Sabrina Tavernise, New York Times, September 21, 2016
One of the biggest worldwide public health triumphs in recent years has been maternal mortality. Global death rates fell by more than a third from 2000 to 2015. The United States, however, is one of the few countries in the world that have gone against the grain, new data show. Its maternal mortality rate has risen despite improvements in health care and an overwhelming global trend in the other direction.
The United States has become an outlier among rich nations in maternal deaths, according to data released Wednesday by the Institute of Health Metrics and Evaluation, a research group funded by the Gates Foundation and based at the University of Washington.
There were 28 maternal deaths–defined as deaths due to complications from pregnancy or childbirth–per 100,000 births in the United States in 2013, up from 23 in 2005, the institute found. The rate in 2013, the most recent year for which the institute had detailed data for the United States, was more than triple Canada’s. The institute is projecting that the American rate dipped in the last two years to 25 by 2015.
Another analysis this month looked at increases by state and found particularly high rates in the District of Columbia, New Jersey, Georgia and Arkansas, especially among black women. (The absolute rate can vary by data set, but the upward trend has been clear.)
Most people imagine maternal mortality as 19th-century-style deaths such as hemorrhage in childbirth or death from eclampsia, a condition involving high blood pressure. Those types of deaths still happen, but their rate has not changed much.
Instead, the increase in recent years has been driven by heart problems and other chronic medical conditions, like diabetes, which has increased sharply in the population. Researchers have theorized that an increase in obesity–particularly acute among poor black women, who have much higher rates of maternal mortality than whites–may be contributing to the problem.
“The really scary thing to us is all the deaths from cardiovascular disease and heart failure,” said Dr. William Callaghan, who runs the Maternal and Infant Health Branch in the Division of Reproductive Health at the Centers for Disease Control and Prevention. “It’s a quarter of all deaths. There were almost none in the remote past.”