Tuesday, May 06, 2014

Good News/Bad News On US Pregnancies

The bad news first, because the good news at the end leaves you feeling better: 

A World Health Organization report on maternal mortality rates notes global improvement in those rates.  The annual number of women who died due to childbirth or pregnancy fell from 523,000 in 1990 to 289,000 in 2013.

That's great, though we can do better.  What's not so great is the trend in the United States:

“The United States is among just eight countries in the world to experience an increase in maternal mortality since 2003 – joining Afghanistan and countries in Africa and Central America,” a team at the University of Washington writes in another report on maternal deaths, published in the Lancet.
In the U.S., 18.5 mothers died for every 100,000 live births in 2013, more than double the figures for Saudi Arabia, where 7 mothers die for every 100,000 giving birth, and Canada, where 8.2 per 100,000 die.
“There’s no reason that a country with the resources and the medical expertise that the US has should see maternal deaths going up."
And it’s not because older women are having babies. The biggest increase in maternal mortality was among women aged 20 to 24.

Bolds are mine.  Note that the United States doesn't have the excuse of immense poverty or wars or natural catastrophies to explain the rising number of women who die because of childbirth.  So what is causing this rise in maternal mortality rates?  One guess:

A lack of access to prenatal care and other health services, and pregnancies complicated by obesity, diabetes, and other conditions, may be to blame, Dr. Christopher Murray of the Institute for Health Metrics and Evaluation at the University of Washington and colleagues found.
“There’s no reason that a country with the resources and the medical expertise that the U.S. has should see maternal deaths going up,” Murray said in a statement. “The next step would be to examine local-level differences in maternal deaths to look for patterns and the drivers behind those patterns.”

I hope those studies are done and that they pay attention to racial and ethnic differences and to income.  As an aside, creating a network of free antenatal and child clinics has worked in other countries to drastically reduce both maternal and infant mortality rates.

Then the good news:

Teen pregnancy rates in the US are down, in all fifty states and for all racial and ethnic groups.  This appears to be driven by better contraception use:

While there was a substantial drop in the pregnancy rate for 15–17-year-olds and 18–19-year-olds between 2008 and 2010, pregnancies among 18–19-year-olds constituted the majority (69%) of teen pregnancies. During this same time period, increasing proportions of 18–19-year-olds reported having ever had sex, yet fewer of them became pregnant. The likely reason is improved contraceptive use and use of more effective methods. 
The rates still differ by states (being higher in the southern states) and between racial and ethnic groups.