The finding comes from a report, appearing in the September issue of the journal Obstetrics and Gynecology, that the maternal mortality rate in the United States increased between 2000 and 2014, even while the rest of the world succeeded in reducing its rate. Excluding California, where maternal mortality declined, and Texas, where it surged, the estimated number of maternal deaths per 100,000 births rose to 23.8 in 2014 from 18.8 in 2000 – or about 27%.
But the report singled out Texas for special concern, saying the doubling of mortality rates in a two-year period was hard to explain “in the absence of war, natural disaster, or severe economic upheaval”.
From 2000 to the end of 2010, Texas’s estimated maternal mortality rate hovered between 17.7 and 18.6 per 100,000 births. But after 2010, that rate had leaped to 33 deaths per 100,000, and in 2014 it was 35.8. Between 2010 and 2014, more than 600 women died for reasons related to their pregnancies.
No other state saw a comparable increase.
In the wake of the report, reproductive health advocates are blaming the increase on Republican-led budget cuts that decimated the ranks of Texas’s reproductive healthcare clinics. In 2011, just as the spike began, the Texas state legislature cut $73.6m from the state’s family planning budget of $111.5m. The two-thirds cut forced more than 80 family planning clinics to shut down across the state. The remaining clinics managed to provide services – such as low-cost or free birth control, cancer screenings and well-woman exams – to only half as many women as before.
The report is here and its interpretation is much more circumspect:
The Texas data are puzzling in that they show a modest increase in maternal mortality from 2000 to 2010 (slope 0.12) followed by a doubling within a 2year period in the reported maternal mortality rate. In 2006, Texas revised its death certificate, including the addition of the U.S. standard pregnancy question, and also implemented an electronic death certificate. However, the 2006 changes did not appreciably affect the maternal mortality trend after adjustment, and the doubling in the rate occurred in 2011–2012. Texas cause-of-death data, like with data for most states, are coded at the National Center for Health Statistics, and this doubling in the rate was not found for other states. Communications with vital statistics personnel in Texas and at the National Center for Health Statistics did not identify any data processing or coding changes that would account for this rapid increase. There were some changes in the provision of women’s health services in Texas from 2011 to 2015, including the closing of several women’s health clinics. Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a 2-year period in a state with almost 400,000 annual births seems unlikely. A future study will examine Texas data by race–ethnicity and detailed causes of death to better understand this unusual finding.
The study is actually much more scathing in regards to something much more basic:
It is an international embarrassment that the United States, since 2007, has not been able to provide a national maternal mortality rate to international data repositories such as those run by the Organization for Economic Cooperation and Development.22 This inability reflects the chronic underfunding over the past two decades of state and national vital statistics systems. Indeed, it was primarily a lack of funds that led to delays (of more than a decade in many states) in the adoption of the 2003 revised birth and death certificates. This delay created the complex data comparability problem addressed in this study. The lack of publication of U.S. maternal mortality data since 2007 has also meant that these data have received a lesser degree of scrutiny and quality control when compared with published vital statistics measures such as infant mortality. For example, had the National Center for Health Statistics and the Texas vital statistics office both been publishing annual maternal mortality rates, the unusual findings from Texas for 2011–2014 would certainly have been investigated much sooner and in greater detail. Accurate measurement of maternal mortality is an essential first step in prevention efforts, because it can identify at-risk populations and measure the progress of prevention programs.
The study notes the same thing as the WHO does here, the US is one of the few countries in the world where the mortality rate for pregnant women is going up and it has one of the highest in the developed world (for example it is double that of Canada). That’s pathetic.