Maternal deaths rise in U.S. as the MMR worldwide improves

by faithgibson on June 16, 2013

in Contemporary Childbirth Politics

April 13, 2010 | Nathanael Johnson

A massive new analysis of worldwide maternal mortality shows that deaths are down significantly around the globe – but in the United States, deaths are up to 17 per 100,000, compared to the last U.S. estimate of 12 per 100,000.

This suggests that California’s most recently reported rate of 19 per 100,000 is not an outlier or a fluke, but a representation of a national problem.

Flickr photo by Munroe Photography

This study, which comes from the Institute for Health Metrics and Evaluation at the University of Washington, is much more powerful than previous analyses. The team spent two years assembling a dataset three times larger than the set of numbers used to make previous estimates.

“Just to give you some perspective,” said Christopher Murray, one of the study’s co-authors, “a sample that’s 5 percent larger is a big deal in public health.”

So 300 percent must be a really big deal. In addition, the team was able to fix biases that had been present in previous estimates and apply the newer statistical methods.

There’s a bedeviling confounder in U.S. maternal mortality numbers: We haven’t done a very good job of counting deaths in the past, so undoubtedly part of any increase is due to better reporting. This report doesn’t ask how much of the increase is real, but even if 100 percent of the rise were attributable to better counting it would be cold comfort.

The fact remains that a lot of mothers have died in this country who probably would have been fine if they had lived in Italy (which has the lowest rate, 3.9 per 100,000), Sweden, or Albania.

This new information also provides a correction for the story on maternal deaths California Watch published in February: We said (based on the U.N. estimates) that California’s rate was higher than that of Kuwait or Bosnia. This study estimates that Kuwait’s maternal mortality rate is significantly higher (26.1 per 100,000), though Bosnia (at 11.8 per 100,000) still has California beat.

“We’ve done as much as we can to make those countries comparable,” Murray said.

And the power of this analysis is most evident in the margins of error for each of the country rates – before, when it was hard to tell if some governments were cooking the books, the uncertainty intervals were much wider.

Now it is possible to compare Slovakia (5 to 9 deaths per 100,000) with the U.S. (15 to 19 per 100,000), with confidence. The U.S. ranks 39th overall, tied with Macedonia.

While the poor U.S. performance is troubling to public health scientists, it’s not entirely surprising.

“The U.S. doesn’t rank so well in any health outcome, so we’re pretty sure that finding is robust,” Murray said. “We are ranked around 40th for young and middle-aged mortality too. The thing about maternal mortality is it’s totally preventable – there’s no excuse for these rates.”

These findings offer an opportunity to researchers to learn from the success of countries like Egypt, where the rate dropped 8 percent per year. What was Egypt doing right?

It also reaffirms the great medical mystery of our time: What is the U.S. doing wrong?

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