6 ms·

This article is disturbing on many levels. The sound bite that the US has a problem with maternity healthcare is ingrained, but this makes me take a second look

This article is disturbing on many levels. The sound bite that the US has a problem with maternity healthcare is ingrained, but this makes me take a second look. First is that we report maternal mortality even when not directly associated with birth -- "Among pregnancy-related deaths with information on timing, 53% occurred 7–365 days postpartum." Is that standard for reporting countries? Is our problem with maternity healthcare really a problem of better reporting? Secondly is that 22.7% of the deaths are related to "mental health conditions". From the footnote, "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." This is extraordinarily disturbing!

neves 4y ago
USA is the richest country of the world and does not have paid maternity leave. It is very weird and my hypothesis is that this fact relates to these mental health conditions.
- nxm 4y ago
  At a federal level no, but some states do require many weeks at minimum. I also think 9months is beyond excessive for maternity/paternity leave (father of kids here).
  - yebyen 4y ago
    I had a search because I didn't believe that any states required employers to offer paid family leave. Some research revealed that the situation is somehow both better than I thought, and also seemingly much worse than I imagined: https://www.ncsl.org/research/labor-and-employment/state-family-and-medical-leave-laws.aspx#:~:text=Paid%20Family%20Leave%3A%2011%20states,paid%20family%20and%20medical%20leave https://www.ncsl.org/research/labor-and-employment/state-fam... https://www.zippia.com/advice/average-paid-maternity-leave/ https://www.zippia.com/advice/average-paid-maternity-leave/ There are a few North Korea comparisons in here that I think are tongue-in-cheek but two statistics jumped out at me: (1) 1/3 of new mothers take little to no time off after [...] new child and instead opt to return to work as soon as they’re able (2) The highest rates of paid family leave across any segment or industry appear to be in the 30% range. So only 30% of the jobs most likely to offer this benefit actually do.
    - pkaye 4y ago
      California has PFL as part of its state disability insurance. https://edd.ca.gov/en/disability/Types_of_Claims/ https://edd.ca.gov/en/disability/Types_of_Claims/
  - encoderer 4y ago
    My first born, now about 5, was born while I was aggressively chasing promotions in a tech company. During her first year I mostly saw her to put her to bed at night and on the weekends. This time around I’m a full time indie hacker and I see my son for hours every day. He’s six months old now. I’m insanely fortunate to have a profitable and growing business, but I’ve come to believe that everybody should be able to have months with their children without losing their house, insurance, etc. It may seem crazy but 100 years ago a 40 hour work week seemed crazy to many.
    - frumper 4y ago
      The way you describe aggressively chasing promotions sounds different than losing your house. There is a middle ground in there. I also agree that people should be able to spend months with their children though. I'm glad California is supportive of that.
  - anon291 4y ago
    Unpopular opinion: paternity leave doesn't need to be multiple months long in the vast majority of situations. Maternity leave is different of course. Six weeks is luxuriously long for the most common situation. Perhaps on your first child you should get a bit more. Nine months is excessive for paternity leave. I can't comment to maternity leave, but it would make more sense there. Long paternity leave drives everyone crazy.
    - sumeno 4y ago
      Are you kidding? Six weeks is laughably short for paternity leave. Taking care of a 2 month old is a 24/7 job and doing it with two people is insanely difficult, that people are forced to do it with one is mindboggling.
- avgcorrection 4y ago
  The “richest country” also has a high Gini coefficient.
- dominotw 4y ago
  > my hypothesis is that this fact relates to these mental health conditions. how though. Mothers go down the path of abusing substances because they know they wont paid get days off at work?
  - neves 4y ago
    taking care of a new born is a insanely stressful task. Add the stress to provide food and housing to your family, I can clearly see how this leads to substance abuse.
- sgtnoodle 4y ago
  Outside of whatever your employer's policy is, it's a state rather than federal matter. It's perhaps a bit reductive to treat the USA as a whole in terms of healthcare. I'm about to go on paternity leave in 2 weeks until the end of the year. California will directly pay me some amount for 8 weeks of it due to paying the relevant workers comp taxes. Companies within the state are required to allow at least 12 weeks of unpaid leave. I work for a great, supportive company that will pay whatever the difference is to make my salary whole. In general, I set my own schedule and am able to prioritize my family's well being over work. My wife's preference is to raise our children, and we're lucky enough to be able to live comfortably on my income alone. Anecdotally, that was the case for our first child as well, and my wife still suffered from rather severe post partum depression a bit less than a year after giving birth.
  - kodah 4y ago
    > it's a state rather than federal matter. It's perhaps a bit reductive to treat the USA as a whole in terms of healthcare. The person you're responding to is Brazilian. To most people outside of the US there is a wrong assumption that the entire United States is a monoculture with one mind and one voice. It's also a readily abundant point of view on the internet. It's almost like judging the entirety of British culture off of the sum of the Harry Potter stories.
    - neves 4y ago
      The fact that it isn't a federal law, makes it an USA thing. Were aren't talking about some states giving 1 year and other giving 10 months. Brazil is a median income country and our society decided that every woman gets 120 days (17.14 weeks) of paid maternity leave. Good companies give 180 days. The salary is paid by Social Security
      - sgtnoodle 4y ago
        Federalization of everything isn't a panacea, and the history and internal culture and politics of the USA mean certain societal problems are most pragmatically addressed at the state level. It sounds like a pretty nice deal for mothers in Brazil, though. Googling the paternity leave policy, fathers in Brazil are only entitled to five days paid leave. In my personal situation, 8 weeks seems pretty nice in comparison. For a nuclear family, that's potential for 16 weeks total, vs. Brazil's ~18 weeks. Also keep in mind that, legally within California, there's a distinction between paid leave for parental bonding vs. paid leave for recovering from injuries related to pregnancy. I believe mothers in CA are entitled to up to 52 weeks of paid leave if their medical situation warrants it. What's the equivalent social policy in Brazil?
- deleted 4y ago
  [deleted]
coderintherye 4y ago
>First is that we report maternal mortality even when not directly associated with birth -- "Among pregnancy-related deaths with information on timing, 53% occurred 7–365 days postpartum." If someone gets a surgery and then dies 8 days later due to complications from the surgery, you don't go around saying the death was "not directly associated" with the surgery. There are lots of things that affect the body during pregnancy that can lead to death in the year after. [1] [1] https://www.cdc.gov/vitalsigns/maternal-deaths/index.html#:~:text=In%20the%20week%20after%20delivery,to%201%20year%20after%20delivery https://www.cdc.gov/vitalsigns/maternal-deaths/index.html#:~....
- echelon 4y ago
  > dies 8 days later due to complications But 365 days? That's sounds like it's mental health related. It seems like we should track cause of death so we can have richer and more actionable information. Edit: I didn't mean to imply that this wasn't postpartum depression. I was curious if/why other nations aren't tracking the full calendar year after birth, and if our way of counting prevents us from directly comparing figures. I want to mathematically compare. Our figures are alarming.
  - baby 4y ago
    Are you a doctor?
    - robertlagrant 4y ago
      Are you? If not, on what basis are you assessing that a doctor is required for this question?
  - _Microft 4y ago
    "Postpartum depression" is both mental health and maternity related for example.
  - jjulius 4y ago
    >That's sounds like it's mental health related. Directly from the cited link in the post you're responding to: >Cardiomyopathy (weakened heart muscle) is the leading cause of deaths 1 week to 1 year after delivery.
kube-system 4y ago
Drug use is a huge issue in the US, and people who struggle with addiction (and associated mental health) are also more likely to get into situations where unplanned pregnancies happen. This isn't as much of a problem with maternal care as it is a problem with drug addiction, and this is simply the downstream consequence of that.
- deleted 4y ago
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- deleted 4y ago
  [deleted]
- j_walter 4y ago
  My mother was a doctor that spent a great deal of time with expectant mothers. Based on her limited but also extensive experience on the subject drug use by the mother caused a significant portion of the mortality in unborn fetuses. This was particularly seen higher in the minority population (Black, Native American, etc.) and she is frustrated when she sees all the statistics that racism is the only reason behind the minority fetal mortality rate being higher than for Caucasians. They don't ever account for decision making in those studies and even in this study I'm sure drug use is considered a "preventable condition".
  - kube-system 4y ago
    Addiction is a treatable and preventable condition, but addiction is not a choice. These are overwhelmingly not bad people who want to harm their unborn child, they simply do not have the required mental state to choose otherwise.
    - j_walter 4y ago
      Some addiction is treatable and preventable. Sometimes your brain has been changed beyond a point of return though.
bamboozled 4y ago
How is any of this a surprise, healthcare is screwed in the USA unless one can afford it. The worst thing about America besides the guns is the inhumane lack of free, quality healthcare.

neves 4y ago

USA is the richest country of the world and does not have paid maternity leave. It is very weird and my hypothesis is that this fact relates to these mental health conditions.

nxm 4y ago
At a federal level no, but some states do require many weeks at minimum. I also think 9months is beyond excessive for maternity/paternity leave (father of kids here).
- yebyen 4y ago
  I had a search because I didn't believe that any states required employers to offer paid family leave. Some research revealed that the situation is somehow both better than I thought, and also seemingly much worse than I imagined: https://www.ncsl.org/research/labor-and-employment/state-family-and-medical-leave-laws.aspx#:~:text=Paid%20Family%20Leave%3A%2011%20states,paid%20family%20and%20medical%20leave https://www.ncsl.org/research/labor-and-employment/state-fam... https://www.zippia.com/advice/average-paid-maternity-leave/ https://www.zippia.com/advice/average-paid-maternity-leave/ There are a few North Korea comparisons in here that I think are tongue-in-cheek but two statistics jumped out at me: (1) 1/3 of new mothers take little to no time off after [...] new child and instead opt to return to work as soon as they’re able (2) The highest rates of paid family leave across any segment or industry appear to be in the 30% range. So only 30% of the jobs most likely to offer this benefit actually do.
  - pkaye 4y ago
    California has PFL as part of its state disability insurance. https://edd.ca.gov/en/disability/Types_of_Claims/ https://edd.ca.gov/en/disability/Types_of_Claims/
- encoderer 4y ago
  My first born, now about 5, was born while I was aggressively chasing promotions in a tech company. During her first year I mostly saw her to put her to bed at night and on the weekends. This time around I’m a full time indie hacker and I see my son for hours every day. He’s six months old now. I’m insanely fortunate to have a profitable and growing business, but I’ve come to believe that everybody should be able to have months with their children without losing their house, insurance, etc. It may seem crazy but 100 years ago a 40 hour work week seemed crazy to many.
  - frumper 4y ago
    The way you describe aggressively chasing promotions sounds different than losing your house. There is a middle ground in there. I also agree that people should be able to spend months with their children though. I'm glad California is supportive of that.
- anon291 4y ago
  Unpopular opinion: paternity leave doesn't need to be multiple months long in the vast majority of situations. Maternity leave is different of course. Six weeks is luxuriously long for the most common situation. Perhaps on your first child you should get a bit more. Nine months is excessive for paternity leave. I can't comment to maternity leave, but it would make more sense there. Long paternity leave drives everyone crazy.
  - sumeno 4y ago
    Are you kidding? Six weeks is laughably short for paternity leave. Taking care of a 2 month old is a 24/7 job and doing it with two people is insanely difficult, that people are forced to do it with one is mindboggling.
avgcorrection 4y ago
The “richest country” also has a high Gini coefficient.
dominotw 4y ago
> my hypothesis is that this fact relates to these mental health conditions. how though. Mothers go down the path of abusing substances because they know they wont paid get days off at work?
- neves 4y ago
  taking care of a new born is a insanely stressful task. Add the stress to provide food and housing to your family, I can clearly see how this leads to substance abuse.
sgtnoodle 4y ago
Outside of whatever your employer's policy is, it's a state rather than federal matter. It's perhaps a bit reductive to treat the USA as a whole in terms of healthcare. I'm about to go on paternity leave in 2 weeks until the end of the year. California will directly pay me some amount for 8 weeks of it due to paying the relevant workers comp taxes. Companies within the state are required to allow at least 12 weeks of unpaid leave. I work for a great, supportive company that will pay whatever the difference is to make my salary whole. In general, I set my own schedule and am able to prioritize my family's well being over work. My wife's preference is to raise our children, and we're lucky enough to be able to live comfortably on my income alone. Anecdotally, that was the case for our first child as well, and my wife still suffered from rather severe post partum depression a bit less than a year after giving birth.
- kodah 4y ago
  > it's a state rather than federal matter. It's perhaps a bit reductive to treat the USA as a whole in terms of healthcare. The person you're responding to is Brazilian. To most people outside of the US there is a wrong assumption that the entire United States is a monoculture with one mind and one voice. It's also a readily abundant point of view on the internet. It's almost like judging the entirety of British culture off of the sum of the Harry Potter stories.
  - neves 4y ago
    The fact that it isn't a federal law, makes it an USA thing. Were aren't talking about some states giving 1 year and other giving 10 months. Brazil is a median income country and our society decided that every woman gets 120 days (17.14 weeks) of paid maternity leave. Good companies give 180 days. The salary is paid by Social Security
    - sgtnoodle 4y ago
      Federalization of everything isn't a panacea, and the history and internal culture and politics of the USA mean certain societal problems are most pragmatically addressed at the state level. It sounds like a pretty nice deal for mothers in Brazil, though. Googling the paternity leave policy, fathers in Brazil are only entitled to five days paid leave. In my personal situation, 8 weeks seems pretty nice in comparison. For a nuclear family, that's potential for 16 weeks total, vs. Brazil's ~18 weeks. Also keep in mind that, legally within California, there's a distinction between paid leave for parental bonding vs. paid leave for recovering from injuries related to pregnancy. I believe mothers in CA are entitled to up to 52 weeks of paid leave if their medical situation warrants it. What's the equivalent social policy in Brazil?
deleted 4y ago
[deleted]

coderintherye 4y ago

>First is that we report maternal mortality even when not directly associated with birth -- "Among pregnancy-related deaths with information on timing, 53% occurred 7–365 days postpartum." If someone gets a surgery and then dies 8 days later due to complications from the surgery, you don't go around saying the death was "not directly associated" with the surgery. There are lots of things that affect the body during pregnancy that can lead to death in the year after. [1] [1] https://www.cdc.gov/vitalsigns/maternal-deaths/index.html#:~:text=In%20the%20week%20after%20delivery,to%201%20year%20after%20delivery https://www.cdc.gov/vitalsigns/maternal-deaths/index.html#:~....

echelon 4y ago
> dies 8 days later due to complications But 365 days? That's sounds like it's mental health related. It seems like we should track cause of death so we can have richer and more actionable information. Edit: I didn't mean to imply that this wasn't postpartum depression. I was curious if/why other nations aren't tracking the full calendar year after birth, and if our way of counting prevents us from directly comparing figures. I want to mathematically compare. Our figures are alarming.
- baby 4y ago
  Are you a doctor?
  - robertlagrant 4y ago
    Are you? If not, on what basis are you assessing that a doctor is required for this question?
- _Microft 4y ago
  "Postpartum depression" is both mental health and maternity related for example.
- jjulius 4y ago
  >That's sounds like it's mental health related. Directly from the cited link in the post you're responding to: >Cardiomyopathy (weakened heart muscle) is the leading cause of deaths 1 week to 1 year after delivery.

kube-system 4y ago

Drug use is a huge issue in the US, and people who struggle with addiction (and associated mental health) are also more likely to get into situations where unplanned pregnancies happen. This isn't as much of a problem with maternal care as it is a problem with drug addiction, and this is simply the downstream consequence of that.

deleted 4y ago
[deleted]
deleted 4y ago
[deleted]
j_walter 4y ago
My mother was a doctor that spent a great deal of time with expectant mothers. Based on her limited but also extensive experience on the subject drug use by the mother caused a significant portion of the mortality in unborn fetuses. This was particularly seen higher in the minority population (Black, Native American, etc.) and she is frustrated when she sees all the statistics that racism is the only reason behind the minority fetal mortality rate being higher than for Caucasians. They don't ever account for decision making in those studies and even in this study I'm sure drug use is considered a "preventable condition".
- kube-system 4y ago
  Addiction is a treatable and preventable condition, but addiction is not a choice. These are overwhelmingly not bad people who want to harm their unborn child, they simply do not have the required mental state to choose otherwise.
  - j_walter 4y ago
    Some addiction is treatable and preventable. Sometimes your brain has been changed beyond a point of return though.

bamboozled 4y ago

How is any of this a surprise, healthcare is screwed in the USA unless one can afford it. The worst thing about America besides the guns is the inhumane lack of free, quality healthcare.