Worldwide, the news is good. The U.S. is the exception.
The big news from The Lancet is that maternal mortality — the number of women who die in pregnancy and childbirth, per 100,000 live births — has fallen worldwide, from 422 in 1980, to 320 in 1990, and all the way down to 251 by 2008.
Unmentioned in much of the news coverage was the trend reported for the United States, which shows up on the map of rates of change in maternal mortality for each country:
The red states, so to speak, are those with increases in maternal mortality rates from 1990 to 2008. The U.S. is joined by a cluster of sub-Saharan countries in Africa, Afghanistan, and a few other small ones. Big improvements were concentrated in Asia, North Africa and Latin America.
Maybe the U.S. maternal mortality rate was already so good in 1980 that it had nowhere to go but up? Not so. Among countries that already had low rates — below 50 per 100,000 in 1980 — all groups showed continuing improvement except the U.S.
That light blue line for “North America, High Income,” is for the U.S. and Canada. The upward part of the trend is driven entirely by the U.S. (Numbers for each country are in supplemental materials behind the Lancet‘s pay wall.)
This reversal in the U.S. was recently seen in California, where maternal deaths tripled in the last decade. Explanations for that are not clear. Obesity, fertility treatments and older birth mothers all contribute, but can’t explain the whole pattern. Increased C-sections and induced pre-term births are suspected culprits.
Given that the rest of the already-well-off world found ways to improve over the last three decades, I can’t think of a good excuse for the U.S.’s poor showing.
I’m not an expert on this issue in general, but this is what I learned today, FYI: In poor countries, maternal mortality has been shown to fall with increases in women’s overall empowerment and education, access to health care and clean water, and trained delivery personnel — factors that help differentiate sub-Saharan countries that have seen progress from those that haven’t. Overall higher consumption levels help, too, naturally — and within poor countries, the poorest mothers face much higher risks for the same reasons whole countries have it worse (education, sanitation and health care). Finally, economic dependence among poor countries, especially multinational corporate investment, is associated with higher levels of maternal mortality.