"However, these figures are completely wrong, and they have been known to be wrong for many years now. The U.S. National Center for Health Statistics, the branch of the Centers for Disease Control (CDC) charged with collating health and vital statistics, has published three separate reports elaborating in excruciating detail on one crucial fact about U.S. maternal mortality: It is measured in a vastly more expansive way than anywhere else in the world.
As a result, U.S. maternal mortality is overestimated by two to three times. Properly measured, the real U.S. maternal mortality rate in 2019 was 9.9 maternal deaths per 100,000 births, which would put it at 36th place—still not impressive by comparison, but somewhat better than Canada and a bit worse than Finland or the United Kingdom.
...
Historically, the United States and most countries have tracked maternal mortality using data based on the cause of death listed on death certificates. When a person dies and the cause is assessed by an examiner of some kind, certain “maternal” causes, such as “eclampsia” or “obstetric trauma,” are commonly tracked. If a woman has died due to one of these pregnancy-related causes, she is listed as a maternal death. This process is fairly straightforward and has been widely adopted across many countries.
But in 2003, the U.S. CDC decided to launch an improved death certificate form. Among the various changes proposed was the addition of a checkbox, wherein whoever filled out the paperwork would identify if the deceased had been pregnant in the last 42 days or the last year. The reason for this checkbox was that the CDC believed (correctly, as it turns out) that in only measuring “maternal causes of death,” it might be underestimating the true health hazards of pregnancy. Pregnancy might alter the course of other diseases and conditions or interact with them in important ways.
The CDC anticipated that the checkbox would increase measured maternal deaths; it did not anticipate just how much it would increase them. As it happens, the CDC’s own reporting, which I have confirmed elsewhere, shows that the addition of the checkbox approximately doubled maternal mortality rates.
You might think a sudden doubling in maternal death rates would be obviously flagged as a data issue to correct, but this turns out not to be so. Because the United States has a federal system, individual states added the checkbox in different years. While individual state maternal deaths showed sharp level shifts, the national maternal death count drifted upward gradually as states added checkboxes to their death certificates: California in 2003, Florida in 2005, Texas in 2006, Ohio in 2007, Tennessee in 2012, etc.
In 2018, further modifications were made to the data-processing protocols used by the National Center for Health Statistics for pregnancy-related checkbox deaths, leading to more thorough inclusion of them. The result was a massive but gradual artificial inflation of maternal mortality.
This doesn’t mean that the American way of measuring death is wrong. It’s just quite different from the countries that it’s being compared to...
But the U.S. case is particularly beguiling, since the United States now tracks all deaths of women who were pregnant, not only women who gave birth. Women who miscarried early or had abortions—whether officially reported or not—are also counted in the checkbox method. As a result, the United States may be the only country in the world where central vital records systems track all pregnancy-related mortality, not just maternal mortality."
This does a lot to explain why listed US outcomes are worse than countries like Kazakhstan or Chile, but it still leaves the US with similar outcomes to countries with similar standards of living (better than some, worse than many) despite spending dramatically more money on childbirth services. Even without the US doing so anomalously poorly in its actual outcomes, the figures suggest a lot of dead weight spending.
> Well, the CIA factbook figures on maternal mortality rank the US second-to-last out of the selected countries...
Funnily enough, even *that* is more complicated than it first appears: https://foreignpolicy.com/2024/01/31/united-states-maternal-mortality-crisis-statistics-health/ (The U.S. Maternal Mortality Crisis Is a Statistical Illusion -- Accurate counting has produced a seemingly dire death rate.)
"However, these figures are completely wrong, and they have been known to be wrong for many years now. The U.S. National Center for Health Statistics, the branch of the Centers for Disease Control (CDC) charged with collating health and vital statistics, has published three separate reports elaborating in excruciating detail on one crucial fact about U.S. maternal mortality: It is measured in a vastly more expansive way than anywhere else in the world.
As a result, U.S. maternal mortality is overestimated by two to three times. Properly measured, the real U.S. maternal mortality rate in 2019 was 9.9 maternal deaths per 100,000 births, which would put it at 36th place—still not impressive by comparison, but somewhat better than Canada and a bit worse than Finland or the United Kingdom.
...
Historically, the United States and most countries have tracked maternal mortality using data based on the cause of death listed on death certificates. When a person dies and the cause is assessed by an examiner of some kind, certain “maternal” causes, such as “eclampsia” or “obstetric trauma,” are commonly tracked. If a woman has died due to one of these pregnancy-related causes, she is listed as a maternal death. This process is fairly straightforward and has been widely adopted across many countries.
But in 2003, the U.S. CDC decided to launch an improved death certificate form. Among the various changes proposed was the addition of a checkbox, wherein whoever filled out the paperwork would identify if the deceased had been pregnant in the last 42 days or the last year. The reason for this checkbox was that the CDC believed (correctly, as it turns out) that in only measuring “maternal causes of death,” it might be underestimating the true health hazards of pregnancy. Pregnancy might alter the course of other diseases and conditions or interact with them in important ways.
The CDC anticipated that the checkbox would increase measured maternal deaths; it did not anticipate just how much it would increase them. As it happens, the CDC’s own reporting, which I have confirmed elsewhere, shows that the addition of the checkbox approximately doubled maternal mortality rates.
You might think a sudden doubling in maternal death rates would be obviously flagged as a data issue to correct, but this turns out not to be so. Because the United States has a federal system, individual states added the checkbox in different years. While individual state maternal deaths showed sharp level shifts, the national maternal death count drifted upward gradually as states added checkboxes to their death certificates: California in 2003, Florida in 2005, Texas in 2006, Ohio in 2007, Tennessee in 2012, etc.
In 2018, further modifications were made to the data-processing protocols used by the National Center for Health Statistics for pregnancy-related checkbox deaths, leading to more thorough inclusion of them. The result was a massive but gradual artificial inflation of maternal mortality.
This doesn’t mean that the American way of measuring death is wrong. It’s just quite different from the countries that it’s being compared to...
But the U.S. case is particularly beguiling, since the United States now tracks all deaths of women who were pregnant, not only women who gave birth. Women who miscarried early or had abortions—whether officially reported or not—are also counted in the checkbox method. As a result, the United States may be the only country in the world where central vital records systems track all pregnancy-related mortality, not just maternal mortality."
This does a lot to explain why listed US outcomes are worse than countries like Kazakhstan or Chile, but it still leaves the US with similar outcomes to countries with similar standards of living (better than some, worse than many) despite spending dramatically more money on childbirth services. Even without the US doing so anomalously poorly in its actual outcomes, the figures suggest a lot of dead weight spending.