I'm gonna risk sounding dismissive here but the article very cautiously points at a cause: "While this study wasn’t able to explore specific causes of death, a large body of prior research, much of it published by Khan, has found cardiovascular disease (hypertensive disorders, heart failure and stroke) is a major contributor to poor maternal health outcomes."
Hypertensive disorders are typically associated with obesity so the reason could be that there's an increasing share of pregnancies happening with people who are overweight. I leave the sociodynamic interpretation of this up to the reader.
Obesity rates increased slightly between 2014 to 2021, but I’m not sure that will account for doubling of mortality rate. It could mean that more obese people are having kids than before, but that would be far from trivial to prove
I'd first look at the use of assidted fertility treatments (ARTs). I can't find solid data on trends that cover through 2021, but infertility rates and the use of ARTs have both gone up.
It seems reasonable that there would be increased risks during a pregnancy when the body wasn't prepared to get pregnant without intervention.
Unplanned pregnancies might happen to people who aren't ready to have a child, physically and mentally - or who don't have easy access to medical care.
IVF, in contrast, only produces planned pregnancies, and only in people with easy access to medical care.
This would be my assumption, though I haven't found data on it and frankly it is a pretty politically unpopular topic to research.
The human body wants to reproduce as its default state. When it can't, there must be physical or environmental reasons (or the likely rare genetic condition that can be a primary cause of infertility).
For sure. The human body after decades of low level environmental toxins can also struggle.
I raise this only as personal guess and don't have data to support it, but I very much expect that issues often seen today with what are referred to as "geriatric pregnancies" are related more to the consistent drip of toxins in our water, air, and foods rather than an issue driven only by aging.
Would it require matrix-level test tube humans to decouple the effects of age from the world environment everyone share? Humans will probably always deal with air issues from lightning induced fires though.
I guess if we look at maternal deaths versus time for healthy BMI folks from the ages of 20-21 over the last century we could gather some insight.
Well that's really why there isn't solid data for it, how do you have a control group when the problem is universal?
Historical data may help a bit, though I expect it'd still be really hard to narrow down enough factors to get anything meaningful out of it. There are so many environmental changes from our food, what's in our water, pladtic and chemical uses in everyday products, radio frequencies we're exposed to, etc.
These days most unplanned pregnancies would probably fall on physical prime as opposed to planned ones. And mental state doesn't really have effect on maternal death rates.
I agree with GP that IVF probably provides motherhood to a lot of people who have preexisting medical issues.
chronic COVID-19 infection may have more adverse effects on the menstrual cycle than COVID-19 vaccines, which have so far presented no long-term adverse events linked to fertility or reproduction
So there’s nothing detrimental, just a temporary change (which can happen for many reasons).
Because respiratory virus is an oversimplification of COVID, yes that's why people die from it, but it affects all cells with ACE2 receptors, for example neurons and blood vessel linings.
Covid virus during pregnancy increases risk of bad outcomes dramatically, but a lot of patients have the wrong (reverse) idea, and therefore refuse the vaccine. Refusing the vaccine is probably a contributing factor. (Source: wife is OB).
In case you're familiar with the recent controversy about whether this is a statistical artifact:
> There's actually been a lot of controversy about whether or not the increase that's been observed is a true increase or is an artifact of how we're now collecting data,” Khan said. “But when we examined deaths only in the states that had already adopted the checkbox and did it the exact same way, we captured an increase with acceleration in the last three years.
Yes - for further context, there's been a big statistical increase in maternal deaths in the US in part due to changes in reporting. [1]
There was strong evidence that the US wasn't reporting all maternal deaths that meet the WHO definition; pregnancy and birth are major medical events, and can easily aggravate other medical conditions. But often you couldn't extract that information from the cause of death reported on a death certificate.
So the US added a 'pregnant or recently pregnant?' checkbox to cause of death reports, and started counting all deaths with the box checked, minus accidents, suicides and falls. So even if a woman had a terminal illness before getting pregnant, that would still count as a maternal death. Then they gradually rolled out the new form one state at a time, over the course of 15 years - so instead of seeing a clear step in the data, there's a long gradual increase.
This makes measuring any real changes in maternal death rates extremely challenging.
However, this report says maternal death rates are rising even after accounting for the changes in reporting.
By your logic there isn’t an increase in maternal deaths because they were already this high for a long time before and nobody cared, arguably an even worse situation. There is no way to spin this that isn’t societal neglect of pregnancy.
The fact the pregnant box is ticked doesn't mean the death is related to pregnancy. You can get pregnant with terminal cancer and it is unlikely to end well regardless of the pregnancy.
The poster above just says it makes analysis of historical statistics difficult, he is not jumping to conclusion.
First, where does the "nobody cared" come from? Second, so what you're saying is that any maternal deaths at all means society is neglecting pregnant women? Because your argument applies even if we believe there's zero maternal deaths per year and later we find out there's actually one per year.
If this keeps up, we're going to have to ban you. We've had to warn you about this quite a few times in the past, and it's not cool. If you'd please review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it.
(Btw I've warned the GP in a couple other places in this thread, just in case it seems like the mods are taking sides)
I suspect this is due to the intermingled effects of biology and politics.
* Consider that with the loss of Roe v Wade many states, including my own, have adopted draconian policies towards abortion without consideration for medical necessity.
* Consider also the study indicated the most increased risk age groups are late 20s and early 30s.
What’s interesting is there was a study published December indicating first time mothers in the 16-20 age group when compared to the 21-25 age group were about 20% less likely to experience detrimental risks of regular vaginal births. The numbers held identical when compared between the US and third world countries without common access to advanced medical care. The study concluded that age is among the most serious of factors with regards to maternal health of first time mothers and this could explain why males developed a selective preference for younger females.
US maternal mortality has been among the worst in the OECD for many years - long before Roe was overturned - and the worst of any high income country.
It seems to be due to lack of access/income and race if I recall correctly. For the highest income quintile it’s roughly in line with the OECD. The lower your income the worse you do, and if you’re black the numbers are off the charts. A few years ago you were 3X more likely to die in childbirth in America than Canada, and 6X more likely than Scandinavia. Not sure the exact stack up now.
[edit] Here’s an NPR write up from 2017 [1] and 2023 [2]. And a more recent one suggesting the numbers may be overestimated in aggregate but suggests race is a huge factor, with black women 3X more likely to die in childbirth than white. Note the CDC disagrees with the idea it’s over-counting. [3] Even using the revised-down estimates America does not compare favorably to the OECD. [4]
Doesn’t really align with the articles I linked saying 2/3 of the deaths occur post partum and 80% are preventable.
By the way, I actually looked into your thesis last time this came up. If you control for all that it really doesn’t change Americas rankings. There’s enough studies on the impact of obesity, etc, on maternal mortality that you can napkin it out. I don’t happen to have the work I did anymore I don’t think but by all means, you’re welcome to check. It has a meaningful effect but it by no means accounts for the delta.
If you’re going to float something like this it would be great if you shared what led you to that conclusion, as I may have missed something. Other countries that have similar levels of obesity do not have the same outcomes, or even proportional ones.
yes but thats not relevant because by the time you go the hosptial its already too late.
Diseases we are talking about in this context have no medical solution.
They mothers probably benefit from being in the hospital up to the birth if they have a high risk sickness which I guess most people can't afford in the US.
If you are at risk you can be admitted to a hospital in advance. Also there are protocols like inducing labour a week early to reduce risks with too large infants. Etc.
But “red” states have been making reproductive healthcare harder and harder to access during the study period. One hypothesis to test is whether there are increases in mortality in such states after controlling for factors outside of access to reproductive healthcare. This will likely be hard to tease out because health outcomes tend to be worse in general in such states.
Yes that is possible, but it’s not what the commenter wrote - which is what I was responding to. Your other claim here would require other evidence to substantiate it.
I wish we didn't use euphemisms like "reproductive healthcare" when talking about abortion, because I don't know if this comment is suggesting there have been actual changes to healthcare for pregnant women, or just saying there have been more unwanted babies delivered that would have been killed in-utero previously.
I know that private equity purchases of healthcare companies have decreased access to healthcare in rural areas and decreased quality of care at many hospitals. I know that PBMs (pharmacy benefit managers) have decreased access to medicines. I know that the AMA has restricted the number of OBGyn residency spots which keeps the number of doctors too small, and correspondingly overworked. I know that many experienced nurses left the field entirely during covid, due to hours/stress/pay/trauma leaving many hospitals and clinics understaffed and with inexperienced nurses barely out of school running wards.
Any of the things I listed in the second paragraph seem far more impactful than changing how many weeks pregnant a person can be to have an elective abortion, in terms of maternal deaths.
The term is accurate if for no other reasons than:
- Methods utilised during abortions are also utilised in non-abortion treatments particularly where the fetus is nonviable or has already died, including miscarriage, ectopic pregnancy, and fetal demise.
See: "In Oklahoma, a woman was told to wait until she's 'crashing' for abortion care"
Statton ... learned she had a type of molar pregnancy, in which some of the tissue is cancerous. ... Her doctor told her she was at risk of hemorrhage and even death, but that she couldn't get treated there. The treatment for a patient in her condition is a dilation and curettage or D&C – an abortion procedure that clears pregnancy tissue from the uterus. Over the course of a week, again and again, she says doctors told her they could not care for her. After a week of being transferred to three different Oklahoma hospitals, Statton says her doctors actually suggested she leave the state and go to a place where an abortion is legal.
- Non-abortion treatments and procedures are increasingly withheld from pregnant women out of concern that they will be interpreted as abortions, as they in fact have been.
There have been several nationally publicized incidents where women experiencing pregnancy complications were turned away at hospitals due to fear that performing an abortion would be ruled as illegal.
This should also be brought up whenever people do one of those population decline scare stories. It's a real risk!
> first time mothers in the 16-20 age group when compared to the 21-25 age group were about 20% less likely to experience detrimental risks
The negative effect on lifetime income of having children young is extremely high, though, and people will shame teenagers for pregnancy. Especially as this almost invariably results in them being single parents. Bringing down teenage pregnancy rates has been a long term health project.
> Bringing down teenage pregnancy rates has been a long term health project.
A project that in the US is wildly inconsistent, muddled, and rife with political interference, heavily tinged with US religious prudery.
We know how to reduce teen pregnancy. Fact based sex education, access to contraception, these are straightforward. Instead we have the worst of all possible worlds where schools teach abstinence and the kids learn from porn.
Does anyone have any idea why? The much higher mortality rate for black women especially stands out. People have often remarked on this as evidence of racism, but does anyone know the actual mechanism here? Are black women less fit to survive a risky procedure in the first place? Are facilities actually treating black women worse? Do black women primarily only have access to inferior facilities? (if so, do women of other races also have worse outcomes at said facilities?) The article refutes increasing maternal age, which would have been my next guess.
I don't have answers, just questions and guesses. If anyone's got anything definitive, I'd love if they weighed in.
there's a few obvious things, poverty and worse economic conditions and thus worse medical care, higher rates of obesity, as the article points out cardiovascular diseases are generally considered to be a driver of mortality rates.
As for racism, a known observation is that black women in particular are treated as "tough" and tend to not have symptoms taken as seriously, as far as I'm aware that even holds when the doctors are black. It's a bad and very old stereotype.
Black women in the US are almost 10 times as likely to die during/after childbirth, compared to all women in the UK (and white women in the US are almost 4 times as likely to die as in the UK).
Why are you comparing black women in the U.S. to mostly white women in the UK? The maternal mortality rate for black women in the UK is about 4 times higher than for white women in the UK: https://lordslibrary.parliament.uk/maternal-mortality-rates-...
If you refer to my original post, my focus was to provide additional detail that was being requested. Note that I also compared US white women to all UK women.
It is a US based site which provides a breakdown on the US population, and compares it to other developed countries.
I pulled out some figures I thought were interesting - both for black and white populations it shows a significant difference to the country I live in (UK).
Even the group with the best outcomes in the US, still shows a roughly 2.5 times higher incidence of death. I am interested in why the outcomes are worse across all groups.
>more people are having children later in life, so we wanted to investigate this question. However, we found that’s not why we’re seeing a spike in the number of maternal deaths,”
when we shifted this way in the last 60 years, mortality was decreasing. This wouldn't be my go-to guess.
>While this study wasn’t able to explore specific causes of death
it's public data in quite a number of places in the world.
Generally speaking it's bleeding or blood related things; heart, or blood brain stroke type. Women during birth have the same problems as high G fighter pilots. Gotta tighten all your muscles.
>Black individuals are three times more likely to die from pregnancy-related deaths than white individuals.
Randomly tacked onto the end. The thing about statistics on race, it's really hard to rule out all the other factors and make conclusions. It's not some sort of allegation that black moms are systematically being killed.
> The thing about statistics on race, it's really hard to rule out all the other factors and make conclusions. It's not some sort of allegation that black moms are systematically being killed.
When I see people argue that systemic racism is a driver, they're not arguing that there's a conspiracy directly targeting people of color. Rather, they're arguing that racism drives things that create conditions where people of color disproportionately suffer harm.
A classic example of this from several decades ago is redlining, which prevented people of color from moving into safer neighborhoods, and undermined the neighborhoods they were able to buy homes in. Settlement patterns have long-term generational effects, so while it would be incorrect to say that predominately black neighborhoods have higher levels of asthma, violence, poverty etc as a deliberate plot, it's absolutely true to say that those are consequences of direct racism from several decades ago.
I don't think this should be a particularly controversial point. Where I think it gets more controversial is two points -- 1. What redress, if any, should people downstream from historical racism have? They're still suffering the effects, after all. 2. What patterns and decisions are happening _now_ that will similarly have downstream generational effects?
I'm not going to even attempt to suggest answers to those, just hoping to illuminate the framing here.
>A classic example of this from several decades ago is redlining, which prevented people of color from moving into safer neighborhoods, and undermined the neighborhoods they were able to buy homes in. Settlement patterns have long-term generational effects, so while it would be incorrect to say that predominately black neighborhoods have higher levels of asthma, violence, poverty etc as a deliberate plot, it's absolutely true to say that those are consequences of direct racism from several decades ago.
No, the latter argument isn't logical followed, and not a conclusion one can make.
The 30 year old dad with asthma problems for his kids is not that way because of some housing racism that happened decades before this dad was born.
>I don't think this should be a particularly controversial point. Where I think it gets more controversial is two points -- 1. What redress, if any, should people downstream from historical racism have?
If something didn't directly affect you, then your claim to redress is far significantly less. That's even acknowledging generational trauma.
>They're still suffering the effects, after all. 2. What patterns and decisions are happening _now_ that will similarly have downstream generational effects?
redress from who though? Less than 2% of people in north america ever owned slaves at the peak. Nobody alive today ever owned slaves, nor were slaves. It's also not completely clear if there's any harm being done today and if there is, then how much harm and most especially by who. These aren't just assumed to be the government's fault and so they should pay.
Would be interesting to compare the rates across different countries in the same time period. If they didn’t increase elsewhere, then it isn’t covid, but rather an American specific problem. The fact that healthcare isn’t a guaranteed right is certain to have some effect somewhere in American health data, just depends where exactly it shows up.
Somebody else posted a link with data from 2022 and 2023:
> In 2022, there were 22 maternal deaths for every 100,000 live births in the U.S. — more than double, sometimes triple, the rate for most other high-income countries in this analysis. In half of the countries, there were less than five maternal deaths per 100,000 live births.
> It’s been well documented that the COVID-19 pandemic had a greater impact on Latino people, with one study finding that roughly a third of Latina maternal deaths were linked to COVID. In addition, lower vaccine uptake, especially among Black and Hispanic women, was found to be leading to more maternal deaths by the end of 2021...
> In half of the countries, there were less than five maternal deaths per 100,000 live births (Norway, Switzerland, Sweden and the Netherlands have less than 3.0). For Black women, maternal mortality is exceptionally high (chart shows 49.5 for black women in the USA).
> In 2022, Norway’s maternal mortality rate was 0.
> All countries, apart from the U.S., guarantee at least one such home visit within one week postpartum, although Medicaid programs in some U.S. states cover these visits.
> The majority of deaths in the U.S. occur in the postpartum period, from one day after giving birth to a full year later.
> All countries included in this study, apart from the U.S., mandate at least 14 weeks of paid leave from work. Several countries provide more than a year of parental or home care leave.
> The U.S. and Canada have the lowest overall supply of midwives and ob-gyns
> Our findings suggest that an undersupply of maternity providers, especially midwives, and lack of access to comprehensive postpartum support, including maternity care coverage and mandated paid maternity leave, are contributing factors.
But if the underlying causal factor is obesity, then it is meaningless to say various races were impacted more heavily - in fact, it is worse than meaningless cause it implies they are causal factors.
It is not meaningless, nor misleading. It's a reality. They ARE affected more heavily.
All you're saying is that the reason they're affected more heavily is not really race. But that does not change the fact they are affected more at all.
Imagine if you tried to say it's misleading to say black people are targetted by the police, because in reality it's criminals who are targetted. Can you see the problem?
I'm six times vaccinated and still can't work full time 11 months out from catching covid so good luck with that idea. And I know people who are doing worse than I am. "Vaccination is like having an airbag. Avoiding contact is like keeping your hands on the wheel."
> In that same period, the overall maternal mortality rates in the U.S. nearly doubled, from 16.5 to 31.8, with the largest increase of 18.9 to 31.8 occurring from 2019 to 2021.
31.8 what? Football fields? I'm guessing per 100k, but this is a .edu domain for Christ's sake.
”The U.S. National Center for Health Statistics, the branch of the Centers for Disease Control (CDC) charged with collating health and vital statistics, has published three separate reports elaborating in excruciating detail on one crucial fact about U.S. maternal mortality: It is measured in a vastly more expansive way than anywhere else in the world.”
"But the U.S. case is particularly beguiling, since the United States now tracks all deaths of women who were pregnant, not only women who gave birth. Women who miscarried early or had abortions—whether officially reported or not—are also counted in the checkbox method."
"While this study wasn’t able to explore specific causes of death, a large body of prior research, much of it published by Khan, has found cardiovascular disease (hypertensive disorders, heart failure and stroke) is a major contributor to poor maternal health outcomes."
tl;dr: obesity ("hypertension")
but why stop at maternal deaths? obesity is driving premature death rates in every category
this is a national crisis but no one wants to say it out loud because someone's feelings will be hurt
Basically every healthcare professional has been saying it out loud for decades. Its proxy, body mass index (BMI), is on every checklist and some city level political leaders have even been able to tax beverages with sugar.
The Obamas, and Michelle Obama specifically, addressed it directly (14 years ago):
There’s also the ongoing closure of labor and delivery wards across the country, especially in rural America. There’s been an increase in retirements and burnout among experienced obgyn’s too.
But I guess none of the complicating factors make for as good of a straw man for the inane point you’d like to use these women’s suffering to prove.
I do not remotely disagree, though I don't think people are saying we should "only think" of it then.
But a proper healthcare system should absolutely be discussing obesity with women who intend to get pregnant at least, just as it should be discussing it with people who want to have surgery requiring general anaesthesia, with people who have mobility issues or knee/hip problems, etc.; if not more generally even outside of the context of immediate interventions.
Because it makes difficult, traumatic and bad health situations worse. Giving birth is routinely the first two of those things.
There is a positive-discrimination aspect here, though: yes, obesity complicates the health of older people, is raising mortality rates across the board. But society doesn't want women to die in childbirth anymore, and that makes this targeted intervention re: obesity a proper thing to do.
> Anything to avoid personal responsibility I guess
Something can be caused by obesity without the primary “blame” being personal responsibility. If Americans are more obese than Scandinavians, is it because there just happen to be more individuals in the US who lack personal responsibility?
Societal problems are a result of societal sickness. We should aim at the root societal causes rather than attribute personal moral failings to the individuals who are a product of that society.
>> Of course this post will probably be massively downvoted
You overestimated how much people would care about your cute, linkbait post that doesn't actually contain any information other than hinting at a hot take and a couple of obfuscated links.
Hypertensive disorders are typically associated with obesity so the reason could be that there's an increasing share of pregnancies happening with people who are overweight. I leave the sociodynamic interpretation of this up to the reader.