Tuesday, October 31, 2017

Dying to give birth:why is maternal mortality so high?

We can't welcome the news, but we can welcome the fact that the dangerously high and rising US maternal morality rate is finally getting more attention, most recently in this excellent Quartz article by Annalisa Merelli.
With an estimated 26.4 deaths for every 100,000 live births in 2015, America has the highest maternal mortality rate of all industrialized countries—by several times over. In Canada, the rate is 7.3; in Western Europe, the average is 7.2, with many countries including Italy, Norway, Sweden, and Austria showing rates around 4. More women die of childbirth-related causes in the US than they do in Iran (20.8), Lebanon (15.3), Turkey (15.8), Puerto Rico (15.1), China (17.7), and many more.
(Ahem---Puerto Rico, though not a state, is part of the US)
While most of the world has drastically reduced maternal mortality in the past three decades, the US is one of just a handful of countries where the problem worsened, and significantly.
Between 700 and 1,200 women die from complications related to pregnancy or childbirth every year in the US. Fifty times that number—about 50,000 in all—narrowly escape death, while another 100,000 women a year fall gravely ill during or following a pregnancy.
The dire state of US data collection on maternal health and mortality is also distressing. Until the early 1990s, death certificates did not note if a woman was pregnant or had recently given birth when she died. It took until 2017 for all US states to add that check box to their death certificates. Calculating the number of near-deaths and severe illnesses related to pregnancy is still guesswork. There is no standard or official method of tracking, and cases are not routinely documented. In other words, data collection about maternal health and mortality is a complete mess. Even gathering reliable data for this story was difficult. Quartz was forced to turn to state data where there was a lack of national data, and to supplement gaps of any data with anecdotal evidence.
With poor statistics, it becomes harder, but no less pressing to ask why so many American women are dying. Experts often blame---guess who? the women:
Other, related trends were evident in the US over that 1990-2015 period, in particular steep increases in the rates of obesity and diabetes. Couple that with a growing trend of women deciding to delay motherhood until they were older, and you very quickly arrive at a refrain that is often used to explain why America is failing to keep its number of maternal deaths at acceptable levels: that new mothers are “older, fatter, and sicker.”
“The increasing number of women who enter pregnancy with higher rates of obesity, hypertension, diabetes, abnormal placentation…are typically the first and only factors considered,” points out Christine Morton, a researcher at the CMQCC, in a commentary paper.
In other words, she notes, it’s presented as the women’s fault.
In a culture that places such emphasis on the value of self-determination and personal responsibility, it’s perhaps not surprising that expectant or new mothers would be judged deficient in their apparently poor life choices. But that ignores the fact that increased rates of obesity and related chronic health conditions are global, not just American, and that in other countries, they do not amount to a death sentence. Obesity among white mothers worldwide nearly doubled between 1980 and the early 2010s. Maternal deaths nearly halved (pdf, p.5-6).
Suellen Miller, a professor of gynecology and director of the Safe Motherhood Project at the University of California-San Francisco (UCSF), told Quartz that “all over the world, there is an obstetric demographic shift to older women, to more obese women, to women with more chronic conditions, and in many places to women who smoke.“ And yet, outside of the US, many women are safely delivering babies despite conditions that, some years ago, would have made that impossible. In certain parts of the world—Scandinavia and Western Europe, in particular—a focus on more dedicated care, before, during, and after birth leads to dramatically different results.
It’s not enough to say “that women are entering pregnancy ‘older, fatter and sicker,’ although that may be part of the story,” Morton insists. Instead, we need to understand why American women are fatter and sicker in the first place, and why manageable conditions end in women dying.[my bolding]
Did you know that suicide accounts for 20% of these post-partum deaths? Neither did I, until I read the Quartz article. You should too.

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