A recent analysis challenges the perceived scale of the maternal health crisis in the United States, suggesting that the actual rates of maternal mortality may be lower and more stable than previously reported, despite still being alarmingly high for a developed nation. This comes against a backdrop of increasing concern over the years, particularly highlighted during the COVID-19 pandemic, when maternal mortality rates appeared to surge, prompting federal initiatives aimed at addressing these critical health issues.
The traditional method of tracking maternal deaths in the US underwent a significant change in 2003 with the introduction of a “pregnancy checkbox” on death certificates across states, a move aimed at capturing more accurate data on pregnancy-related deaths. However, a study published in the American Journal of Obstetrics and Gynecology by researchers from the University of British Columbia and international institutions suggests that this checkbox may have inadvertently led to a substantial overestimation of maternal mortality rates.
According to the study’s findings, a large portion of the deaths recorded as maternal mortality due to the checkbox were associated with “less specific and incidental causes of death.” This discrepancy led the researchers to apply a “definition-based approach” to identifying maternal deaths, focusing on cases with explicit mentions of pregnancy among multiple causes of death. Their analysis revealed a maternal death rate that showed minimal change from 10.2 deaths to 10.4 deaths per 100,000 live births from 1999 to 2021, a stark contrast to the significant increase reported by traditional methods.
This new perspective on maternal mortality rates does not diminish the severity of the maternal health crisis in the US but rather underscores the complexities involved in accurately monitoring and addressing it. The CDC acknowledges the challenges inherent in surveillance methods, with Robert Anderson, chief of mortality statistics, affirming a confidence increase in maternal mortality, particularly during the pandemic, despite the acknowledged overestimations.
The study’s revelation about the potential overestimation of maternal deaths calls for a reassessment of data collection methods, particularly the usage and interpretation of the pregnancy checkbox on death certificates. Experts suggest that clarifying the checkbox’s intent and ensuring a more rigorous examination of cases before inclusion in maternal death counts could enhance the quality of data and contribute to a more accurate understanding of the maternal health crisis.
As the debate continues, the pressing need for improved maternal health care in the US remains undiminished, with calls for actionable solutions to avert preventable deaths and support women’s health during pregnancy, childbirth, and the postpartum period. This study represents a step towards refining our approach to maternal mortality surveillance, emphasizing the importance of precision in data to effectively tackle the ongoing health crisis.
