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For every 1,000 live births, Norway has 13 OB-GYNs and 54 midwives, thefound, compared with 12 OB-GYNs and four midwives in the U.S.

Regular care means problems are spotted and treated early, said Roosa Sofia Tikkanen, a doctoral candidate at the Center for Global Health Inequalities Research in Norway.“Maternal mortality is an entirely preventable event providing you have access to basic health care,” Tikkanen said. “Not high-tech health care but basic health care.”What happens during and after delivery also makes a difference. The national rate for cesarean sections, which are more likely than vaginal births to lead to complications, is about 16% in Norway compared to 32% in the U.S. The Scandinavian country also mandates generous paid leave, which research links to better postpartum health.

Commonsense Childbirth, which has locations in Orlando and Winter Garden, Florida, offers a small-scale model of European care. It has clinics, a birthing center and training for health professionals.The midwives who run the program welcome vulnerable patients that other practices turn away, such as those who are uninsured or haven’t had prenatal care until late in pregnancy.

Founded by British immigrant Jennie Joseph about 26 years ago, it has never had a maternal death.

“We have these four tenets that go with my model: access, connection, knowledge and empowerment,” she said. Some patients “cry because they’ve never had that kind of care or respect.”“Hawaii has exceptionally high land value and so there’s often pressure to redevelop — anything — to a more intense commercial use,” she says. “It takes a lot of commitment to say we’re going to keep something that’s important to us, even in the face of that kind of pressure.”

Remarkably little of Hawaii’s 20th-century architecture has been preserved, especially in urban areas, says William Chapman, dean of the school of architecture at the University of Hawaii at Manoa.The mid-20th-century was a particularly harsh period for historic buildings in Honolulu, he says: “We lost a lot.” What’s left is “probably two handfuls of buildings, dating back in time to the pre-territorial period, back to the 19th century.”

Developers use neglect as an excuse to tear down buildings, Chapman says. “Old-timers love to talk about the house being held together because the termites hold hands, right? I get sick of that.”This image shows an exterior view of the Manoa Heritage Center in Honolulu, founded in 1996 by Sam and Mary Cooke in 1996. (Kristina Linnea Garcia via AP)