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Over the last two decades, the United States became an international outlier in maternal mortality.

While maternal death rates fell steadily around the world, the opposite was reported stateside. According to the World Health Organization, there were 21 maternal deaths in the U.S. for every 100,000 live births in 2020, up from around 12 in 2000 and almost double the average rate in high-income countries. “Maternal outcomes in the United States are a public health crisis, and they are only getting worse,” reads an Op-Ed in The New York Times. “We know the data. We need to focus on the solutions.”

Well, it turns out the data were wrong.

The demographer Lyman Stone explains in Foreign Policy that, in 2003, the U.S. began adding a pregnancy checkbox to death certificates. Previously, a death was only classified as “maternal” if the cause was directly related to pregnancy (e.g., eclampsia or a postpartum hemorrhage). After the change, any death that occurred during or recently after a pregnancy was considered maternal.

The reform was meant to avoid undercounting maternal deaths, and it worked. As more states implemented the checkbox, the maternal mortality rate steadily rose.

Stone doesn’t think there is anything inherently wrong with the new way of measuring maternal deaths: “If pregnancy alters the course of some other disease or condition and a mother dies not ‘of’ pregnancy but ‘with’ pregnancy, then that is validly considered a form of maternal mortality!” The problem is comparing that data internationally and making a mountain out of a change in measurement.

Counted the old way, the U.S. maternal mortality rate was 10.8 deaths per 100,000 births in 2020. In other words, U.S. maternal mortality is flat, not rising.


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