U.S. maternal death rate increasing at an alarming rate
news.northwestern.edu
news.northwestern.edu
Hypertensive disorders are typically associated with obesity so the reason could be that there's an increasing share of pregnancies happening with people who are overweight. I leave the sociodynamic interpretation of this up to the reader.
Being obese and carrying a baby to term is risky. Everything is much more complicated.
I do wonder if they make the BMI of mothers available in a publicly available dataset somewhere, it would be interesting to test your hypothesis.
That is not what it looks like to me. Body mass index (BMI), a proxy for obesity, is a relevant statistic in almost every wellness exam.
https://www.cdc.gov/obesity/index.html
https://health.gov/healthypeople/objectives-and-data/browse-...
The hottest new medicine is a medicine that reduces obesity. See Novo Nordisk market cap change:
It seems reasonable that there would be increased risks during a pregnancy when the body wasn't prepared to get pregnant without intervention.
Unplanned pregnancies might happen to people who aren't ready to have a child, physically and mentally - or who don't have easy access to medical care.
IVF, in contrast, only produces planned pregnancies, and only in people with easy access to medical care.
I agree with GP that IVF probably provides motherhood to a lot of people who have preexisting medical issues.
IVF on the other hand very likely skews older, and I wonder if those needing IVF are also less healthy on average than non-IVF.
The human body wants to reproduce as its default state. When it can't, there must be physical or environmental reasons (or the likely rare genetic condition that can be a primary cause of infertility).
Theres numerous studies to support that.
Not saying its the cause but just saying its one possible cause along with obesity and abortion restrictions if we're throwing theories out there.
chronic COVID-19 infection may have more adverse effects on the menstrual cycle than COVID-19 vaccines, which have so far presented no long-term adverse events linked to fertility or reproduction
So there’s nothing detrimental, just a temporary change (which can happen for many reasons).
The studies all conclude that and agree with you but still seems unusual to me.
That's gotta be COVID. Could be the virus, could be substandard care due to COVID, but obesity didn't go up that much in two years.
> There's actually been a lot of controversy about whether or not the increase that's been observed is a true increase or is an artifact of how we're now collecting data,” Khan said. “But when we examined deaths only in the states that had already adopted the checkbox and did it the exact same way, we captured an increase with acceleration in the last three years.
There was strong evidence that the US wasn't reporting all maternal deaths that meet the WHO definition; pregnancy and birth are major medical events, and can easily aggravate other medical conditions. But often you couldn't extract that information from the cause of death reported on a death certificate.
So the US added a 'pregnant or recently pregnant?' checkbox to cause of death reports, and started counting all deaths with the box checked, minus accidents, suicides and falls. So even if a woman had a terminal illness before getting pregnant, that would still count as a maternal death. Then they gradually rolled out the new form one state at a time, over the course of 15 years - so instead of seeing a clear step in the data, there's a long gradual increase.
This makes measuring any real changes in maternal death rates extremely challenging.
However, this report says maternal death rates are rising even after accounting for the changes in reporting.
The poster above just says it makes analysis of historical statistics difficult, he is not jumping to conclusion.
* Consider that with the loss of Roe v Wade many states, including my own, have adopted draconian policies towards abortion without consideration for medical necessity.
* Consider also the study indicated the most increased risk age groups are late 20s and early 30s.
What’s interesting is there was a study published December indicating first time mothers in the 16-20 age group when compared to the 21-25 age group were about 20% less likely to experience detrimental risks of regular vaginal births. The numbers held identical when compared between the US and third world countries without common access to advanced medical care. The study concluded that age is among the most serious of factors with regards to maternal health of first time mothers and this could explain why males developed a selective preference for younger females.
The point would be stronger with some substantiation. If you've any ready to hand that would be useful.
I know that private equity purchases of healthcare companies have decreased access to healthcare in rural areas and decreased quality of care at many hospitals. I know that PBMs (pharmacy benefit managers) have decreased access to medicines. I know that the AMA has restricted the number of OBGyn residency spots which keeps the number of doctors too small, and correspondingly overworked. I know that many experienced nurses left the field entirely during covid, due to hours/stress/pay/trauma leaving many hospitals and clinics understaffed and with inexperienced nurses barely out of school running wards.
Any of the things I listed in the second paragraph seem far more impactful than changing how many weeks pregnant a person can be to have an elective abortion, in terms of maternal deaths.
BTW I kind of like that the paper authors avoided this kind of speculation as to what may or may not have caused it.
I'm not sure what you're suggesting here. Clearly an event that happened after the study couldn't have impacted the study.
It seems to be due to lack of access/income and race if I recall correctly. For the highest income quintile it’s roughly in line with the OECD. The lower your income the worse you do, and if you’re black the numbers are off the charts. A few years ago you were 3X more likely to die in childbirth in America than Canada, and 6X more likely than Scandinavia. Not sure the exact stack up now.
[edit] Here’s an NPR write up from 2017 [1] and 2023 [2]. And a more recent one suggesting the numbers may be overestimated in aggregate but suggests race is a huge factor, with black women 3X more likely to die in childbirth than white. Note the CDC disagrees with the idea it’s over-counting. [3] Even using the revised-down estimates America does not compare favorably to the OECD. [4]
[1] https://www.npr.org/2017/05/12/527806002/focus-on-infants-du...
[2] https://www.npr.org/2023/07/09/1186694708/u-s-maternal-death...
[3] https://www.npr.org/sections/health-shots/2024/03/13/1238269...
[4] https://data.worldbank.org/indicator/SH.STA.MMRT?locations=O...
Yes higher income ppl tend to be less overweight, eat healthy food, exercise and have less life stress.
What does this even mean btw. They get admitted to hospital from point of conception? Where are you pulling this from.
By the way, I actually looked into your thesis last time this came up. If you control for all that it really doesn’t change Americas rankings. There’s enough studies on the impact of obesity, etc, on maternal mortality that you can napkin it out. I don’t happen to have the work I did anymore I don’t think but by all means, you’re welcome to check. It has a meaningful effect but it by no means accounts for the delta.
If you’re going to float something like this it would be great if you shared what led you to that conclusion, as I may have missed something. Other countries that have similar levels of obesity do not have the same outcomes, or even proportional ones.
ok i'll add "trust me bro i looked at the data" like you.
> first time mothers in the 16-20 age group when compared to the 21-25 age group were about 20% less likely to experience detrimental risks
The negative effect on lifetime income of having children young is extremely high, though, and people will shame teenagers for pregnancy. Especially as this almost invariably results in them being single parents. Bringing down teenage pregnancy rates has been a long term health project.
A project that in the US is wildly inconsistent, muddled, and rife with political interference, heavily tinged with US religious prudery.
We know how to reduce teen pregnancy. Fact based sex education, access to contraception, these are straightforward. Instead we have the worst of all possible worlds where schools teach abstinence and the kids learn from porn.
I don't have answers, just questions and guesses. If anyone's got anything definitive, I'd love if they weighed in.
> 56.9 percent for black women. It stands at 36.2 percent for white women [1]
Obesity increases the risk of maternal mortality.
[1] https://www.self.com/story/black-women-health-conditions
As for racism, a known observation is that black women in particular are treated as "tough" and tend to not have symptoms taken as seriously, as far as I'm aware that even holds when the doctors are black. It's a bad and very old stereotype.
https://qz.com/1275938/22-american-mothers-on-what-its-like-...
If rich mothers give up work after giving birth and poor mothers return quickly to work, that could have an impact.
And in America, rich/poor and white/black trends are big confounders.
EDIT: And their "recent" data point is 2021... Of course health outcomes would be worse in that year for various reasons.
https://www.commonwealthfund.org/publications/issue-briefs/2...
Black women in the US are almost 10 times as likely to die during/after childbirth, compared to all women in the UK (and white women in the US are almost 4 times as likely to die as in the UK).
This 2024 report (pdf) has 2022 data, which is lower than 2021, but still above the average of the pervious 10 years: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022...
It is a US based site which provides a breakdown on the US population, and compares it to other developed countries.
I pulled out some figures I thought were interesting - both for black and white populations it shows a significant difference to the country I live in (UK).
Even the group with the best outcomes in the US, still shows a roughly 2.5 times higher incidence of death. I am interested in why the outcomes are worse across all groups.
(Archive Today is useful for rendering over-desigend, brittle, websites, I'm finding with increasing frequency.)
when we shifted this way in the last 60 years, mortality was decreasing. This wouldn't be my go-to guess.
>While this study wasn’t able to explore specific causes of death
it's public data in quite a number of places in the world.
Generally speaking it's bleeding or blood related things; heart, or blood brain stroke type. Women during birth have the same problems as high G fighter pilots. Gotta tighten all your muscles.
>Black individuals are three times more likely to die from pregnancy-related deaths than white individuals.
Randomly tacked onto the end. The thing about statistics on race, it's really hard to rule out all the other factors and make conclusions. It's not some sort of allegation that black moms are systematically being killed.
When I see people argue that systemic racism is a driver, they're not arguing that there's a conspiracy directly targeting people of color. Rather, they're arguing that racism drives things that create conditions where people of color disproportionately suffer harm.
A classic example of this from several decades ago is redlining, which prevented people of color from moving into safer neighborhoods, and undermined the neighborhoods they were able to buy homes in. Settlement patterns have long-term generational effects, so while it would be incorrect to say that predominately black neighborhoods have higher levels of asthma, violence, poverty etc as a deliberate plot, it's absolutely true to say that those are consequences of direct racism from several decades ago.
I don't think this should be a particularly controversial point. Where I think it gets more controversial is two points -- 1. What redress, if any, should people downstream from historical racism have? They're still suffering the effects, after all. 2. What patterns and decisions are happening _now_ that will similarly have downstream generational effects?
I'm not going to even attempt to suggest answers to those, just hoping to illuminate the framing here.
No, the latter argument isn't logical followed, and not a conclusion one can make.
The 30 year old dad with asthma problems for his kids is not that way because of some housing racism that happened decades before this dad was born.
>I don't think this should be a particularly controversial point. Where I think it gets more controversial is two points -- 1. What redress, if any, should people downstream from historical racism have?
If something didn't directly affect you, then your claim to redress is far significantly less. That's even acknowledging generational trauma.
>They're still suffering the effects, after all. 2. What patterns and decisions are happening _now_ that will similarly have downstream generational effects?
redress from who though? Less than 2% of people in north america ever owned slaves at the peak. Nobody alive today ever owned slaves, nor were slaves. It's also not completely clear if there's any harm being done today and if there is, then how much harm and most especially by who. These aren't just assumed to be the government's fault and so they should pay.
Compares US to other developed countries, and compares other things such as maternity leave and other health care opportunities.
Note that some of the biggest risk area in the US is the 41 days AFTER child birth, where the US sees some of the worst results.
> In 2022, there were 22 maternal deaths for every 100,000 live births in the U.S. — more than double, sometimes triple, the rate for most other high-income countries in this analysis. In half of the countries, there were less than five maternal deaths per 100,000 live births.
> It’s been well documented that the COVID-19 pandemic had a greater impact on Latino people, with one study finding that roughly a third of Latina maternal deaths were linked to COVID. In addition, lower vaccine uptake, especially among Black and Hispanic women, was found to be leading to more maternal deaths by the end of 2021...
> In half of the countries, there were less than five maternal deaths per 100,000 live births (Norway, Switzerland, Sweden and the Netherlands have less than 3.0). For Black women, maternal mortality is exceptionally high (chart shows 49.5 for black women in the USA).
> In 2022, Norway’s maternal mortality rate was 0.
> All countries, apart from the U.S., guarantee at least one such home visit within one week postpartum, although Medicaid programs in some U.S. states cover these visits.
> The majority of deaths in the U.S. occur in the postpartum period, from one day after giving birth to a full year later.
> All countries included in this study, apart from the U.S., mandate at least 14 weeks of paid leave from work. Several countries provide more than a year of parental or home care leave.
> The U.S. and Canada have the lowest overall supply of midwives and ob-gyns
> Our findings suggest that an undersupply of maternity providers, especially midwives, and lack of access to comprehensive postpartum support, including maternity care coverage and mandated paid maternity leave, are contributing factors.
It seems pretty clear what's happening here.
Imagine if you tried to say it's misleading to say black people are targetted by the police, because in reality it's criminals who are targetted. Can you see the problem?
31.8 what? Football fields? I'm guessing per 100k, but this is a .edu domain for Christ's sake.
"But the U.S. case is particularly beguiling, since the United States now tracks all deaths of women who were pregnant, not only women who gave birth. Women who miscarried early or had abortions—whether officially reported or not—are also counted in the checkbox method."
Do US doctors relay this risk to their patients?
tl;dr: obesity ("hypertension")
but why stop at maternal deaths? obesity is driving premature death rates in every category
this is a national crisis but no one wants to say it out loud because someone's feelings will be hurt
The Obamas, and Michelle Obama specifically, addressed it directly (14 years ago):
But I guess none of the complicating factors make for as good of a straw man for the inane point you’d like to use these women’s suffering to prove.
But a proper healthcare system should absolutely be discussing obesity with women who intend to get pregnant at least, just as it should be discussing it with people who want to have surgery requiring general anaesthesia, with people who have mobility issues or knee/hip problems, etc.; if not more generally even outside of the context of immediate interventions.
Because it makes difficult, traumatic and bad health situations worse. Giving birth is routinely the first two of those things.
There is a positive-discrimination aspect here, though: yes, obesity complicates the health of older people, is raising mortality rates across the board. But society doesn't want women to die in childbirth anymore, and that makes this targeted intervention re: obesity a proper thing to do.
But if you read the other comments here, you see people arguing about Roe v. Wade, racism, statistical errors, covid vaccines, etc.
When the whole time the answer is just right there, the hippo in the room if you will lol. Anything to avoid personal responsibility I guess.
Something can be caused by obesity without the primary “blame” being personal responsibility. If Americans are more obese than Scandinavians, is it because there just happen to be more individuals in the US who lack personal responsibility?
Societal problems are a result of societal sickness. We should aim at the root societal causes rather than attribute personal moral failings to the individuals who are a product of that society.