A new article at The Daily Beast highlights the risks of motherhood in India in a striking way. Every year, half a million women die as a result of pregnancy. And for every death, there are 20-30 cases of maternal injury. At the same time, high-end private clinics support surrogate mothers bearing children for infertile couple from the wealthy world. It’s an ugly dichotomy, and it points to financial inequalities and health sector weakness.

Human Rights Watch has a new feature on maternal mortality in India, and they found that most maternal deaths come from bad referrals. Women in life-threatening emergencies were being referred to health facilities that either would not accept them or couldn’t provide the care they needed. (Women at private surrogacy clinics, of course, are already at a facility that can handle obstetric emergencies.)

Overcoming this problem this would require a two-prong solution. Better referral systems, to make sure women are going somewhere that can care for them, and more facilities equipped to take emergency referrals. Both of those things are tough to achieve.