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)
May 2019, ScientificAmerican.com 49
Maternal Mortality
Data in the U.S. Is
an Unreliable Mess
As bad as the numbers sound, the
U.S. MMR is widely considered to be
an underestimate. That is because
different methods are used to count
deaths related to pregnancy, and
reporting is inconsistent. The World
Health Organization, for instance,
defines maternal deaths as the death
of a woman while pregnant or within
42 days of the end of a pregnancy. But
the Centers for Disease Control and
Prevention defines maternal mortality
as “the death of a woman while preg-
nant or within one year of the end of
a pregnancy.” Both these definitions
exclude accidental or incidental causes
of death. The difference in time frame
for maternal mortality is further com-
plicated at the state level, where data
collection from death certificates is
not comparable because of different
definitions of the cause and time of
death. States could fix this problem by
creating standardized maternal mor-
tality review committees, which com-
pre hensively evaluate each maternal
death and discuss the factors that
contributed to the outcome.
Poverty, lack of insurance,
insufficient access to care,
racism and experiences of
discrimination, and exces-
sive use of unnec essary
inter ventions such as
episiotomy and cesarean
sections are all known to
be associated with poor
health outcomes.
SOURCES: GLOBAL HEALTH OBSERVATORY DATA REPOSITORY, WORLD HEALTH ORGANIZATION ( WHO MMR data ); MATERNAL MORTALITY 1990–2015 TABLES
IN GLOBAL BURDEN OF DISEASE STUDY 2015. GLOBAL BURDEN OF DISEASE COLLABORATIVE NETWORK. INSTITUTE FOR HEALTH METRICS AND EVALUATION,
2016 (IHME MMR data ); IHME ( diabetes ); ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT (age ); WHO (weight ); WORLD BANK ( GDP );
“RECENT INCREASES IN THE U.S. MATERNAL MORTALITY RATE: DISENTANGLING TRENDS FROM MEASUREMENT ISSUES,” BY MARIAN MACDORMAN ET AL.,
IN OBSTETRICS & GYNECOLOGY, VOL. 128, NO. 3; SEPTEMBER 2016 ( ACOG data and map )
As published in Obstetrics & Gynecology,
a publication of the American College of
Obstetricians and Gynecologists (ACOG).
© 2019 Scientific American © 2019 Scientific American