(continued from Part I)
By Ina May Gaskin, CPM, MA
Originally published by Mothering, No. 147, 2008-03-04
Whereas the British get their 400 pages of detailed reporting and analysis every three years, with special attention given to making these public, our single statistic per year of the number of women who die within 42 days of giving birth, issued by the CDC and the National Center for Health Statistics and derived from the same sources, comes with no details, no identification of important trends, no analysis, and no recommendations. With so little media interest in this subject and nothing but that single number once a year from the CDC, it’s no wonder that we in the US have a false sense of security about maternal death.
Even the published maternal death rate is far from accurate. According to the CDC in 1998, there is so much underreporting and misclassification in the US system that the actual number could be as many as three times greater than what is officially published number each year. (11) What an admission for the CDC officials to have to make. Think how it would be received if the Federal Aviation Administration had to admit that they count and investigate only half to a third of the plane-crash deaths that occur each year. For instance, by making a more careful survey, Michigan recently found that its supposed maternal mortality rate of 7.6 deaths per 100,000 births should be revised to 18 per 100,000 births. According to the physician who wrote that report, It is likely that other states significantly underestimate their maternal mortality as well. (12) I have found no news coverage yet of these problems, except for a few articles that appeared in 1999 and 2000 in obstetrical trade publications. (13-17)
One striking reason for this great inaccuracy is that the 50 states aren’t required to use the same death-certificate form. That’s right. Although there have been efforts since 1979 to get every state to ask the obvious question about whether the deceased woman had been pregnant in the weeks or months preceding her death, only 21 states have included such a question. (18) This is important, because the ability to gather accurate statistics depends upon how each woman’s death certificate is filled out. Women of childbearing age may die from a host of causes, and all of these deaths need to be distinguished from those that are directly or indirectly related to a woman’s pregnancy or birth. An almost 30-year effort to get the states to cooperate by including the pregnancy question on the death certificate still leaves more than half of the states without it. (18) Sadly for women, this results in an unknown number of deaths will be misclassified every year.
States That Ask the Pregnancy Question *
Alabama, California, Florida, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New Mexico, North Dakota, Texas, and Virginia.
*[Although they have about six different way of posing the question.]
What this means, in practical terms, is that if a woman with Tameka McFarquhar’s problem goes to a hospital and then dies, she is likely to do so in an emergency room, operating room, or intensive care unit. If this happens in a state in which the death certificate lacks the essential question, and the woman’s family does not insist on an autopsy, it is very possible that the certificate could list her death as due to hemorrhage without ever referring to her recent pregnancy. In the world of statistics, this translate to one fewer maternal death—which would be false. A recent article in a major obstetrical journal revealed a rate of underreporting of maternal death in Massachusetts of 93 percent. (21)
Another problem noted by the CDC is the extent to which “the completeness and quality of maternal death reporting could be improved if physicians completed the cause-of-death section of the death certificate more accurately.” (22) Health-care systems that prioritize the prevention of maternal death make sure that anyone authorized to fill out a death certificate has had the training necessary to do it correctly. There is an old expression about large databases: “GIGO,” for “garbage in, garbage out.” Clearly, this is the situation we have in the US about this important subject. Why do we continue to allow this kind of sloppiness?
