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

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

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.

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 A newer version of the form, released in 2003, added a dedicated question asking whether the person who died was currently or recently pregnant — effectively creating a flag for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:

  • 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.

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Comments (1)

  1. Submitted by Beth-Ann Bloom on 06/12/2015 - 08:21 pm.

    Bad data

    Has the death rate of women in this cohort changed? Looking at the Scientific American graphs most of the reported increased in maternal mortality are not associated with obstetric issues but with other causes. If a pregnant woman dies in a car crash or of a drug overdose those are counted as cases of maternal mortality.

    While the death of a young person is tragic and should be prevented and the fact that these deaths disproportionately occur among poor people and/or people of color is inexcusable this article is yet another time when bad data is used to drive social policy. Even while admitting that the numbers are unlikely to represent declining maternal health, the author still offers suggestions to improve care around pregnancy.

    Just as the IT folks assure us that garbage in results in garbage out; in social policy poor data often results in poor interventions. WE need to pay attention to the quality of data before we allow it to drive discussion and policy making.

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