Despite a perception of having one of the best (and most expensive) medical systems in the world, the United States appears to be backsliding in two of the most basic of healthcare measures--maternal and childhood mortality, recent reports reveal.
U.S. deaths from obstetrical causes within one year of giving birth rose from 7.6 per 100,000 to 13.3 per 100,000 between 1996 and 2006, the Los Angeles Times reports. In California during the same time period, the maternal death rate tripled, from 5.6 deaths per 100,000 births to 16.9. Though maternal deaths are still considered rare, at a rate of two per day, maternal mortality is higher here than in 40 other industrialized countries--including Croatia, Hungary and Macedonia--and is double that of Canada and much of Western Europe.
Although reasons for the rise are not fully understood, a 1999 change in how maternal mortality statistics are calculated is believed to be responsible for about 30 percent of the bump. As for the rest, some suspect that U.S. medicine has not sufficiently evolved in line with the changing profile of the American mother, who today is more likely to be over 30 and obese. Some experts blame the higher number of cesarean sections, which account for one-third of all births--up from one-fifth in 1997.
In response to the alarming statistics, in January, the Joint Commission issued a "sentinel event alert" warning of the rising maternal mortality rates; Amnesty International called for sweeping changes in maternal healthcare in the U.S.; and the California Department of Public Health has commissioned a statewide review of medical charts in maternal death cases to identify reasons for the rise and seek ways to improve.
"Mothers shouldn't die in childbirth," said Dr. Elliott Main, chief of obstetrics at Sutter Health and director of the ongoing California review. The trend, he said, may signal a much larger problem with U.S. maternal healthcare.
In happier news, the number of children younger than 5 who die worldwide this year will fall to 7.7 million, down from 11.9 million two decades ago. But despite faster improvement than predicted by the United Nations, the 2.1 percent annual decline by the U.S., still doesn't match the annual 4.4 percent decline needed to meet the organization's goal to reduce it by two-thirds between 1990 and 2015. Worldwide, the United States ranks just 42nd in this measure, falling considerably from its 29th spot 20 years ago.
Surprisingly, researchers have found high U.S. rates not only among Latino and black populations, but also among higher-income whites, a group that traditionally has better access to medical care. Researchers also report substantially higher levels of preventable deaths from diseases such as diabetes and pneumonia, according to the Los Angeles Times.
"We certainly have outstanding medical science and centers of excellence that rival the best in the world," said Cathy Schoen, an expert on global health systems at the nonpartisan Commonwealth Fund. "But many other countries have been putting many more resources into thinking about how they can improve....They have been far more strategic."
But just today, the United States adopted new national standards to ensure that all babies are screened for at least 30 treatable conditions at birth, reports The Medical News. "The issuing of national guidelines is a tremendous step forward," says Jennifer Howse, PhD, president of the March of Dimes.
To learn more:
- read this Los Angeles Times article
- read this other Los Angeles Times piece
- see this piece in The Medical News
- check out this Wall Street Journal article