Too Many Infants—and Moms—Die at Birth

The U.S. rates of infant and maternal mortality are both far higher than they should be.

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The National Center for Health Statistics offers some encouraging news this morning: The U.S. infant mortality rate seems to finally be dropping, even though we still rank a dismal 29th in the world, tied with Poland and Slovakia. The main reason for that poor showing is the rise in premature births. From 2000 to 2005, the share of preterm births increased 9 percent, to 12.7 percent. Babies born at 34 to 36 weeks were three times as likely to die as were full-term babies, who are born at 37 to 41 weeks of gestation.

But I was struck earlier this week by a related startling statistic while reading a front-page story in the Washington Post about Sierra Leone's shocking rate of women dying in childbirth (1 in 8). Women in the United States have a 1-in-4,800 lifetime risk of dying in labor, according to a 2007 United Nations report—much higher than the 1-in-48,000 rate in top-ranked Ireland. In fact, the United States ranked a dismal 41st out of an analysis of 171 nations, which included underdeveloped countries like Sierra Leone. Even more troubling is that our mortality rate is the highest that it has been in decades, according to the latest report from the National Center for Health Statistics. What gives?

Experts cite a number of possible reasons, including:

1. Lack of access to good healthcare for all women: A fair percentage of pregnant women are underinsured or have no health insurance at all. This means they're less likely to seek prenatal care and get screened for dangerous conditions like gestational diabetes and pre-eclampsia. Black women, who are more likely than white women to lack good prenatal care, have a maternal mortality rate three times higher than that of white women, possibly because of their higher risk of developing hypertension and other complications. Several studies have shown that at least 40 percent of maternal deaths in black women could have been prevented with better-quality healthcare.

2. Increased number of C-sections: Nearly one third of women now get C-sections, compared with 1 in 5 a decade earlier. The vast majority of women who have one C-section wind up with another on subsequent pregnancies. And studies suggest that women who have undergone several previous C-sections are at particularly high risk of dying from excessive bleeding.

3. Rise in obesity: A larger percentage of women who become pregnant are overweight or obese, and this increases their risk of pregnancy-related diabetes, hypertension, and other conditions. They also tend to have larger babies who have a hard time squeezing through small pelvic openings, often necessitating a C-section.

4. Increase in maternal age: More women are giving birth these days in their late 30s and 40s, when risks of pregnancy complications surge. This delay in childbearing could account for some of the increase in mortality.

5. New way of collecting statistics: The NCHS report acknowledges that the recent increase in maternal death "largely reflects" the fact that more states are noting pregnancy status on a woman's death certificate. The report counts only those deaths noted to be caused by pregnancy or pregnancy management, but many of these went largely uncounted in years past because of poor record keeping. This last reason shouldn't let us off the hook but rather should spur us to action. Clearly, the problem is worse than we previously thought. And it should be a part of the discussion when it comes to new plans to fix the healthcare system.