Washington has the highest infant mortality rate of all the world's richest capitals, according to a survey highlighting the failure of the world's wealthiest country to prevent high rates of child deaths among its poorest citizens.
Save the Children said in a study on Tuesday that 6.6 babies die per 1,000 live births in Washington, making the U.S. capital the most dangerous city in the developed world to be born.
In contrast, only 1.6 babies die per 1,000 live births in the Czech capital Prague, which topped the charity's index measuring child survival in the world's wealthiest capitals.
Prague was followed by Stockholm, Oslo, Tokyo and Lisbon.
The headline figure for Washington masked huge disparities between rich and poor.
Babies born in Ward Eight, just 6 km (4 miles) from the White House, were 10 times more likely to die before their first birthday than babies born in the city's most affluent Ward Three, the study showed.
"It's survival of the richest," said Carolyn Miles, chief executive of Save the Children USA, in a statement.
Unemployment, poverty and murder rates in Ward Eight, where 93 percent of the population of 71,000 are black, are among the nation's highest.
"The underlying health of mothers... in these poor communities is not good," Miles told the Thomson Reuters Foundation in an interview.
"High rates of diabetes and high rates of obesity contribute to these women having more pre-term babies."
Typically, at risk babies are born to single mothers who live in subsidised housing, Ward said. They often do not know about the risks of childbirth and do not get sufficient pre-natal care.
"Community outreach and community engagement with pregnant moms is really something that has worked in other places - and we need more of that in Washington DC," she said.
Somalia worst country for mothers
The United States as a whole performed poorly in Save the Children's annual flagship State of the World's Mothers report, slipping two places to number 33 out of 179 countries surveyed.
Norway came first, from second place in 2014, scoring highly on all five indicators: maternal and child health, children's access to education and women's political and economic status.
The worst country to be a mother was Somalia, for the second year running. Almost 15 percent of Somali children do not live to see their fifth birthday, the charity said.
The United States had the highest maternal death rates in the developed world. American women face a 1 in 1,800 risk of maternal death compared to less than 1 in 19,000 in Poland.
"An American woman is more than 10 times as likely to die in pregnancy or childbirth as a Polish woman," Save the Children said in a statement.
The United States has the highest healthcare costs in the world, according to a 2014 study by The Commonwealth Fund, a New York-based research foundation.
Some 37 percent of Americans skipped a recommended test, treatment or medication in the last year because of its cost, compared to four percent in Britain, it found.
People rely on health insurance to recover money spent on healthcare. But 12 percent of Americans do not have health insurance, according to an April poll by Gallup.
However there has been some progress since the Affordable Care Act was passed in 2010 to insure more Americans and slow the growth in healthcare spending by giving tax subsidies to help poorer Americans buy private health insurance.
In the five years since the law was passed, the number of uninsured Americans has fallen by more than 11 million to 37 million from 48.6 million, the U.S. Centers for Disease Control and Prevention says.