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Too many U.S. women are dying during childbirth. The problem is not the paperwork.

An article in Scientific American indicates that the increase in the pregnancy-related death rate may be the result of a change in how death certificates are filled out. Still, the rate’s way too high.

A Lancet study published last year put the 2013 U.S. maternal death rate at 18.5 deaths per 100,000 live births.
REUTERS/Carlos Barria

I’ve written here many times about how American women are dying during pregnancy and childbirth at twice the rate they were 30 years ago.

The U.S. Centers for Disease Control and Prevention (CDC) reports that pregnancy-related deaths increased from 7.2 deaths per 100,000 live births in 1987 to 17.8 deaths per 100,000 live births in 2011.

A Lancet study published last year put the 2013 U.S. maternal death rate even higher, at 18.5 deaths per 100,000 live births.

That, of course, is a shocking and disturbing trend.

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But, according to an article published online this week in Scientific American, much of that sharp increase in the pregnancy-related death rate may be the result of a change in how death certificates are filled out today compared to 30 years ago.

The article provides a good lesson about not taking any fact regarding health and medicine for granted.

A new form

Dina Fine Maron, Scientific American’s associate editor for health and medicine, explains why the statistic about the doubling of the U.S. maternal death rate is being questioned: 

Statistics for 40 states and the District of Columbia, gleaned from death certificates, indicate that whereas the reported maternal mortality rate from 1999 to 2002 was 9.8 per 100,000 live births, it jumped to 20.8 per 100,000 live births for the period 2010 to 2013. But the numbers in the latter period may have been affected by a small change in the forms that are filed when a person dies. Until relatively recently most states relied on a death certificate form that was created in 1989. A newer version of the form, released in 2003, added a dedicated question asking whether the person who died was currently or recently pregnant — effectively creating a flag for capturing maternal mortality. Specifically, this recently introduced question asks if the woman was pregnant within the past year, at the time of death or within 42 days of death. 

The addition of this question means that the apparent increase in maternal mortality in the U.S. “is almost certainly not a real increase. It’s better detection from the new certificates,” says Robert Anderson, chief of the Mortality Statistics Branch with the CDC’s National Center for Health Statistics. “The numbers are going up but it’s most likely not because women are more likely to die,” he contends.

Still unacceptably high

Of course, as that comment by Anderson makes clear, even if the sharp jump in U.S. maternal deaths over the past three decades is due to an administrative issue, more women are dying today as a result of pregnancy and childbirth complications than they were in the 1980s or 1990s — more, in fact, than in any other developed country.

And that’s a scandal — one, unfortunately, that still gets little attention.

“There is no charity walk to raise awareness about the 700 to 800 women that die each year during pregnancy or shortly after giving birth in the U.S.,” writes Maron. “There are no dedicated colored-plastic wristbands.”

As Maron points out, several factors may explain the high maternity death rate in the United States:

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  • Poorer pre-natal health. An increasing number of pregnant women have existing chronic health conditions, such as diabetes and high blood pressure, which significantly raise the risk of complications during pregnancy.
  • Inadequate post-natal care. Women weakened by childbirth complications have an increased risk of dying up to a year after the end of the pregnancy, yet many do not receive quality follow-up medical care.
  • Racial inequalities in health care. Although black women in the U.S. are not more likely than white women to have underlying pregnancy complications, such as preeclampsia, they are two to three times more likely to die of those complications.

“For now,” writes Maron, “more interventions to keep women healthier even before they get pregnant, better care during and after pregnancy and better tracking of maternal deaths will be essential tools in the fight to save women from these preventable deaths.”

You can read her article on the Scientific American website.