From a brief zoom interaction with my colleague, Holly Mattix-Kramer, earlier today on maternal mortality rates:
Reacting to your posting in the chat, Holly, it is a source of great sadness that a woman should die becoming a mother. If my wife, sister, daughter was the woman who died, this would be the biggest tragedy in my entire life.
But thinking about this from the standpoint of the community as a whole, maternal mortality is a small blip on the screen of preventable deaths in the US.
In 2022, the MMR was 22.3/100,000. That is a total of 817 deaths. OK, so I picked a low year. So in 2021 MMR was 32.9/100,000, which is 1204 deaths. And the highest number I could find on how many of those deaths might be preventable was 80%. That is 963 in 2021 and 654 in 2022. Why the variability with MMR? I am not a statistician, but I bet the fact that we are dealing with a small base of numbers is an important factor; wouldn’t this make slight differences look very large?
Motor vehicle accidents in 2022 were 42,514. That is 65 times higher than maternal deaths that year.
Kidney disease deaths (hitting you where you live, Holly) in 2022 were 57,987. That’s 89 times higher than maternal deaths.
And remember that, even though we are properly focused on the differential between white and Black moms, the number of Black moms who die is an even smaller number. About 1/7th of all births in the US are to Black moms. Around 500,000. If the Black MMR is 3 times the total MMR, then it is 66.9/100,000. (I know that isn’t right, because we should multiply by the white births, but I don’t know that number.) That means about 67 time 5, or 335 Black moms die. Again, a terrible, unspeakable tragedy, but an even smaller number from a public policy standpoint, particularly if only 80% are preventable, which lowers the number to 268.
Yes, I know that every preventable death is worth saving, but I am not arguing we do nothing about this. I am just arguing that we take into account that how much money and energy and attention we allocate to MMR should be at least roughly proportional to the size of the problem. About 480,000 people in the US still die from smoking. That’s 1,315 per day, higher than the maternal death number for the entire year of 2021.
Yet our colleagues in public health continue to rank MMR as a huge problem deserving of the designation of a “crisis.”
I usually start this discussion in my classes by asking the class how many people have to die from a disease, condition or life event before we start really focusing on it and spending a lot of money to lower it. The consensus is usually 10,000. Maternal mortality isn’t anywhere near that.
I am not saying we shouldn’t put some focus on MMR. And we should definitely focus on the disparities between Black and white mothers. But in my opinion, we are over-reacting to the problem as a whole. Beyond my opinion that we are over-reacting to this problem, there is also the point I tried to raise with the student today. Something with a small “n” is not a very good thing to use as our outcome measure to address poor access to maternal care. There will be too much variability, and at some point some one opposed to putting more money into caring for poor, Black moms, is going to do the math and say “this isn’t that big a problem.”
So, we should look for more compelling measures to highlight the problem of maternal care deserts. Numbers of primary care docs per population served? Numbers of dollars spent on maternal care per population served? Money spent on FQHC’s? Maybe some measure of morbidity? Extra money spent on intensive care? I don’t know what would be best to use; this is not my expertise. But the people with the expertise keep insisting this is a crisis!
That would have been a much more interesting and compelling result of the policy analysis presented.
OK, thanks for listening. I feel better now.
DS
PS, Don’t get me started on K-12 school shooting deaths. Between 1999 and 2022, this number has peaked at 50, with most years well below that. https://www.security.org/blog/a-timeline-of-school-shootings-since-columbine/. Yet we have produced an entire generation of children, whom we routinely run through gun detectors to get to their classrooms, scared to death of going to school. In some of those 23 years, more people died of lightening strikes than being shot at school. I get that the media blows this sort of thing up, but too many public health experts are doing the same. ds
