US Maternal Mortality

has doubled in the last 20 years. And the rate for African American women is more than three times that for white women.

Amnesty International issued a report Friday that calls on President Obama to take action.
“This country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful,” said Larry Cox, executive director of Amnesty International USA.
“Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies,” Cox said in a news release.

Indeed. (Thanks, Jender-Parents!)

11 thoughts on “US Maternal Mortality

  1. I’m wondering what the evidence is that the increase in mortality is due to problems with access to the ‘best hospitals and doctors’ – as opposed to, for instance, background health conditions such as diabetes, which has increased greatly, particularly among african-american women, and which is a huge risk factor during pregnancy and delivery. I am not saying that’s the cause – I have no idea and surely the causes are multiple and hard to determine – I am just concerned about what looks like the unsupported assumption here that it’s access to ‘the best hospitals and doctors’ that saves lives. It’s much discussed in public health circles that people overestimate the importance of clinical care to health, at the cost of attention to social and structural determinants of health.

  2. There is an interesting new book out called The Spirit Level. Despite the strange title, it is about the impacts of economic inequality, as measured by the difference between the richest and the poorest folks in a country. It was rather scary to hear how many indicators are highly correlated with this inequality. I don’t recall if maternal mortality was something they looked at but I am wondering if this increase might also be related with the increase in income spread we’ve been seeing over the past 20+ years.

  3. “I am just concerned about what looks like the unsupported assumption here that it’s access to ‘the best hospitals and doctors’ that saves lives.”

    Based on the quote in the post, at least, this was not the assumption, unsupported or otherwise. Rather, the assumption was that women who have access to “good maternal care” will have lower maternal mortality rates than women who do not have such access.

    Since the actual assumption would appear to be uncontroversial, and given the known (if not “much discussed”) racial disparities in U.S. health care practices (which, presumably, have been exacerbated by the great rise in health care costs over the past 20 years), Amnesty International’s statement hardly seems cause for wonder.

    There is an increasingly prevalent desire to downplay the continued significance of race in the U.S., but really….

  4. I don’t think Rebecca meant to downplay that at all. I think she also wanted to bring in background and social economic conditions– and their racial aspects. I took her to be broadening the discussion.

  5. That simply hadn’t occurred to me. I guess I was too preoccupied wondering was she seemed to be challenging a seemingly uncontroversial statement and concern, while using it as an occasion for “broadening the discussion.”

  6. Jender is correct, anon. I was absolutely not trying to downplay race – indeed, notice that I appealed to racial disparities in my original post!

    It’s actually a fairly major problem that our focus tends to be on improving access to clinical care whenever we worry about health disparities in this country, despite tons of evidence that that’s not the main issue – and that clinical care generally comes into the picture only at the end, once there is a health problem to be dealt with, and vast differences in health status are already in place. This problem has NOTHING to do with where one comes down on how race fits in.

    Also, the evidence that access to prenatal care *in developed countries* has any impact on maternal mortality is scant, at best – this is also a much-discussed fact. Poverty, obesity, social stress, substance abuse, etc have a huge impact on maternal mortality. But once you control for these things, it’s pretty much impossible to find convincing evidence that prenatal care itself saves maternal lives.

    There is a reason why the WHO uses maternal mortality rates as its signal measure for the health status of a nation – it’s because it has been shown again and again to serve as a remarkably good proxy for a wide range of social conditions. Different countries have VERY different approaches to prenatal and labor and delivery care – in some very healthy, wealthy countries, pregnant women make virtually no contact with the doctors and hospitals, and they have the LOWEST maternal mortality rates. Maternal mortality rates track social conditions and disparities, not use of doctors and hospitals.

    So, anon, I respectfully disagree. I think “the assumption … that women who have access to “good maternal care” will have lower maternal mortality rates than women who do not have such access” is not at all uncontroversial, and I think you read my comment oddly uncharitably.

  7. It seems odd, Rebecca, to expect to be read charitably when you uncharitably attributed an assumption in an effort to make a broader point.

    I would not have thought that anyone, including Amnesty USA, is denying that “poverty, obesity, social stress, substance abuse, etc” have a significant impact on maternal mortality. But that wasn’t what Amnesty was calling attention to: they were calling attention to maternal mortality in relation to the “haphazard approach to maternal care” in the U.S.

    You are claiming that we should seriously question whether prenatal care makes any significant difference, in developed countries, to maternal mortality. Yet some “background health conditions” surely could be addressed, at least as they directly bear on a pregnancy, in the course of prenatal care. If a woman has diabetes, isn’t that more of a reason for her regularly to see a doctor when pregnant?

    I took exception to your suggestion that since maternal mortality for African American women is most importantly tied to issues they bring to the health care system, the health care system is not importantly flawed regarding racially disparate access to prenatal care or, as you now add, “clinical care” generally.

    You claim that “in some very healthy, wealthy countries, pregnant women make virtually no contact with the doctors and hospitals, and they have the LOWEST maternal mortality rates.” That might well be true, but it hardly suggests that prenatal care is not important to maternal mortality: it merely suggests that wealthier, healthier women don’t greatly benefit from it. This is compatible with the likelihood that poorer, less healthy women with less access to prenatal care might well benefit from it–precisely because they came to pregnancy less healthy.

    I’m sorry you find uncharitable my challenging your apparent downplaying of racial disparities (and bias) in the U.S. health care system itself.

  8. I entirely agree that poorer, less healthy women will often benefit from prenatal care. I also agree that making prenatal care accessible to these women is a worthy goal. ALL I was saying is that when confronted with a statistic about increases in maternal mortality, and in particular with a racial disparity in these increases, to immediately begin talking about clinical care risks rhetorically enforcing the already-pervasive assumption that the best/only/obviously most important way to address systematic health problems and disparities is to get more people into better doctors’ offices. I would have been happier if Amnesty Int’l had been just as outraged, but had been outraged at the wide range of social problems and structural racism (certainly including problems with access to health care) that lie at the route of the increase.

    I remain mystified as to the sense in which you see me as downplaying racial disparities. I just don’t get it. I certainly don’t mean to be doing that at all, and would be interested to know where you find that in what I have said.

  9. Deadly Delivery: The Right to Maternal Health

    Every minute one woman dies as a consequence of complications during birth or pregnancy. That’s more than 500,000 women a year, 1 woman every minute of every day. These women do not die of diseases that can’t be treated or complications that can’t be prevented. To quote Mahmoud Fathalla, former president of the International Federation of Obstetricians and Gynecologists, “they die because societies have yet to determine that their lives are worth saving”.

    Join us on April 19th 6:30pm at Riverside Church in New York for a Discussion about Maternal Mortality

    Speakers Include:
    Jennifer Dohrn, Certified Nurse Midwife Bronx & South Africa
    Larry Cox, Amnesty International Executive Director USA as well as
    Amnesty International Executive Directors from Sierra Leone, Peru and Burkina Faso

    The rights of all women and girls matter!

    Learn the truth about the world’s missing mothers

    For more information contact: 212.633.4215/

    Sponsored by: Amnesty International, The Education Ministry;Social Justice Ministry; and Theatre of the Oppressed of The Riverside Church

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