New research from the University of Maryland Population Research Center (MPRC), published in Birth, investigates the rapidly increasing rate of maternal mortality—the death of a woman during or soon after pregnancy—in Texas in recent years. Researchers discovered an 87 percent increase in maternal deaths in Texas when comparing data from 2011-2015 with 2006-2010, but say some of the spike is attributable to overreporting and a flawed data collection system.
Marian MacDorman, a research professor at the MPRC and the study’s lead author, said the situation in Texas represents parallel public health emergencies: (1) a sharp increase in the maternal mortality rate in recent years; and (2) a lack of reliable data to better characterize and further understand the increase.
“Both the increasing maternal mortality rates in Texas and the substantial data problems identified in our study constitute an urgent call for action,” MacDorman said. “While the dramatic increase in maternal deaths in Texas is most concerning, this is a problem that needs to be addressed nationwide.”
According to MacDorman's latest study, "The problems in reporting of pregnancy status are compounded by United States coding rules that code every death with the pregnancy or postpartum checkbox checked to maternal causes, regardless of what is written in the cause-of-death."
MacDorman and colleagues previously published research in April of 2016 showing the U.S. maternal death rate increased 27% overall between 2000 and 2014, while rates declined internationally.
Researchers analyzed data collected in states that include a pregnancy question on the U.S. standard death certificate filled out by physicians, medical examiners and coroners. In a commentary accompanying the Birth article, MacDorman and colleagues urge for a “systemic evaluation” of current reporting methods for maternal deaths, and the implementation of validation studies, data quality checks and enhanced education and training at state and national levels.
“Without accurate data to measure the magnitude of the problem and to identify at-risk populations, the efficacy of maternal mortality prevention efforts are severely compromised,” MacDorman said. “Simply put, if accurate maternal mortality data is not available, prevention efforts are scattered and unfocused and more women die.”
Maternal mortality has long been seen as a primary indicator of the quality of health care both in the United States and internationally. In 1990, the United Nations named maternal mortality reduction as a Millennium Development Goal, leading to an unprecedented effort to reduce maternal mortality worldwide. Maternal mortality decreased by 44% worldwide from 1990 to 2015, including a 48% decline among developed regions. However, the U.S. maternal mortality rate has shown consistent increases, in contrast to international trends.
MacDorman’s co-authors include Marie Thoma from the School of Public Health at the University of Maryland, as well as Eugene Declercq from the School of Public Health at Boston University.
January 9, 2018