Save the Children released its annual “State of the World’s Mothers” report Monday, including a list of the best places in the world to be a mom. Here’s a hint: It’s not the United States. In fact, the U.S. didn’t even crack the top 10, and fell one spot from last year’s ranking to 31st out of the 178 countries on the list.

The best place to be a mom, according to the report, is Finland. Nine of the top 10 countries are in Europe, with a heavy emphasis on Scandinavia: Norway, Sweden, Iceland, the Netherlands, Denmark, Spain, Germany, Australia and Belgium round out the list.

All but one of the bottom 10 countries on the list are in West and Central Africa. The worst places to be a mom, according to the report, included Côte d’Ivoire, Chad, Nigeria, Sierra Leone, Central African Republic, Guinea-Bissau, Mali, Niger, DR Congo and Somalia. Many of the countries where moms and young children fare worst are places where there has been recent (or chronic) conflict or a natural disaster, according to the report.

Why does Europe fare so much better on the list than the United States? There are several factors, said Carolyn Miles, president and CEO of Save the Children. 

“We do well on education and economic status of women, but we’re not doing well on maternal health and children’s health,” she said. “If you look at things like maternal deaths, the number of women that die in pregnancy or birth in the U.S., it’s 1 in 2,400. That’s pretty good, but there are only 5 developed countries in the world that are worse. There are a lot of countries that put a lot of emphasis on prenatal care, delivery and care of newborns to an extent that we don’t.”

Also, while women’s representation in Congress is at an all-time high, it is still only 19 percent, while we make up 51 percent of the population. In top-ranked Finland, by contrast, women hold about 43 percent of government positions, Miles said. Better representation in government often leads to more mother- and child-friendly policies, Miles said.

The United States once reached as high as four in the annual rankings, Miles said. But the lack of emphasis on high-quality prenatal care and lagging representation in government has caused it to slip.

“I don’t dismiss the fact that 19 percent representation is the best we’ve ever been,” Miles said, referring to the record number of women in U.S. Congress. “Reports like ours point out how interconnected [representation and policies] are. Many countries have been able to to this much better than we have. It’s doable, we just have to have political prioritization that we haven’t had.”