High maternal mortality rate in USA. Why - Politics Forum.org | PoFo

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#14866657
Why does the U.S. have a higher maternal mortality rate than Iran, Libya and Turkey?
Black women in the US are up to three times more likely to die in pregnancy. Why?
The WHO determined that half of the U.S. deaths were preventable.


More U.S. women are dying from pregnancy or childbirth complications today than in recent history, causing alarm stateside as maternal mortality drops worldwide.

The United Nations set a goal to reduce the global maternal mortality rate by 75% between 1990 and 2015, and while most nations succeeded in lowering that number, the U.S. has experienced an uptick in recent years. A report published in the September issue of the journal Obstetrics & Gynecology found that from 2000 to 2014, the maternal mortality rate for 48 states and Washington, D.C. increased 27% from close to 19 deaths per 100,000 live births to close to 24 deaths per 100,000 live births. In Texas, the rate doubled between 2010 to 2012.

Another recent report from the Institute for Health Metrics and Evaluation reported a rise in the U.S. maternal mortality rate since 2000 (with a slight drop in the past two years), and a 2015 report from the World Health Organization (WHO) pointed out that the U.S. has a higher maternal mortality rate than Iran, Libya and Turkey. The WHO determined that half of the U.S. deaths were preventable.

“This is a really important issue,” says Marian MacDorman, author of the Obstetrics & Gynecology study and a research professor at the University of Maryland. “These are deaths of young women with families and often young children who need care.”

Here’s what may be at play:

Record keeping problems: National data on maternal mortality is inconsistent, and some health authorities argue that the uptick in maternal deaths is at least partially due to improved detection of pregnancy-related deaths. However, MacDorman says the 27% increase observed in her study is a true rise in maternal deaths, rather than a reporting issue.

More American women are obese: America’s growing obesity problem is a factor. There’s also a growing number of pregnant women in the U.S. with chronic health problems like high blood pressure, heart disease, and diabetes—all of which put women at a greater risk for complications during pregnancy. According to the CDC, heart-related problems make up a substantial portion of pregnancy-related deaths.

Access is inconsistent: Between 2000 to 2015, Texas saw a spike in maternal mortality while the state also underwent changes to reproductive health services, including the closure of several clinics offering abortions and other services. In 2011, the state’s family planning budget was cut by two-thirds. Experts say the lack of access is probably not solely responsible for the state’s dramatic spike in deaths, but as The Texas Tribune reports, it may have exacerbated the issue. “I’ve done my best to try to investigate this as a data error and I can’t find any changes to account for it,” says MacDorman. “It’s very concerning what’s happening in Texas.”

Racial disparities persist: Black women in the United States are up to three times more likely to die in pregnancy and childbirth compared to white women. While they are not significantly more likely to develop conditions like hemorrhage and preeclampsia—which threaten a women’s health during childbirth—they are more likely to die from them.

Rise in cesarean births: The rates of c-section deliveries among American women rose 53% from 1996 to 2007, now accounting for 32% of births. “Cesarean has its place, and it has saved the lives of mothers and babies,” says Dr. Michael Lu, an associate administrator with the Maternal and Child Health Bureau at the Health Resources and Services Administration. “But cesarean has its complications and these can increase the risk of maternal death.” C-sections require intensive surgery, and are associated with higher health and safety risks for mothers and infants.

Women are having children later: Lu says older women are at a greater risk for maternal mortality, with a couple caveats. “It’s not clear whether it’s age, or that older women have more chronic conditions when they enter pregnancy,” he says. “The demographic of childbearing is changing. Women are getting older and they are entering pregnancy with more conditions like obesity, diabetes, and heart disease.” To combat the problem, Lu says his department is focusing on improving the health of women before they get pregnant, and improving the quality and safety of maternal health care nationwide.



http://time.com/4508369/why-u-s-women-s ... hildbirth/
#14866673
One issue with birthing in the US is that it's a big business, and it's more about money than anything else.

The US has a very high C-section rate (something like 40%+) where most other developed nations are like in the 5% area. This is because doctors do a lot of interventions like drugs and shit that slow the birth process, and then when the baby doens't come out, they jump to surgery.

This is why my daughter was born at home, and my son was born at a birthing center run by midwives, not doctors. It only cost about $4000 each for the prenatal care, and the birth. Hospital stays can get in the $15k area easily.


The US is a VERY backwards country in many respects, and resembles a developing nation more than a developed nation in many many aspects. Americans are very very blind to this, so nothing improves, and is often made worse by voting for morons like Trump.

Anyway, with the birthing stuff, I think we need to bring midwives back into the fold, rather than leave the birthing to doctors who just want to administer drugs, and do surgeries.
#14866728
Rancid wrote:Anyway, with the birthing stuff, I think we need to bring midwives back into the fold, rather than leave the birthing to doctors who just want to administer drugs, and do surgeries.


Amen! My youngest was born at home via midwife. My second-to-youngest was born via midwife in a midwife center. first three were in hospitals and we will never go back, much better experience with midwives and the absolutely best medical results when compared to hospital births.

Suntzu wrote:You stated the answer. Factor out Blacks and the rate is similar to Europe.


I wonder if this factors in blacks birthing at home instead of going to the hospital or counts complications from attempted abortions as "maternal mortality"?

I would be curious to see those stats broken down. I personally knew several ghetto mamas who had babies in their toilets :eek:
#14866828
Blacks don't birth at home. They go to the hospital because their healthcare is "free".


Garbage. Post your racist nonsense elsewhere. Go back to school.

If you look at maternal mortality rates by nation you see two really important things. The rates in the developed world are much lower than elsewhere and nations with universal health care do much better than those without. For example, the UK has about 1/2 the maternal mortality rate as the US. France 2/3 of that in the UK.

Epidemiologists will tell you that we are dealing with a truly rare event all the way. The rate in the US is 21 per 100,000 live births. In France it is 8 per 100,000 live births. There is considerable difficulty in reporting and accountability. Some states only recently added a pregnancy box to death certificates. That said, a pregnant woman in the US is twice as likely to die from her pregnancy than she is to die in a traffic accident. (Fun fact but among epidemiologists an often used example of bad pop "science".)

In comparison to other countries the US has a distinct disadvantage though with regard to uninsured. Even in these days of Obamacare and its opportunity for coverage, a great many Americans, and particularly young ones, are uninsured. Blacks are about twice as likely as whites to be uninsured. Government insurance programs are inconvenient and in no way compare with private insurance in outcomes.

I am inclined to agree that unhealthy mothers, combined with poor access to health care lead to the US' higher numbers than virtually every nation with universal health care. While the British Medical Journal (BMJ) has published studies in the US showing an increased maternal mortality rate with obese mothers, this does not explain the dramatic difference between the US and UK.

It is naive to blame "blacks" who certainly do drive up the statistics somewhat unless you ask why. Clearly black women are more likely to be clinically obese than white women. (32% white, 57% black.) This is not enough in and of itself to tell the story. (Besides, weight gain in pregnancy make these data suspect wrt this question.) Very young mothers are at higher risk of mortality than older ones for several significant criteria. One thing is sure. Poverty and access to prenatal care are two very important factors. Whites are more than twice as likely as blacks to be completely uninsured.

One thing is crystal clear. The US system of private insurance provides much poorer rates of maternal mortality than does ANY of the highly developed nations with universal health care.

But Wait! Cuba has highly touted universal health care but their maternal mortality rate is almost 4 times that of the US. What gives? Poverty gives.

I won't take a side on this. It is my job to defer to the research. But if I were to hazard a guess as to why the US rate is more than 5 times higher than that of Italy I would give credit to the comprehensive coverage offered by the Servizio Sanitario Nazionale.

America should not be surprised by its poor outcomes compared to other developed nations. Overall we rank 37th place in health care. Our system sucks and the republican party is committed to making it far worse. Many US conservatives are ignorant of this and simply not smart enough to understand the data anyway. Our maternal mortality rate is not inconsistent with our poor results in many other medical outcomes.
#14866882
Suntzu wrote:Blacks don't birth at home. They go to the hospital because their healthcare is "free".


You misunderstood me. They gave birth at home because they either didn't have a car (which was very common) or didn't know they were pregnant in the first place :eek:
#14866884
Drlee wrote:It is naive to blame "blacks" who certainly do drive up the statistics somewhat unless you ask why. Clearly black women are more likely to be clinically obese than white women. (32% white, 57% black.) This is not enough in and of itself to tell the story. (Besides, weight gain in pregnancy make these data suspect wrt this question.)


Obese women are more likely to not know they were pregnant in the first place and to therefore give birth in unsanitary conditions, often times far away from proper treatment. Hemorrhaging and infection, especially if the birth is not reported and assistance sought, could explain why a more obese black population contributes to higher rates of maternal mortality. Like I said, I saw some of this first hand.

I also had asked the question, and no one addressed this, but perhaps you know, are complications from abortion included in the statistics for maternal mortality? This could also explain a higher rate among blacks based on disproportionate representation in per capita abortions.
#14866886
Victoribus Spolia wrote:You misunderstood me. They gave birth at home because they either didn't have a car (which was very common) or didn't know they were pregnant in the first place :eek:


Probably accounts for 0.01% of Black births. Blacks generally know were babies come from and what pregnancy looks and feels like. Not having a period for nine months might be a clue.
#14866891
In the early 1970s, the Population Council and CDC conducted large prospective studies of abortion safety; these concluded that abortion was considerably safer than continuing a pregnancy to delivery. By 1975, the Institute of Medicine had concluded that the public health benefits of abortion were well established.

A sentinel report from Planned Parenthood in New York City documented extraordinary safety as well. In 170,000 first-trimester abortions, the complication rate was 1%.

Most recently, researchers at UC-San Francisco used California Medicaid data on 54,911 abortions to see how many women had an emergency room visit or hospitalization as a result. The overall complication rate was 2%, and most complications were minor. Only 0.03% of patients were transferred by ambulance to an emergency department on the day of the abortion.


The risk of death from abortion plummeted after legalization in the early 1970s. In recent decades, the risk of death from abortion has been around 1 per 100,000 procedures. To put that in some perspective, the estimated risk of death from an injection of penicillin is about 2 per 100,000 injections.

According to national data from the CDC, the risk of death from pregnancy and childbirth is 14 times higher than with abortion. Critics complained that abortion deaths were grossly under-reported, invalidating the comparison. This claim has no merit. Some under-reporting of abortion-related deaths is likely, but under-reporting of pregnancy and childbirth deaths occurs as well. Assume that the true number of abortion-related deaths is three times that reported by the CDC. Pregnancy and childbirth would still have a mortality ratio several times that of abortion. Selective under-reporting of abortion-related deaths cannot account for a difference this large. Moreover, the disparity in risk has persisted for decades.

Pregnancy and childbirth complications

According to the CDC, about 60% of women having live births will develop one or more complications of pregnancy, birth and the post-partum interval. This translates into more than 2 million women per year in the U.S.

Pregnancy and childbirth-related deaths

The risk of maternal mortality continues to increase in the U.S. The pregnancy-related mortality ratio has increased progressively from 7 deaths per 100,000 live births in 1987 to 18 per 100,000 live births in 2009.


The bottom line is that abortion is about as deadly as paddling a canoe. And 100 times safer than riding a motorcycle. It is over 20 times safer than having a baby using the latest data.

Women who do not know that they are pregnant, having babies at home, are extremely rare. Certainly such a small number that it is statistically insignificant. That is why they are click-bait on the web.

We deal with a lot of obese homeless women and I have never seen one in advanced pregnancy who did not know it.
#14867115
The OP askes why the USA has a higher maternal mortality rate than Iran, Libya or Turkey, and Victo has offered a response: it's the racism of normal Americans that allows them to not support normal social programs for huge segments of the population.

I guess the Turks aren't racist enough against the Kurds that they would deny them top-notch healthcare.
#14868144
@Drlee is spot on.

Universal healthcare is the key of success.

20 years ago, maternal mortality rate was awfully high in Turkey. Infant mortality too. Because, a significant proportion of the populations had no form of social security protection at all.

Today, Turkey is one step away from universal healthcare. Nowadays, those lacking an employment related healthcare plan can purchase a standard comprehensive healthcare plan from State's Social Security Agency for roughly $13 per month per family. If family does not have a prescribed level of minimum income, then the State forfeits the premium.

Net results are: Everybody has a healthcare coverage. Infant mortality is down. Maternal mortality is down. Life expectancy has been increasing fast. And benefit-cost ratio of overall healthcare system is quite high. (If they manage to nationalize all private hospitals and absorb them into public hospital system, it will go higher)
#14868159
Healthcare for poor Blacks (and others) is free in the U.S. Prenatal care is free. Food is free. Birthing is free. The reason Blacks have higher maternal mortality is the same reason they have higher rates of obesity, heart disease, diabetes, etc., stupid people win stupid prizes.
#14868210
lol, free. Go try living on that, Sun.

It is so free, the homeless are just the people too lazy to go cash their checks hand delivered to them by millionaires on a golden platter.
#14868259
Zagadka wrote:lol, free. Go try living on that, Sun.

It is so free, the homeless are just the people too lazy to go cash their checks hand delivered to them by millionaires on a golden platter.


It's not free? Medicaid doesn't pay for child birth and prenatal care? WIC is gone? :lol:
#14868262
You have a strange definition of "free". If they had healthcare, the hospital wouldn't eat those costs. Emergency care is never free for anyone, and medicare covers very little outside of that.

You're basically saying the medical equivalent of saying that we have free mass transit because of sidewalks.

You are taking this tack that our entire failing healthcare system does not need to be fixed.
#14868279
Healthcare for poor Blacks (and others) is free in the U.S. Prenatal care is free. Food is free. Birthing is free. The reason Blacks have higher maternal mortality is the same reason they have higher rates of obesity, heart disease, diabetes, etc., stupid people win stupid prizes.


This is a common misconception. None of these is true. Let's see where the mistakes lie.

Even in countries with universal health care, the care is not free. The funding is diverse, spending is controlled, quality is mandated and the costs spread over the entire population making them very inexpensive compared to ours. From the standpoint of outcomes however the main thing is that the quality of health care is relatively the same across the population.

Higher rates of Obesity


They are. But not enough to explain the differences.

As for CHIP. The federal program that helps fund natal care:

Chew on this one. The highest rate of death is in Texas. (Go figure.) Texas has the highest rate of uninsured mothers. The quality of care varies widely by state:

Here:

Texas has the largest number of uninsured people in the U.S., and there have been substantial cuts to women’s health programs that offer family planning and other routine services to low-income women, including screening for diabetes, hypertension and cervical cancer, which if left untreated could play a role in maternal deaths. Many of the dozens of clinics shuttered in recent years due to slashed state funding also offered prenatal care.


It is pretty obvious at least one of the causes for the very high death rate in Texas.

Sadly there is also evidence that doctors in programs for the poor are less responsive than the are to those with private insurance. Poor women are slow to access care because care is slow to let them in. You and I can run to the doctor pretty much anytime. A person on assistance can't do that.

stupid people win stupid prizes


Don't walk near any mirrors. :roll:
#14868310
Zagadka wrote:You have a strange definition of "free". If they had healthcare, the hospital wouldn't eat those costs. Emergency care is never free for anyone, and medicare covers very little outside of that.

You're basically saying the medical equivalent of saying that we have free mass transit because of sidewalks.

You are taking this tack that our entire failing healthcare system does not need to be fixed.


I will agree that the healthcare system needs to be fixed. It is not the cause of high maternal mortality or infant mortality. The very poor are on Medicaid. Medicaid pays for prenatal care as well as birthing and neonatal care. WIC provides for nutrition for . . . wait for it . . . Women, Infants and Children. Black women have higher maternal mortality rates because they eat too much, smoke too much, drink too much and do illegal drugs too much. They are also slovenly and neglect to get prenatal care even though it is free. Poor Mexicans, Orientals and even poor Whites do seem to have those problems to the same degree.
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