes have suffered life-threatening complications while giving birth.

Now, the two athletes who survived giving birth, Olympic gold medalists Allyson Felix and Tianna Bartoletta, are speaking out to shine a spotlight on the Black maternal health crisis in the United States as they mourn the loss of their teammate, Tori Bowie.

Bowie, 32, was found dead in her home last month near Orlando, Florida. Authorities said Bowie was eight months pregnant and had been in labor when she died.

An autopsy report released this week found that Bowie’s death was “natural,” noting that possible complications included respiratory distress and eclampsia.

Eclampsia is a medical emergency that happens when a pregnant woman with preeclampsia develops seizures, which can lead to coma or death, according to the U.S. Centers for Disease Control and Prevention.

Bowie won a gold medal at the 2016 Olympics alongside Felix and Bartoletta as a member of the 4x100m U.S. relay team.

In reaction to Bowie’s cause of death, Bartoletta shared a post on Instagram noting that three of the four members of that gold medal-winning relay team “have nearly died or died in childbirth.”

“Why? Black women have the HIGHEST maternal mortality rate. 3 times higher than white women,” Bartoletta wrote on Instagram, alongside a photo of the teammates celebrating their 2016 Olympic win. “And the more educated the black woman, the higher her mortality rate becomes.”

Bartoletta added that when she went to the hospital last year after going into labor with her son at 26 weeks pregnant, she was “NOT AT ALL confident that I’d be coming home.”

“We went to the hospital with my medical advance directive AND my will. Additionally I had a VERY tough conversation with @cwryaniii about who to save if it came down to it,” Bartoletta wrote, referencing her partner Charles Ryan.

Felix, who also faced a potentially deadly experience when she gave birth to her daughter in November 2018, commented on Bartoletta’s post, writing, “It’s heartbreaking.”

“We continue to face a maternity mortality crisis in this country. Black women are at risk. It’s why I won’t stop doing this work,” Felix wrote. “We can’t sit by and continue to watch our loved ones die when many of these complications are preventable. Standing with you T.”

Felix, now 37, has said publicly in the past that just before giving birth to her daughter Camryn, she was diagnosed with severe preeclampsia, high blood pressure that typically occurs in women after the 20th week of pregnancy, according to the CDC.

Felix’s condition was discovered during a routine prenatal visit. She was immediately admitted to the hospital and underwent an emergency C-section, after which her daughter spent a month in the neonatal intensive care unit (NICU).

“Looking back, I wish I would have been better informed about potential warning signs and talked to the doctor about those symptoms,” she said in 2021, when she joined the CDC’s “Hear Her” campaign, which works to create public awareness of the warning signs of pregnancy emergencies. “I really want women to have information, to know if they’re at risk, to have a plan in place, to not be intimidated in doctor’s offices and to feel empowered to speak up when they have concerns.”

While eclampsia is more rare, preeclampsia, a condition of high blood pressure and kidney damage during pregnancy, is common, affecting as many as 1 in 25 pregnancies in the U.S., according to the CDC.

As Black women, both Felix and Bowie are among the population most affected by preeclampsia, data shows.

According to the Preeclampsia Foundation a U.S.-based nonprofit organization, the rate of preeclampsia is 60% higher among Black women than white women, and Black women are more likely to develop severe preeclampsia.

The American College of Obstetricians and Gynecologists also lists being Black as among the “moderate risk” factors for preeclampsia, a condition for which the exact cause is not known.

Bowie, Felix and Bartoletta, as Black women, are also in the highest risk category for death due to pregnancy-related complications.

In the U.S., Black women and Native American women are two to three times as likely to die from a pregnancy-related cause as white women, according to the CDC. Across all races, the U.S. has one of the highest maternal mortality rates in the world, with around 700 women dying each year as a result of complications due to pregnancy.

Despite having one of the world’s most advanced health care systems, the U.S. has the highest rate of maternal mortality among developed nations and the rate has steadily risen for nearly 40 years, according to the CDC.

In 2021, the Biden administration issued a “nationwide call to action” on the maternal health crisis in the U.S. That same year, President Joe Biden issued the first-ever presidential proclamation for Black Maternal Health Week.

In late 2020, the U.S. Department of Health and Human Services launched an action plan to combat the high rates of pregnancy-related complications and deaths. The plan set out three key targets aimed at improving maternal health by 2025: reducing the maternal mortality rate by 50%, reducing low-risk cesarean deliveries by 25% and controlling blood pressure in 80% of reproductive age women.

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