during pregnancy

An Erroneous Report About Maternal Mortality Rates in Texas Highlights a National Problem

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A study published in 2016 highlighted some very distressing data on the maternal mortality rate in Texas. The data showed that mothers in Texas were dying at an alarming rate. Between 2010 and 2012, researchers found that the rate skyrocketed, from 72 in 2010 to 148 in 2012. The national maternal mortality rate in 2013 was 28 deaths per 100,000 live births, for comparison. Experts scrambled to explain the dramatic spike, and wondered if it was connected to the decrease in family-planning funding in Texas. In 2011, the legislature reduced the state’s budget for family-planning by two-thirds. The statistics were frightening. New research, however, contradicts the findings in the original study. Which is good news for Texas! But the corrections show a disturbing flaw in how this data is collected.

The data collection in that 2016 study was, as it turns out, sloppy and full of errors. Over half of the pregnancy-related deaths recorded during that time frame were recorded in error.

In 2013, the Texas Maternal Mortality and Morbidity Task Force was established to study the maternal mortality rate following that disturbing report. They cross-checked records for all 147 pregnancy-related deaths. They found that out of those 147 reported deaths, only 56 fell under the actual definition of maternal mortality. Maternal mortality is any death of a pregnant woman during pregnancy or within 42 days of giving birth. This definition excludes deaths that occur because of accidental or incidental causes, like murder or car accidents.

The correction in data collection dropped Texas’s maternal mortality rate from 38.4 to 14.6 deaths per 100,000 lives births. However, the correction was hardly a reason to celebrate.

The issue, say experts and researchers, is HOW pregnancy-related death data is collected. The problems with that study are indicative of a national problem. In 2003, in an effort to collect data on pregnancy-related deaths, the federal government added a checkbox to standard death certificates, indicating if the person was pregnant or postpartum at the time of their death. States have jurisdiction of their own death certificates, so the addition of this checkbox was completed at different points. Texas added it in 2006.

But the addition of that checkbox did not have the desired effect on data collection.

Elliott Main, the medical director of the California Maternal Quality Care Collaborative, told The Washington Post, “What we’re finding now is that it is often checked in error, just like any other checkbox on a big form. Because pregnancy-related deaths are so uncommon, the frequency of the box being checked in error can significantly impact the maternal mortality rate reported.” There is very little uniformity in reporting that it’s difficult to get accurate statistics. Which makes pinpointing the national maternal mortality rate almost impossible. In fact, it’s so hard to get accurate data that the federal government hasn’t released a report on the matter since 2007.

However, even with the problems with data collection, and even using the most conservative estimates, the United States is still far behind the rest of the developed world.

Main says, “The maternal mortality rate is still higher by anybody’s count than it was in the 1990s. No matter how you look at it, even with the conservative estimate, the rate is higher than it should be compared to other high-resource countries.” A report citing a 2015 study puts the maternal mortality rate in the U.S. at 26.4 per every 100,000 live births in 2015. In 2015, Britain’s rate was 9.2, Australia’s 5.5 and Finland’s 3.8 per 100,000 live births.

Fixing the issues with data collection is imperative, so experts can focus on investigating and preventing pregnancy-related deaths.

(Image: iStock / Wavebreakmedia)