Over the last 30 years, nearly every wealthy country in the world has made it much safer for people to have babies. Only one outlier has moved in the opposite direction: the United States, where the rate of people dying in childbirth continues, stubbornly and tragically, to rise. In 2021, 1,205 US women died from birth-related causes, up from 754 in 2019.
This isn't true, though I can hardly blame North for the error. Her numbers come straight from the CDC, which published them even though it knows they're wrong. Here are the real numbers:
The CDC published a detailed study showing that the reported increase in maternal mortality was due solely to the addition of a pregnancy checkbox to the standard death certificate. When they checked the actual cause of death, there was no increase at all in maternal mortality.
But they've nonetheless continued to publish the raw numbers, even though they're completely wrong. Because of this, the myth of the rise in maternal mortality continues to spread.¹
Now, it is true, as North says, that maternal mortality is much higher among Black mothers than it is among white mothers. However, North is a little too credulous here. The solutions she highlights have little evidence of success, and anyway, the evidence we do have points fairly strongly away from racism as a cause.
¹Actually, we have no idea what's happened since 2018, since the CDC has never bothered to publish corrected numbers since then.
Doesnt the checkbox only affect the increase until 2017? After 2017, the checkbox is in use everywhere and the staggered implementation is no longer affecting the stats.
So the increase up to 2017 may be largely a result of the new measurement checkbox, but this measurement change does not impact any stats beyond 2017. Any increases between 2017 and 2024 cannot be due to the implementation of a new measurement system as it has been in place and unchanged over this time period.
Since the data in the chart shown here only goes through 2021, it does look a bit like 2017-2020 is fairly flat, with a significant rise in 2021 (possibly due to covid).
I think some of us pointed this out last time Kevin posted this chart.
It looks like Kevin is the one willfully refusing to see what the numbers say in this case.
Kevin, have you done much or any research lately to see if there are new developments in terms of understanding the difference between white and black mortality since you last wrote your bigger post back in 2019?
Ok, so pregnant women are dying in increased numbers, but that's not related to their pregnancy. Yeah, that's still a problem.
Also, maternal mortality deals with deaths occurring after the birth that are related to complications from giving birth--so not related to pregnancy check box effect.
Ok, so pregnant women are dying in increased numbers, but that's not related to their pregnancy.
No, that's not what the data shows. What it shows that, prior to 2017, a lot of the women who died while they were pregnant were not classified as pregnant for the purposes of tracking maternal mortality. The figures reported prior to that were substantially too low.
Obesity:
- directly causes pre/eclampsia; sky-high blood pressure and a resulting much increased incidence of acute strokes, heart attacks, and hemorrhage during pregnancy, birth, and post-natal period.
- directly causes gestational diabetes; uncontrolled sky-high blood sugar causes vascular damage, tears up blood vessel linings, which also leads to heart attacks and strokes - usually in a chronic sense, not acute, but probably contributes to vascular accidents during pregnancy. Gestational diabetes can also cause higher birth weight babies with oversized heads and/or hearts (it’s not rare, though much reduced over last decade). This causes infant morbidity and birth complications for the mother, usually just c-section/early delivery.
African Americans, especially AA women, have higher incidence of:
- clotting disorders (too much->PE/stroke, too little->hemorrhage).
- autoimmune diseases like lupus, sarcoidosis, sjogren’s, rheumatoid arthritis, asthma, which can complicate things. Some think pregnancy can cause the mother’s immune system to be “turned down” to avoid attacking the fetus, a respite from autoimmune diseases, but the medications to treat them can complicate things.
My novice opinion: obesity/pre-eclampsia, plus pre-existing clotting disorders, less pre-natal care and attention, can explain the difference in AA maternal mortality. I also believe the evidence of dr.s responding less to AA women’s complaints of pain, etc., but think (guess) it’s likely to be a smaller contributing factor.
Maternal death is pretty rare overall, so just a few extra deaths from clotting disorders and pre-eclampsia definitely show up.
So you’d wonder, obviously the dr.s studying maternal mortality correct for bmi, blood pressure, diabetes right?… But I’ve read a few of the papers: a few don’t, most try to… But overall, epidemiology is a much worse science than you expect. Through no fault of the doctors (mostly) - they work with the data they have, observational/correlational, experiments difficult/impossible or unethical, selection biases abound… and like everyone they can have agendas; publish or perish, publicity, politics..
So ends my polemic!
I wouldn't say that racism is not the cause. While you make a strong argument that it is not racism by medical professionals that is the cause, I have heard it argued that the cause is probably related to everyday racism and misogyny that women of color experience while they are pregnant. That everyday racism increases their stress and their stress increases the likelihood of negative outcomes in pregnancy.
Probably more accurate to say racism by medical professionals is not the cause.