> In 2021, Joseph et al. published a paper in Obstetrics & Gynecology demonstrating that the entire recorded increase in maternal mortality since 2003 was due to a change in the way data was gathered. In 2003, U.S. states began to include pregnancy checkboxes on death certificates. This led to a whole lot more women who died while pregnant being identified as such. The apparent steady increase in maternal mortality was due to the fact that states adopted this new checkbox at different times:
> In fact, when the authors looked at the common causes of death from pregnancy, they found that these had all declined since 2000, implying that U.S. maternal mortality has actually been falling. Meanwhile, a CDC report in 2020 had found the same thing as Joseph et al. (2021) — maternal mortality rose only in states that added the checkbox to death certificates.
The CNN article is about this [1] study, which is based on OECD 2023 maternal mortality data. OECD says here [2] about "Definition and Comparability":
> Maternal mortality is defined as the death of a woman while pregnant or during childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes. This includes direct deaths from obstetric complications of pregnancy, interventions, omissions or incorrect treatment. It also includes indirect deaths due to previously existing diseases, or diseases that developed during pregnancy, where these were aggravated by the effects of pregnancy.
Edit: [1] Also references [3], a 2022 CDC report saying over 80% of pregnancy-related deaths were determined to be preventable.
That may be relevant to something, but not to why the difference is so drastic between Norway and US.
It is indicative of the US healthcare system, however, that up until 2003 it wasn't even known, statistically, that women were actually dieing of childbirth.
It is very relevant. The US definition of maternal death is very expansive. The expanded definition counts any reason a woman who was recently pregnant and dies.
The prototypical example is murder by a spouse. While tragic and extremely important to collect for policy reasons, it is not what “maternal death rate” typically measures.
NVSS has reported monthly updates on this since the 60s, it's wrong to say it wasn't known statistically I think. Maternal mortality review committees have existed since the 1930s also which provide extra data. Maternal mortality is one of the most important vital metrics to track for any country so it indeed would be surprising not to have more data.
It’s amazing how often you find out the differences in metrics are due to how data is collected not due to actual differences.
I read a good paper(1) about newborn deaths rates in Cuba. It’s often touted that Cuba has amazingly low newborn death rates which obvious means communism has far better healthcare than capitalist systems.
Turns out it’s a reporting artifact. If you correct for it, they have the same death rate as other Central American countries with similar GDP per capita.
How does moving the discussion to the legibility of the rate of change
help us understand why large numbers of women are still dying from
pre-industrial causes in the richest nation?
Man! this plus the teenage suicide/mental health rate stats also possibly being an illusion (Obamacare changed data rules the same time mobile social media was taking off, obfuscating everything) has really thrown me for a loop. Not sure what to believe!
A related effect is there is a real tendency in online debates to use countries that speak exotic foreign languages as examples. So there is no way of working out what the data actually represents, what the known strengths and weaknesses are or what they are trying to measure. Or what the legal framework is.
Are saying that Norway speak an exotic foreign language, so we should ignore their results because some people feel that we cant trust their information? Does that mean that we should not compare the US system to these other nations? Who can we compare it to in that case, UK, Australia and New Zealand?
OK thats all fine, this kind of discrepancies/errors happen all the time in statistics. You for some reason completely avoid massive discrepancy between 0 and what US reports. The fact that its slowly falling from relative stratospheric heights gives no comfort to common US citizens, when clearly it can be done much, much better.
I think we all know most probably the main reason - US healthcare is a business with huge prices compared to anywhere else in the world including nations with higher salaries, not public service. So its all nice and top notch if you have millions in some form, not if you are remaining 95% of the country. General compassion to fellow citizens in need is not a strong point of US in general, is it.
People like me could move literally anywhere in the world if wanted. I moved to Switzerland from my crappy home country for example. But hell will freeze sooner than I would want to raise my kids or get old in US, no thank you for many reasons and this being one of biggest.
Obesity in America is an undeclared national emergency. POTUS should invoke the Defense Production Act to nationalize the production of generic tirzepatide at a cost of $50/month for bulk compounded injectables. Compensate Lilly $10 billion and let that be that because national welfare is more important than profits.
This reply is so "American" I find it hard to believe it's not satire.
The, IMO, logical solution would be to change the underlying problem. Maybe even through some "national emergency". Force the food industry to change, help people to make healthy decisions, punish/rewards etc. But no: let's put everyone on medication.
I could imagine the latter to be a legitimate option if a country's people have some genetic trait that makes obesity harder to fight. But I don't believe that's the case in the US.
Everyone seems very keen to accept that obesity is linked to maternal mortality without actually looking at any of the details, how the deaths occur, how they could have been prevented, etc.
Wow Tonga is running away with it. Based on their population apparently just under 30,000 more people got wicked fat in 8 years? What have they been eating on that island
- Their original food culture was wiped by colonialism
- Now they rely on imported foods without regard for its composition
Phrased differently:
It is easier for imported foods to beat existing options, because the island culture does not preserve attractive options so well. And it is easy for imported foods to be unhealthy.
> ... Pacific islanders are more prone to obesity than people in other nations. Now a new study led by the University of Oxford has examined why islanders on Nauru and in the Cook Islands in the Pacific have the highest levels and fastest rates of obesity increase in the world. On both the islands, between 1980 and 2008 the increase in the average body mass index was four times higher than the global average. The paper, published in the journal Public Health Nutrition, provides a novel theory for why obesity levels are so high there. It suggests that social changes, introduced when the islands were under colonial rule, have significantly contributed to unhealthy dietary habits.
I rather strongly doubt the "Norway has zero" statement. It does not directly reference any study nor does any other article stating the same. I don't doubt that it is lower or even rounds to 0 per 100,000, but actually 0 is almost certainly wrong.
In 2021 [0], the deaths per 100,000 in Norway was 1.7 which is ~80 maternal deaths. I find it hard to believe that Norway happened to go from 80 to 0 in two years even including a generous amount of luck.
First, mothers-to-be in the US need single-payer healthcare, not be sentenced to prison for having a miscarriage, and not told they must be dying of sepsis before they can receive healthcare.
In a Where To Invade Next? (2015)-style of policy prescriptions, the US should copy baby boxes, use policies that work, and measure the results of experiments with creative solutions as long as they work rather than putting the military-industrial complex and profits of big pharma and megahospitals before lives and the standards of living of regular people to not go bankrupt.
Income limits usually apply still. In my state, its up to 32K for pregnant women or for those with a child under age 1. For children 1 and 5 it goes down to about 20K.
If you're above those limits, no medicaid. You can go on ACA/Obamacare plans but those are (much) more expensive even with subsidies, at least in my state.
A birth all in all is surely way above 10k dollars. So people are literally expected to pay 5k+ to have a child? If that's not stressful enough for many poorer people I don't know either
There's an incredible variety of health care needed in the 9 months before birth, and well after. That care is poorly covered in the US compared to most developed nations.
>First, mothers-to-be in the US need single-payer healthcare, not be sentenced to prison for having a miscarriage,
In your opinion, sure, but American voters disagree, which is why it's like this. American voters chose the Supreme Court that made this recent change.
I'm pretty sure that the commenter was referring to baby boxes as in "box of supplies to be able to take care of a baby" [0] and not as in "box to abandon a baby if you cannot take care of it" [1].
The US just deserves better. To meet it feels all of this hinges on that zero-sum mentality of "if I help the other guy that means I have it worse", when in reality helping others will also improve the society as a whole. I mean maybe there are people who find appeal in a society of armed, rugged individualists under constant existential stress where even those that "have made it" are at constant risk of crossing paths with a desperate peer at the verge of making a bad decision — but to be honest to me that sounds rather dystopian.
It is nice to be part of a society that is stable and where people care for each other and the value of that reaches far beyond what the bean counters would quantify in measurable terms — but that doesn't mean there are no measurable terms Q.e.d.
> but to be honest to me that sounds rather dystopian.
It sounds that way because it's a dystopian description written in crayon. It's not real.
The US has loads of charity happening; it gives the most in aid; it makes the most businesses (which increase the size of the pie, and are win-win, and not zero sum mentality - other than the people who complain about billionaires); it has by far the most resident migrants of any country[0]; it's just really silly to characterise the US like this. The biggest line item in the 2024 federal budget[1] is healthcare, at $1.53tn. Second is social security, at $1.45tn.
Overseas it spends a fortune too. Just recently it's spending $61bn more[2], making its own citizens poorer, on Ukraine defence and humanitarian aid.
Making the most businesses is not a net positive. Lots of businesses monetize horrible things. It's pretty off topic from maternal deaths, am I supposed to be comforted that there's another landlord or AI startup?
Aside from being about 1/80th the size of the US, and far less obese, their "scale" of obesity is far lower. I had a super-super morbidly obese teacher in college who took up an entire table, and had students do anything for her that required movement. This is relatively common in the US. Once you're at the weight a routine trip to the doctor could have you leaving in a body bag. It's incredibly misleading, and frankly a miracle our health care system can even keep most of these people alive as long as they do, let alone through pregnancy, which is effectively a surgery.
It needs to spend smarter, not more. It's already spending way more per capita then any other nation. It just doesn't have a lot to show for it in terms of key statistics like average age, child mortality, or indeed maternal deaths. Throwing more money at the problem will just ensure more money gets misspent.
Readit News
> In 2021, Joseph et al. published a paper in Obstetrics & Gynecology demonstrating that the entire recorded increase in maternal mortality since 2003 was due to a change in the way data was gathered. In 2003, U.S. states began to include pregnancy checkboxes on death certificates. This led to a whole lot more women who died while pregnant being identified as such. The apparent steady increase in maternal mortality was due to the fact that states adopted this new checkbox at different times:
> In fact, when the authors looked at the common causes of death from pregnancy, they found that these had all declined since 2000, implying that U.S. maternal mortality has actually been falling. Meanwhile, a CDC report in 2020 had found the same thing as Joseph et al. (2021) — maternal mortality rose only in states that added the checkbox to death certificates.
> Maternal mortality is defined as the death of a woman while pregnant or during childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes. This includes direct deaths from obstetric complications of pregnancy, interventions, omissions or incorrect treatment. It also includes indirect deaths due to previously existing diseases, or diseases that developed during pregnancy, where these were aggravated by the effects of pregnancy.
Edit: [1] Also references [3], a 2022 CDC report saying over 80% of pregnancy-related deaths were determined to be preventable.
[1] https://www.commonwealthfund.org/publications/issue-briefs/2...
[2] https://www.oecd-ilibrary.org/sites/1ea5684a-en/index.html?i...
[3] https://www.cdc.gov/maternal-mortality/php/data-research/?CD...
It is indicative of the US healthcare system, however, that up until 2003 it wasn't even known, statistically, that women were actually dieing of childbirth.
The prototypical example is murder by a spouse. While tragic and extremely important to collect for policy reasons, it is not what “maternal death rate” typically measures.
I read a good paper(1) about newborn deaths rates in Cuba. It’s often touted that Cuba has amazingly low newborn death rates which obvious means communism has far better healthcare than capitalist systems.
Turns out it’s a reporting artifact. If you correct for it, they have the same death rate as other Central American countries with similar GDP per capita.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681443/
I just finished this comment before reading yours.
https://news.ycombinator.com/item?id=40607378
https://ourworldindata.org/grapher/number-of-maternal-deaths...
Dead Comment
https://www-ssb-no.translate.goog/helse/artikler-og-publikas...
> Norwegian
Come on, it's in the same writing system, runs through google translate, and there are plenty of English speaking Norwegians.
I think we all know most probably the main reason - US healthcare is a business with huge prices compared to anywhere else in the world including nations with higher salaries, not public service. So its all nice and top notch if you have millions in some form, not if you are remaining 95% of the country. General compassion to fellow citizens in need is not a strong point of US in general, is it.
People like me could move literally anywhere in the world if wanted. I moved to Switzerland from my crappy home country for example. But hell will freeze sooner than I would want to raise my kids or get old in US, no thank you for many reasons and this being one of biggest.
That's not what the article is tackling. Rather, it's quite literally about what types of deaths get categorized as "maternal mortality."
Not only that increases the death rates exponentially, but it also diverts money away from other healthcare areas.
https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...
The, IMO, logical solution would be to change the underlying problem. Maybe even through some "national emergency". Force the food industry to change, help people to make healthy decisions, punish/rewards etc. But no: let's put everyone on medication.
I could imagine the latter to be a legitimate option if a country's people have some genetic trait that makes obesity harder to fight. But I don't believe that's the case in the US.
One theory:
Phrased differently:It is easier for imported foods to beat existing options, because the island culture does not preserve attractive options so well. And it is easy for imported foods to be unhealthy.
https://www.ox.ac.uk/news/2014-08-29-obesity-pacific-islands...
> ... Pacific islanders are more prone to obesity than people in other nations. Now a new study led by the University of Oxford has examined why islanders on Nauru and in the Cook Islands in the Pacific have the highest levels and fastest rates of obesity increase in the world. On both the islands, between 1980 and 2008 the increase in the average body mass index was four times higher than the global average. The paper, published in the journal Public Health Nutrition, provides a novel theory for why obesity levels are so high there. It suggests that social changes, introduced when the islands were under colonial rule, have significantly contributed to unhealthy dietary habits.
In 2021 [0], the deaths per 100,000 in Norway was 1.7 which is ~80 maternal deaths. I find it hard to believe that Norway happened to go from 80 to 0 in two years even including a generous amount of luck.
0: graph at the bottom of https://www.oecd-ilibrary.org/sites/1ea5684a-en/index.html?i...
If I am using the binominal distribution correctly the chance of a 0 death year is 37%.
The total hits "zero" because it's a small country with a low fertility rate.
In a Where To Invade Next? (2015)-style of policy prescriptions, the US should copy baby boxes, use policies that work, and measure the results of experiments with creative solutions as long as they work rather than putting the military-industrial complex and profits of big pharma and megahospitals before lives and the standards of living of regular people to not go bankrupt.
This is already true, pregnant women qualify for Medicaid in every state. Medicaid pays for ~50% of all births.
If you're above those limits, no medicaid. You can go on ACA/Obamacare plans but those are (much) more expensive even with subsidies, at least in my state.
In your opinion, sure, but American voters disagree, which is why it's like this. American voters chose the Supreme Court that made this recent change.
[0] https://en.wikipedia.org/wiki/Maternity_package
[1] https://en.wikipedia.org/wiki/Baby_hatch
It is nice to be part of a society that is stable and where people care for each other and the value of that reaches far beyond what the bean counters would quantify in measurable terms — but that doesn't mean there are no measurable terms Q.e.d.
It sounds that way because it's a dystopian description written in crayon. It's not real.
The US has loads of charity happening; it gives the most in aid; it makes the most businesses (which increase the size of the pie, and are win-win, and not zero sum mentality - other than the people who complain about billionaires); it has by far the most resident migrants of any country[0]; it's just really silly to characterise the US like this. The biggest line item in the 2024 federal budget[1] is healthcare, at $1.53tn. Second is social security, at $1.45tn.
Overseas it spends a fortune too. Just recently it's spending $61bn more[2], making its own citizens poorer, on Ukraine defence and humanitarian aid.
[0] https://www.weforum.org/agenda/2020/01/iom-global-migration-...
[1] https://www.cbo.gov/publication/58946
[2] https://www.chathamhouse.org/2024/04/us-aid-package-ukraine-...
So you don't have people dying instead of calling an ambulance for monetary reasons? Wow I am glad this insanity wasn't real and I just imagined it /s
Btw. charity dropped significantly in the past 3 years, consider trying to just have your billionaires pay normal taxes that will give you more.
Smallish population, lowish birth rates mean the sample is small?
Perhaps they strongly advise abortions in the risky cases?
Perhaps they record maternal deaths differently when there are other factors (ie. a mother who dies of a cancer during childbirth).
A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995720/
Show some respect when you're talking about the most profitable (for big-Med, big-Food, big-Pharma) segment of society!
Trouble ahead.
Not to mention the billions generated by healthy workers...