Childbirth deaths

[Genady]

It is eye opening to me: Why US mothers are more likely to die in childbirth - BBC News

Quote

The United States remains one of the most dangerous wealthy nations for a woman to give birth.

 

[StringJunky]

The joys of 'universal' private health care that do great things for the wealthy and largely ignore those with less means.

Edited March 17, 2023 by StringJunky

[CharonY]

30 minutes ago, StringJunky said:

The joys of 'universal' private health care that do great things for the wealthy and largely ignore those with less means.

What is mortifying to me, when I saw those data years back is the discrepancy between black and white women, even if accounting for income (I think it also incorporated infant deaths). I don't recall the exact numbers anymore, but essentially the outcome were not very different from many developing countries. The pandemic then made it worse.

[StringJunky]

1 hour ago, CharonY said:

What is mortifying to me, when I saw those data years back is the discrepancy between black and white women, even if accounting for income (I think it also incorporated infant deaths). I don't recall the exact numbers anymore, but essentially the outcome were not very different from many developing countries. The pandemic then made it worse.

You mean the black cohort, regardless of whether they are in say Africa or the US, the outcomes are similar? If so, that needs addressing.

Would it be a stretch to say there is a sizable group, even subliminally, that don't want more black babies who will ultimately be voters?

Edited March 17, 2023 by StringJunky

[CharonY]

9 minutes ago, StringJunky said:

You mean the black cohort, regardless of whether they are in say Africa or the US, the outcomes are similar? If so, that needs addressing.

I am focusing on infant mortality as I recall at least the rough order of magnitudes. In some US states (again, before the pandemic) black infant death rates in some states (e.g. Kansas, Lousiana etc.) were up to 16 per 100 (average around 10 or so). That is roughly in the range of countries like the West Bank, Honduras, Mongolia etc. However it is way lower than e.g. India, South Africa or Eritrea for example (around 30ish, as a side note, many Island countries, including African ones are doing remarkably well relative to their wealth).

Overall Africa is probably not a good comparison for these measures, as a while back they were topping the list in terms of infant mortality, but by now they also have countries with the highest improvements in that measure. I.e. the infant mortality does not yet seem to flatten out. In contrast in the US the numbers have been flat for a long time. There have been some increases in infant mortality which might be correlated with economic downturns (again, before the pandemic). 

Also, another study I read showed that highest income black women had similar birth outcomes as the poorest white women. This gap has been well-known for quite a while and quite a few have historically taken the stance that it is because of genetics (certain folks were heavily promoting the perceived physiological differences of black folks). As it now turns out, and a bit related to the Academies of Science report I linked elsewhere, much of it is down to underservicing especially black communities, but to a worrying degree the quality of care specifically black women receive. There are quite a bit of stereotypes out there, ranging from race-based assumptions of pain tolerance, drug abuse and other myths, resulting in some cases wrong treatments. It is one of the reason why EDI in research is getting so many voices, as these issues can creep into day to day activities that are hard to measure.

36 minutes ago, StringJunky said:

Would it be a stretch to say there is a sizable group, even subliminally, that don't want more black babies who will ultimately be voters?

I mean, certain folks get threatened by black folks, regardless of their political leanings (socially black folks tend to be more conservative, but obviously many do not want to align themselves to slavery apologists or consider them thugs). But at the same time they used to be more disenfranchised and were less likely to vote. Among certain younger folks that might be changing, but I rather think that folks just overall don't care them and like to put the blame on genetics or just general inferiority (making bad choices or something like that).

That would also explain the hatred for CRT, despite the fact that this framework actually reduces the view on individual racism and points more to structural failings (e.g. under resourced hospitals in black communities).

[Genady]

The discrepancy between black and white populations does not explain the entire difference between the US and other developed countries. Using the numbers mentioned in the linked article, I estimate that in white women deaths only, there are in the US, per 100000, about 65% more than in UK, Germany and France, and about 135% "higher than in Spain, Italy, Japan and several other countries".

Edited March 17, 2023 by Genady
corrected percent numbers

[CharonY]

 

43 minutes ago, Genady said:

The discrepancy between black and white populations does not explain the entire difference between the US and other developed countries. Using the numbers mentioned in the linked article, I estimate that in white women deaths only, there are in the US, per 100000, about 65% more than in UK, Germany and France, and about 135% "higher than in Spain, Italy, Japan and several other countries".

Oh no, the US system is bad however you look at it. It is just shows that it is disproportionately bad for certain disadvantaged folks. I.e. there is extra badness baked into the issues on top.

[TheVat]

The US healthcare system will persist in these problems until we move away from healthcare as a profit-centered enterprise, all parents are guaranteed extended maternity leave, and public health is funded to where any young woman has easy access to prenatal care, nutritional counseling, and (to be painfully obvious) reproductive choice such that she is in full control of when she starts a family or doesn't.  Also need to end "food deserts" and substandard housing and....really, many aspects of low-income neighborhoods seems to contribute to the health differential.  Only recently does it seem, for example, that public officials have started to see mapping and research that connects diesel soot levels and neighborhood health.  

 

[Sensei]

16 hours ago, CharonY said:

What is mortifying to me, when I saw those data years back is the discrepancy between black and white women, even if accounting for income

https://www.nature.com/articles/s41366-020-00691-4

"Conclusions. The risk of maternal death increases with BMI; it multiplied by 1.6 in overweight women and more than tripled in pregnant women with severe obesity."

[Genady]

According to the data above, there are 17% more obese women among black women than among white women. Even if all obese women experience maternal death, it would've made the maternal death rate among black women 17% higher than among white women. It does not explain why "black women ... were nearly three times more likely to die than white women".

[CharonY]

Moreover, regardless of obesity, maternal death is mostly preventable. Additional care is often needed for obese mothers, but lack of access to this care is ultimately the key element. And although I presume that this is not the rationale behind the post, these line of reasoning have often been used to explain care discrepancies (i.e. putting the onus on the individual), whereas the effect of structural elements are much more pertinent.

[John Cuthber]

There are two interesting* things;

1 the USA seems to be doing badly, in spite of paying more for healthcare (And it has got worse). Maybe they should change the system.

2 there are differences between various bits  of the population.

I'd be interested to see what other factors are in play.
How does maternal age relate to maternal death rate?
How about number of previous births?
(And come to think of it, how to those relate to infant mortality).

* I'm not saying they are only interesting; they may also be scandalous or frightening, but they are interesting.

https://en.wikipedia.org/wiki/List_of_countries_by_maternal_mortality_ratio

 

Edited March 19, 2023 by John Cuthber

[npts2020]

16 hours ago, John Cuthber said:

1 the USA seems to be doing badly, in spite of paying more for healthcare (And it has got worse). Maybe they should change the system.

Trouble is, the "health" care providers own the government (note the ACA which should have been called the health care and insurance industry profits assurance act) and the populace doesn't seem much interested in soshulism in health care.

[CharonY]

On 3/19/2023 at 3:14 AM, John Cuthber said:

How does maternal age relate to maternal death rate?

Both, very young women as well as older women are at higher risk. However, in larger studies the highest risk groups appears to be in women above 30. The risk in younger women, has been shown to drop with better care. I believe a study referred to the risk as a "J" shape (as opposed to an "U" shape). 

On 3/19/2023 at 3:14 AM, John Cuthber said:

How about number of previous births?

I think that varies a lot, depending on country and associated care. I do not remember the details very well, so I would have to check, if interested. But I believe that on average in the US the first and second deliveries had lower risk than a high number (five or more).

However, it has since then be argued that high number of pregnancies are associated with factors that also correlated with lack of health care access (e.g. income and region). In part this is supported by the observation that first pregnancies in low care settings (but I do not recall whether it was a US study) is also associated with higher mortality.