8 ms·

Reminder when comparing with other nations that as this study states: "Pregnancy-related deaths occurred during pregnancy, delivery, and up to a year postpartum

Reminder when comparing with other nations that as this study states: "Pregnancy-related deaths occurred during pregnancy, delivery, and up to a year postpartum." The measure can be very different elsewhere. The WHO defines a maternal death as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes." you'll notice in this study that 30.0% of deaths occurred 43–365 days postpartum, so you will have to adjust numbers accordingly if you are comparing the USA to what most other countries measure. (and not all use the WHO definition!) The reason they use the 42 day cutoff is I assume to aid with other-country comparison. Still lots of websites that compare maternal mortality across the world get this wrong, and compare USA deaths for a full year vs other country deaths for 30-60 days postpartum.

mattmcknight 4y ago
Also, mental health conditions and cardiomyopathy are "preventable"? Their definition of Preventability stretches credibility- lowering the risk is different from preventing something. "A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors."
- _Microft 4y ago
  > Also, mental health conditions and cardiomyopathy are "preventable"? They said that the deaths are preventable, not the conditions themselves.
- kevingadd 4y ago
  You can prevent some mental health conditions by caring properly for the mother, for example a mother struggling to pay rent or unable to access necessary medical care is naturally going to be at higher risk of conditions like depression and if you improve her circumstances it's possible that the depression might at least abate for a while. Lots of people who are managing mental health conditions will spiral if their circumstances get bad enough but will otherwise be OK. While it's unwise to try and simply reduce all mental health conditions to 'circumstances' or 'chemical imbalance', there are lots of things you can do to keep a person in balance to the point that any latent conditions they have aren't enough of a problem to interfere with their daily lives. Motherhood is already very difficult so it is worthwhile to try and keep as many challenges out of a new mother's life as we can.
  - dahfizz 4y ago
    > You can prevent some mental health conditions by caring properly for the mother, By that definition, cancer is preventable. Actually, nearly every possible cause of death is preventable if you're definition is "doing something might reduce risk factors". That's not the normal usage of "preventable death".
    - deleted 4y ago
      [deleted]
    - kevingadd 4y ago
      I'm surprised you would consider all cancer deaths not preventable. You wouldn't consider a smoker's lung cancer death preventable death?
      - zdragnar 4y ago
        Between some and many are. Not all- just like not all cancers are from smoking.
- LorenPechtel 4y ago
  I stopped reading at this point--they're not counting preventable, they're counting cases where something *might* have been able to be done. That doesn't mean success and it means their 80% figure is an attempt to make the data fit what they want, not legitimate research.
- spicybright 4y ago
  If "some chance" is taken to an extreme, I think there's potential to cloud the data so much it becomes almost useless. Do they consider treatments that couldn't possibly be performed on every pregnancy that it might help? (due to finite medical resources, cost that insurance companies won't pay, etc.) I'd much rather see a focus on the basics that other countries do that are consistently missed. Especially when it comes to over-using C-sections and how race plays into treatment.
  - Someone 4y ago
    If “some chance” is taken to the extreme, I would think all pregnancies are preventable, and with it all pregnancy-related deaths.
- ceph_ 4y ago
  > 2 Mental health conditions include deaths of suicide, overdose/poisoning related to substance use disorder, and other deaths determined by the MMRC to be related to a mental health condition, including substance use disorder. Deaths by suicide and drug abuse are indeed preventable. Are you misconstruing the word preventable to mean 100% preventable?
arcticbull 4y ago
Also a reminder that at least a few years ago, the US had the highest maternal mortality rate in the entire OECD against a standardized metric. Like, by a country mile. [1] > Among 11 developed countries, the United States has the highest maternal mortality rate, a relative undersupply of maternity care providers, and is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period. > Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth. [edit] NPR did a thing on it in 2017 too. [2] In 2015 you were 7X as likely to die as a mother in the US as compared to Finland (and 4X Canada) - and while the rest of the world saw dropping numbers, the US saw accelerating increases. And for every woman who dies in childbirth in the US 70 come close. [1] https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries https://www.commonwealthfund.org/publications/issue-briefs/2... [2] https://www.npr.org/series/543928389/lost-mothers https://www.npr.org/series/543928389/lost-mothers
- pitaj 4y ago
  > by a country mile. For reference (so someone doesn't have to click through): 17.4 per 100,000 vs the two closest: France at 8.7 and Canada at 8.6 Does that account for the far higher proportion of people living in rural areas in the US? What about obesity, ethnicity, etc?
  - pchristensen 4y ago
    The USA has about 20-30% of the population that's structurally poor, an artifact of slavery and oppression, but also the wider variety of governmental structures, economic concentrations, and cultures in different states and regions. This shows up in incomes, health statistics, crime, life expectancy, educational outcomes, etc. Probably the most drastic is the difference between coastal California (the richest region in the country) and rural California (would be the poorest state) - see this for more details - https://astralcodexten.substack.com/p/why-is-the-central-valley-so-bad https://astralcodexten.substack.com/p/why-is-the-central-val.... Every place has its economically disadvantaged, but America's poor seem to be more neglected and left behind than in other countries. A lot of other rich countries have better aggregate numbers because they bottom quartile is not as low.
pitaj 4y ago
> The measure can be very different elsewhere. This kind of thing also applies to the oft-repeated "infant mortality" metric. Where other countries don't count premature births or count birth within a certain period as stillbirths instead of infant mortality.

mattmcknight 4y ago

Also, mental health conditions and cardiomyopathy are "preventable"? Their definition of Preventability stretches credibility- lowering the risk is different from preventing something. "A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors."

_Microft 4y ago
> Also, mental health conditions and cardiomyopathy are "preventable"? They said that the deaths are preventable, not the conditions themselves.
kevingadd 4y ago
You can prevent some mental health conditions by caring properly for the mother, for example a mother struggling to pay rent or unable to access necessary medical care is naturally going to be at higher risk of conditions like depression and if you improve her circumstances it's possible that the depression might at least abate for a while. Lots of people who are managing mental health conditions will spiral if their circumstances get bad enough but will otherwise be OK. While it's unwise to try and simply reduce all mental health conditions to 'circumstances' or 'chemical imbalance', there are lots of things you can do to keep a person in balance to the point that any latent conditions they have aren't enough of a problem to interfere with their daily lives. Motherhood is already very difficult so it is worthwhile to try and keep as many challenges out of a new mother's life as we can.
- dahfizz 4y ago
  > You can prevent some mental health conditions by caring properly for the mother, By that definition, cancer is preventable. Actually, nearly every possible cause of death is preventable if you're definition is "doing something might reduce risk factors". That's not the normal usage of "preventable death".
  - deleted 4y ago
    [deleted]
  - kevingadd 4y ago
    I'm surprised you would consider all cancer deaths not preventable. You wouldn't consider a smoker's lung cancer death preventable death?
    - zdragnar 4y ago
      Between some and many are. Not all- just like not all cancers are from smoking.
LorenPechtel 4y ago
I stopped reading at this point--they're not counting preventable, they're counting cases where something *might* have been able to be done. That doesn't mean success and it means their 80% figure is an attempt to make the data fit what they want, not legitimate research.
spicybright 4y ago
If "some chance" is taken to an extreme, I think there's potential to cloud the data so much it becomes almost useless. Do they consider treatments that couldn't possibly be performed on every pregnancy that it might help? (due to finite medical resources, cost that insurance companies won't pay, etc.) I'd much rather see a focus on the basics that other countries do that are consistently missed. Especially when it comes to over-using C-sections and how race plays into treatment.
- Someone 4y ago
  If “some chance” is taken to the extreme, I would think all pregnancies are preventable, and with it all pregnancy-related deaths.
ceph_ 4y ago
> 2 Mental health conditions include deaths of suicide, overdose/poisoning related to substance use disorder, and other deaths determined by the MMRC to be related to a mental health condition, including substance use disorder. Deaths by suicide and drug abuse are indeed preventable. Are you misconstruing the word preventable to mean 100% preventable?

arcticbull 4y ago

Also a reminder that at least a few years ago, the US had the highest maternal mortality rate in the entire OECD against a standardized metric. Like, by a country mile. [1] > Among 11 developed countries, the United States has the highest maternal mortality rate, a relative undersupply of maternity care providers, and is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period. > Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth. [edit] NPR did a thing on it in 2017 too. [2] In 2015 you were 7X as likely to die as a mother in the US as compared to Finland (and 4X Canada) - and while the rest of the world saw dropping numbers, the US saw accelerating increases. And for every woman who dies in childbirth in the US 70 come close. [1] https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries https://www.commonwealthfund.org/publications/issue-briefs/2... [2] https://www.npr.org/series/543928389/lost-mothers https://www.npr.org/series/543928389/lost-mothers

pitaj 4y ago
> by a country mile. For reference (so someone doesn't have to click through): 17.4 per 100,000 vs the two closest: France at 8.7 and Canada at 8.6 Does that account for the far higher proportion of people living in rural areas in the US? What about obesity, ethnicity, etc?
- pchristensen 4y ago
  The USA has about 20-30% of the population that's structurally poor, an artifact of slavery and oppression, but also the wider variety of governmental structures, economic concentrations, and cultures in different states and regions. This shows up in incomes, health statistics, crime, life expectancy, educational outcomes, etc. Probably the most drastic is the difference between coastal California (the richest region in the country) and rural California (would be the poorest state) - see this for more details - https://astralcodexten.substack.com/p/why-is-the-central-valley-so-bad https://astralcodexten.substack.com/p/why-is-the-central-val.... Every place has its economically disadvantaged, but America's poor seem to be more neglected and left behind than in other countries. A lot of other rich countries have better aggregate numbers because they bottom quartile is not as low.

pitaj 4y ago

> The measure can be very different elsewhere. This kind of thing also applies to the oft-repeated "infant mortality" metric. Where other countries don't count premature births or count birth within a certain period as stillbirths instead of infant mortality.