Scientific American 201905

Maternal Deaths per 100,000 Live Births

U.S.

12

10

8

6

4

2

0

26

24

22

20

18

16

14

12

10

8

6

4

2

0

31.7 31.9 30.8 30.6

50.6

424.5

35.7

210.4

40.0

224.8

273.2 27.2 40.8 298.9 27.8 45.9 277.4 27.0 327.0 27.2 43.0

51.4 50.5

192.1

37.9

384.0

63.2

262.6

47.3

398.1

173.4 44.3 39.7

215.4 37.2

353.2

30.4

32.1

224.2

55.2

184.3

46.1 293.0

39.5

58.1

50.2

242.5

271.4

158.1

26.1

29.1

27.1

30.8

27.0

31.1

28.2

31.0 31.3

48.5

26.7

7–3

2.9–0.7

11–8

7.0–4.7

12–10

10.2–11.0

8–5

7.1–5.8

7–5

6.7–3.8

12–14

16.9–26.4

11–6

9.6–4.2

8–4

10.4–4.4

12–7

12.0–6.7

8–6

7.5-5.5

$104,103 $80,190 $75,505 $70,057 $69,331 $59,532 $56,308 $53,800 $53,442 $48,223

Luxembourg Switzerland Norway Iceland Ireland U.S. Denmark Australia Sweden Netherlands

Average across

10 countries

Country

Age

1970 –2016

Mean age

of women

at childbirth

Overweight

1990 –2016

Percent of

female population

classifed as

overweight

Diabetes

1990 –2017

Years lived with

disability (per

100,000 women,

ages 15–49)

GDP per capita (in U.S. dollars)

31

(^31752)
450
33
60
Maternal deaths per
100,000 live births
Maternal Mortality
Rate (MMR)
Past
Comparing Three Oft-Cited
Contributing Factors
KEY
WHO 1990–2015
IHME 1990–2015
1990
1990 2015
2015
Increase Decrease
Present
ME
WI VTNH
WA ID MT MI MA
OR NVWY SD OH PA CT RI
CA UT CO WV DE
AZ KSAR TNNC SC DC
OK GA
HI
NDMN IL NY
IA IN NJ
NEMO KY VA MD
NM
LA MS AL
TX FL
AK
5
(^19872015)
10
15
20
25
30
IHME
ACOG*
CDC
WHO
U.S. Maternal Mortality Rate Estimates
According to different organizations
Inconsistent Data Coll ection across the States
Pregnancy question included in state death certificate
(status in 2014)
How to Reduce Maternal Mortality
To prevent women from dying in childbirth, the first step is to stop blaming them
TEXT BY MONICA R. McLEMORE, GRAPHICS BY VALENTINA D’EFILIPPO
The shameful secret is out: Although the number of women who
die in childbirth globally has fallen in recent decades, the rates
in the U.S. have gone up. Since 1987 maternal mortality has dou-
bled in the U.S. Now approximately 800 maternal deaths occur
every year. One of the most striking takeaways from examining
the data is racial disparity: Black women are three to four times
more likely to die from pregnancy-related conditions such as
cardiac issues and hemorrhage and to bear the brunt of serious
complications as well. That risk is equally shared by all black
women regardless of income, education or geographical loca-
tion. In other words, the factors that typically protect people
during pregnancy are not protective for black women.
Fortunately, most of these deaths are considered preventable,
and therefore, much more can be done to stop them. First, every-
one—from doctors to the media to the public—needs to stop
blaming women for their own deaths. Instead we should focus
on better understanding the underlying contributing factors.
These include a lack of data; not educating patients about signs
and symptoms—and not believing them when they speak up;
errors made by health care providers; and poor communication
among different health care teams. Finally, studies have shown
that interventions such as wider access to midwifery, group pre-
natal care, and social and doula support are effective in improv-
ing maternal health outcomes.
Progress has been slow and uneven. Deaths from hemorrhage,
for example, have been reduced by half in some states because
of standardized tool kits for care. And California has led in the
pursuit of understanding root causes of maternal mortality.
Still, structural racism is proving to be an intractable force.
Monica R. McLemore is an assistant professor in the family
health care nursing department and a clinician-scientist
at Advancing New Standards in Reproductive Health at
the University of California, San Francisco. She maintains
a clinical practice at Zuckerberg San Francisco General.
The U.S. Is an Outlier
The high maternal mortality rate (MMR) in the U.S. is often blamed
on the poor health of mothers, but a comparison with other wealthy
countries undermines this argument. MMR—shown here using two
estimates, one by the World Health Organization (WHO) and one by
the Institute for Health Metrics and Evaluation (IHME)—is not rising in
countries with similarly increased rates of cardiovascular disease, obesity,
diabetes and other conditions during pregnancy. Other factors must
therefore be contributing to the rise in MMR in the U.S. As a 2018 paper
in Obstetrics & Gynecology concluded, “the increased mortality ratios
seen in the United States in recent years reflect significant social as well as
medical challenges and are closely related to lack of access to health care
in the non-Hispanic black population.”
48 Scientific American, May 2019
© 2019 Scientific American