20 July 2015

Maternal mortality #nlpoli

Black women in the United States are twice as likely to die as a result of complications of pregnancy and childbirth as are white and Hispanic Americans, according to new research.  The story turned up in The Economist over the weekend.

colour of risk - economistBetween 2006 and 2010,  the death rate for black women was almost 40 per 100,000 deliveries compared with just over 10 for Hispanics and whites. 

But there’s more.

The United States is one of only eight countries globally to see its maternal mortality rate head up in decade 2003 to 2013..”American women are now more than three times as likely to die from pregnancy-related complications as their counterparts in Britain, the Czech Republic, Germany or Japan,”  according to The Economist.. The overall American rate of maternal death is 18.5 for every 100,000 live births.

One reason for the change might be new counting rules.  A change in the classification of death system came in 1999 and in 2003 states added a specific check-box on their forms for “pregnancy”.  But, as The Economist notes, that likely doesn;t explain why maternal mortality rates in the United States have double in the past 25 years and continue to climb.

More likely though, other factors are at play.  Age is one.  Women older than 35 years  made up 27% of the pregnancy-related deaths but were only 15% of the population during the period of the study. 

Caesarean sections could be another, as any surgery comes with increased risk.  About a third of births are now by C-section in the United States, compared to 21% in 1996.  The risk multiplies with more births as doctors often encourage women who have had one C-section to deliver all their children that way.  More surgeries increases the risk again.

Then there are the changes in the health of Americans.  Obesity,  heart disease,  high blood pressure, and diabetes are all on the increase and they also produce complications in pregnancy. 

Twice as many black Americans are obese compared to white Americans.  “African-Americans are also more likely to be poor,”  according to The Economist, “ have limited access to health care and have higher rates of unexpected pregnancies…”.  They are now four times more likely to die from complications of pregnancy and that discrepancy is double what it was a century ago.


In Canada,  the maternal mortality rate averaged eight per 100,000 over the period between 2003 and 2009 according to figures from the Public Health Agency of Canada.  Both the Canadian and American studies used the same classification system for deaths.

Here are the highlights, word for word from PHAC:

  • “In 2009/10-2010/11, there were 6.1 (95% CI: 4.3-8.6) maternal deaths per 100,000 deliveries in Canada.
  • Over the 1997/98-2010/11 period, maternal mortality rates fluctuated from a low of 6.1 (95% CI: 4.3-8.6) maternal deaths per 100,000 deliveries in 2009/10- 2010/11 to a high of 11.9 (95% CI: 9.1-15.4) maternal deaths per 100,000 deliveries in 2001/02-2002/03.
  • The most common diagnoses associated with these deaths in 2002/03-2010/11 were diseases of the circulatory system; other indirect causes (e.g., diseases of the digestive system and mental disorders and diseases of the nervous system complicating pregnancy, childbirth and the puerperium); postpartum hemorrhage [bleeding]; hypertension complicating pregnancy, childbirth and the puerperium; and obstetric embolism.
  • Maternal mortality varied by province and territory ranging from 0 (95% CI: 0.0-37.5) to 19.0 (95% CI: 5.2-48.6) deaths per 100,000 deliveries for the years 1996/97-2010/11.
  • Maternal mortality rates increased with age. For 1996/97-2010/11, women 40 years and older had 3.6 (95% CI: 2.1-6.0) times the rate experienced by women aged 20-24 years.
  • For 1997/98-2010/11, the late maternal mortality rate was 5.7 (95% CI: 5.0-6.5) maternal deaths per 100,000 deliveries. Neoplasms and injury, poisoning or external causes (e.g., unintentional poisoning) were the most commonly associated diagnoses in these deaths.”

Puerperium is the time from the delivery of the placenta through the first few weeks after the delivery, usually considered to be six weeks long.  The World Health Organization’s International Classification of Disease – the standard used in Canada and the United States  - uses this 42 day period as part of its definition of maternal death.

Newfoundland and Labrador

Table 3 from the PHAC report shows the maternal mortality rate for each Canadian province.

PHAC MM Table 3

At 16.7 per 100,0000 deliveries,  Newfoundland and Labrador had the third highest maternal mortality rate of any of the Canadian provinces and territories during the PHAC reporting period 1996 to 2010.  Only Prince Edward Island (19) and  Yukon (18.8) had higher rates.

Here is the same information presented from highest on the left to lowest on the right. The national average mortality rate in 8.8 per 100,000 deliveries.  Newfoundland and Labrador is double the national average. it’s about two and a half times the Nova Scotia rate and triple the rate in New Brunswick, which has a comparably-sized population. maternal mortality canada

Newfoundland and Labrador has the highest obesity rate among the 19 provinces,  one of the highest rates of hypertension in the country, and the highest prevalence of diabetes in Canada.  It has a slightly higher rate of C-sections compared to other provinces.

Does this mean we have a major undiscovered health crisis in Newfoundland and Labrador?


What you have here, if nothing else, is confirmation that the poor diet, lack of exercise and the diseases they produce have an impact on health for mothers just like they do for everyone else.

What you also have here is that local maternal mortality is on par with the United States average.  But that’s nothing to crow about, given that American maternal mortality is getting progressively worse and worse.