Thursday, May 10, 2018

Why more mothers and babies die in the US

Political left-wing commentator Gordon Campbell writes a column in my local paper, the Hutt News. Last week's (I can't find it on-line)  was essentially about the Royal and Jacinda babies; the price of maternity care in the United States and despite the cost, the "dire"quality of care resulting in extraordinarily high infant and mother deaths. A typical anti-capitalist making the numbers tell his story.

My response:

Gordon Campbell, Hutt News, May 8, blames "dire" quality of care for the relatively high US infant mortality and maternal death rates. It is my experience that whenever statistics diverge strongly from the 'norm' there are sound reasons why, often based on how they are derived.

In 2016 Science Daily pointed out that some countries treat babies born after a very low gestation period and with very low odds of surviving as 'stillbirths'. In the United States these babies would be considered 'born' despite their high chances of death. Accordingly, "These premature births are the biggest factor in explaining the United States' high infant mortality rate."

Similarly, maternal deaths are also measured differently. According to the Economist, 2017, standard definitions used to make international comparisons are not used in the US. The World Health Organisation mandates a measurement based on a maternal death from pregnancy complications  from when the mother becomes pregnant to six weeks after the birth (or termination of pregnancy). New Zealand adheres to this. The US, however, measures deaths up to one year after the birth. As suicide is a leading cause of death among pregnant and new mothers in NZ and the US, extending the period of measurement to one year would make a significant difference to the recorded death rate.

Additionally, The Economist explains:"In rich countries, [maternal] deaths are tallied from vital-registration systems which in turn compile data from death certificates. These, however, are known to undercount maternal deaths, partly because doctors must select a cause of death from thousands of codes. They are more likely to consider the subset reserved for medical problems caused by pregnancy when the form has a checkbox asking whether the woman had been pregnant.
America added this checkbox to its standard death certificate in 2003, though it took more than a decade for all states to adopt it. It has been a mixed blessing, says Andreea Creanga of Johns Hopkins University. A recent study found that its growing use accounted for 80% of the steep rise in maternal mortality recorded in 2000-14."

The United States generally outperforms other countries in the collection and dissemination of rigorous data. Its information systems produce exhaustive, accurate and accessible statistics through which a proper understanding of matters can be achieved. They cannot though control a critic's lack of comprehension about comparability across countries.


Anonymous said...

I have seen this used against the USA as propaganda on the cover of Granma, the Cuban Communist Party "newspaper" with my own eyes when in Havana in 2010. Basically stating that the evil capitalist USA has higher infant mortality rates than in the paradise that is Cuba. It is actually worse than that, because Cuba did (as I understand it) only count an infant death if it occurred after 30 days of birth. So the USA records a still-born as a death, while anything up to 30 days post-birth in Cuba is NOT counted.
Interesting that Gordon Campbell is on the side of the Cuban dictatorship in his assessment of the data...

Anonymous said...

Thank you for looking into that data Lindsay. He is published in the Upper Hutt leader too, and I wondered about the statistics when I read it.
What's that saying about lies, damn lies and Statistics?

Brian Marshall.

Richard McGrath said...

Thank you for that, Lindsay. Apples should be compared to apples, and clearly that is not happening here.