According to recent reports, maternal mortality in the United States has “surged to the highest rate in nearly 60 years, … exacerbating a yearslong trend that has made the U.S. the most dangerous place among high-income countries to give birth.” As one Wall Street Journal article recently put it, “[r]ates have been trending upward over the past two decades in the U.S., even as they’ve fallen in most other countries.” Is this true?
Wall Street Journal
Mostly true. Minor mistakes or inaccuracies.
While there is cause for concern about the maternal mortality rate in the United States, the alarmist suggestion that it’s more dangerous to give birth today than sixty years ago rests on a misunderstanding of the data.
The increase in the maternal mortality rate over the last two decades is due to better reporting in the United States, not an actual increase in the number of deaths. Starting in the early 2000s, states began adding a pregnancy checkbox to death certificates to better identify maternal deaths. Since then, the observed maternal mortality rate has significantly increased, but the CDC has explained this is “not likely due to an increase in the underlying extent of maternal mortality” and instead is “attributed to changes in data collection methods (i.e., the gradual adoption of the checkbox).”
While improved data collection is obviously a good thing, it’s important to note that the checkbox system is far from perfect. One study in Texas found that over half of the pregnancy-coded deaths were false positives and cautioned that “[r]elying solely on obstetric codes for identifying maternal deaths appears to be insufficient and can lead to inaccurate maternal mortality ratios,” and that “[a] method enhanced with data matching and record review yields more accurate ratios.” Another study of Georgia, Louisiana, Michigan, and Ohio found that at least 21% of the potential pregnancy-associated deaths were false positives, in that 97 of 467 women flagged as pregnant on their death certificates were actually confirmed not pregnant. And those false-positive numbers don’t even include further adjustments to the maternal mortality rate to address questions such as whether a postpartum woman killed in a car accident should count as a maternal death.
One final note on the claim that the U.S. maternal mortality rate is significantly worse than that of other countries. International comparisons in this area are notoriously difficult, precisely because reporting and data collection practices vary wildly. For example, many European countries have “enhanced surveillance systems” to detect maternal mortality, which include not just the U.S.’s checkbox component, but also, for example, a review of the underlying medical records by a national committee. These enhanced systems could mean that these countries are better at detecting maternal deaths than the U.S., in which case our higher observed maternal mortality rate fares even worse. But it could also mean that they are simply better at screening out false positives.
The U.S. maternal mortality rate is a serious subject that deserves further study and attention. Women deserve to feel and be safe during their pregnancies, and every death of a young mother is heartbreaking. News reports that gloss over significant nuances in the data in favor of headline-grabbing claims do this important topic no service.