US maternal mortality continues to worsen, and there are large differences by race and state
July 7, 2023
Happy Friday!
JAMA reported this week that maternal mortality rates doubled in the ten years from 1999-2009 to 2010-2019. This rise was across all racial groups and preceded the COVID-19 pandemic, which increased maternal mortality further. Each dot on this graphic represents a state and a racial group. Those above the diagonal line increased in this time period, and almost no dots are below the line.
Source: Fleszar, et al JAMA July 3, 2023 LINK
Maternal outcomes are worst for Native Americans and Blacks and are worst in the South. This graphic gives a sense of the racial and geographic differences:
Source: Fleszar, et al JAMA July 3, 2023 LINK
This study, of course, is not perfect. The database could have incorrect racial and ethnic information, and death certificate information is not standardized across states. These researchers did not include deaths from suicide, homicide, or trauma - which are often included in other maternal mortality statistics.
Implications for employers:
- Here’s a link to an article I wrote in Harvard Business Review this spring, “What employers can do to make childbirth safer.” The gist is that employers can improve benefit design, demand more transparency and reporting to patients and employers from health plans, and push health plans to pay providers for value.
- Employers can provide better data to employees on their maternity benefits, and offer resources to help identify and even cover doulas.
- This spring, the FDA approved a new blood test to predict the risk of preeclampsia, which leads to severe hypertension and seizures and can cause death. This test will likely be performed as part of hospitalizations, so its cost will be borne by facilities that are paid per diem or global fees and will show up as a new charge for facilities paid fee-for-service.
Coming Monday:
Large study shows increased suicide among transgender individuals, and literature demonstrates that gender affirming care is associated with lower mental health risks
Have a great weekend!
Jeff
Black and Native American women have higher rates of complicating factors (like obesity and alcohol abuse, respectively) and are less likely to seek the full availability of maternal healthcare resources (which are also highly unequal, based on income and location). They're also younger and much less likely to have the support of a man, who's living with them.
Women have always prized loyalty and dependability among men, since being abandoned by a male mate while pregnant is often a death sentence in the state of nature. Cultures which still select male mates based on dependability and commitment (rather than the many other available signals) tend to have better health outcomes, stronger families... and less maternal mortality. Hispanic women have the best health outcomes of any racial group, I think. That's what I've read and it seems to be what this data shows. Hispanic women also tend to have stronger marriages and more committed mates.
It's possible that no amount of government services or medical care is sufficient to compensate for the lack of a father in terms of health and success metrics throughout a child's lifetime. It's better to not be obese, and to show up to your ob-gyn appointments, and to only have sex with men who are willing and able to stay and help care for a child. Our public policy should reflect these potential realities, in my opinion.
As far as trans data: sex changes increase subjective (self-reported) mental health in the short- and medium term... but so does a drug addiction. The data that indicates that sex changes might meaningfully reduce lifetime suicidality anywhere close to the average rate, or that they address mental health symptoms in a permanent way, is weak and very mixed. That was my impression when I read it, which was months ago.
I'm looking forward to studies on the tens of thousands of anxious and autistic girls who've sought treatment for gender dysphoria over the past decade. This is a pretty mysterious cohort, for which no good data yet exists. Unfortunately, some people would rather not gather it.