Texas has highest maternal mortality rate in developed world

From the Guardian (Aug 21, 2016):

“The rate of Texas women who died from complications related to pregnancy doubled from 2010 to 2014, a new study has found, for an estimated maternal mortality rate that is unmatched in any other state and the rest of the developed world.

The finding comes from a report, appearing in the September issue of the journal Obstetrics and Gynecology, that the maternal mortality rate in the United States increased between 2000 and 2014, even while the rest of the world succeeded in reducing its rate. Excluding California, where maternal mortality declined, and Texas, where it surged, the estimated number of maternal deaths per 100,000 births rose to 23.8 in 2014 from 18.8 in 2000 – or about 27%.

But the report singled out Texas for special concern, saying the doubling of mortality rates in a two-year period was hard to explain ‘in the absence of war, natural disaster, or severe economic upheaval’.”

For the full article: https://www.theguardian.com/us-news/2016/aug/20/texas-maternal-mortality-rate-health-clinics-funding?CMP=share_btn_tw

How will Texas avoid even more horrors in this realm if/when Zika hits the state and the need for good maternity care rises precipitously, given the cut in clinics across the state?  How is the state preparing to help the populace?

From the NY Times (Sept. 8, 2016):

The rate at which women die during pregnancy or shortly after childbirth has fallen sharply in many nations as maternal care has improved. The United States — and particularly Texas — is a glaring exception.

In Texas, for instance, according to a study in the journal Obstetrics & Gynecology, the maternal mortality ratio — maternal deaths per 100,000 live births — doubled to 35.8 in 2014 from 17.7 in 2000. Compare that with Germany, which had 4.1 deaths per 100,000 live births in 2014.

In California, that figure fell from 21.5 in 2003 to 15.1 in 2014, but in the remaining 48 states and the District of Columbia it increased from 18.8 in 2000 to 23.8 in 2014. The United States as a whole had the second-highest maternal mortality ratio among 31 members of the Organization for Economic Cooperation and Development. Only Mexico had a higher figure.

A Heavier American Toll

Unites States maternal mortality rates are among the highest of members of the O.E.C.D.

Mexico 38.9

Texas 35.8

48 states and D.C. 23.8

Turkey 15.2

California 15.1

Britain 6.7

Maternal deaths per 100,000 live births, 2014.*

Canada 5.7

Germany 4.1

Japan 3.3

Netherlands 2.9

*Canada figure is from 2012, the latest available.

A big part of the problem is the inequality embedded in America’s health care system. The 2010 Affordable Care Act made health insurance more available, but millions of families still cannot afford the care they need. And lawmakers in many states and many Republicans in Congress have repeatedly shortchanged reproductive health programs because of ideological opposition to contraception and abortion.

The surge in maternal mortality in Texas defies easy explanation. Such increases typically happen during war, natural disasters and severe economic distress. State Republican lawmakers sharply reduced spending on women’s health care in 2011 in an effort to eliminate government funding of Planned Parenthood. The cuts, which took effect at the end of that year, don’t account for all of the increase, but they certainly don’t aid maternal health.

The biggest killers during and after pregnancy in Texas are cardiac problems and overdoses involving prescription opioids and illegal drugs, according to a recent report by a task force created by the Texas Legislature. It also found that maternal mortality was much higher for black women in Texas than for white and Hispanic women.

Texas lawmakers could address some of these problems by investing more in health clinics in minority communities and in mental health and addiction treatment. Expanding Medicaid to cover 1.2 million more poor people would also be very helpful. Texas is one of 19 states that have refused to expand Medicaid under the Affordable Care Act, despite the law’s generous terms, with the federal government picking up nearly all of the cost for low-income families.

Texas can also learn from California, which has organized doctors, hospitals, insurance companies and public interest groups in a collaborative to focus on maternal mortality. The group has developed state-of-the-art treatments for causes of maternal death like hemorrhages and pre-eclampsia, a condition characterized by high blood pressure and organ damage.

But even California could go further. Despite some improvement, its maternal mortality ratio far surpasses that in nations like Germany and Britain, where it is 6.7 per 100,000. One reason for Britain’s low figure is a mandatory system of confidential reviews, in place since 1954, of every maternal, newborn and infant death to determine what went wrong and how doctors and hospitals can improve. That’s easier in Britain’s single-payer, government-run health system, but it should not be impossible for state governments to develop something along these lines.

One of the United Nations’ Millennium Development Goals was to reduce global maternal mortality by three-fourths between 1990 and 2015. The world missed that target but still reduced maternal mortality by 45 percent. Set against that progress, America’s record is unconscionable.


2015 Births Down Overall: Historic lows among younger women; rates up among women 30+

Births by Age of Mother, 2002-2016The CDC has issued its preliminary report on US birth data for 2015.   Birth rates are down overall, driven by historic lows among younger women.  But rates among women in their 30s and 40s continue to rise.

Breaking it out by age:  the birth rate for teens fell yet again — decreasing by 8% since 2014, to 22.3 births per 1,000 women, another all-time low in a series of those.  Looking more granularly, in 2015 the rates declined 9% among teens 15-17, 7% among those 18-19, and 10% among those 10-14.  The teen birthrate (15-19) has declined 46% since 2007 (the start of the recent recession), and 64% since 1991.

Among women in their 20s, the rate decreased 3% for women 20-24 in 2015 (with a fall of 27% since 2007); the rate decreased 1% for women 25-29 (with a fall of 8% since 2007, including a less than 1% rise in 2014).

Among women in their 30s, the rate increased less than 1% for women 30-34 (with an overall increase of 5% since 2011, when what had been a downturn since 2007 turned up).  The rate increased 1% for women 35-39 in 2015 (with an overall increase of 13% since 2010).

Among women in their 40s, the rate increased by 4% for women 40-44, for a total gain of 13% since 2007; the rate among women 45+ was unchanged (though the number of births in this age group increased by 5% [from 8443 to 8876], due to an increase in women in this age group, which includes all women 45 and over).

Birth Rates by age of mother 2004-2015

The report did not include preliminary break outs by age at first birth or by race — that data should arrive with the rest of the deets in the Final report in the Fall.


New Era in Childbirth? Childcare Still Part of the Story.

Here’s an overview piece on current fertility research around later motherhood.

ap_120330030723-2Among the methods discussed, lab-grown eggs from stem cells (“Growing eggs in the lab like this would yield a great many eggs unaffected by age for older women trying to conceive through IVF. It also would mean women could skip the hormone stimulation harvesting eggs normally requires, though a minor, outpatient surgery to take tissue from the ovary would be needed.”); egg freezing; ovarian tissue freezing; mitochondrial transplants; genetic screening.

As the reporter notes, these technologies are very expensive, and so only available to the well to do except in states with mandated coverage.  They are also experimental, with varying levels of risk and unknown down-the-line effects on kids and parents.

The stem cell route in particular might take us to a future where age is not a factor in whether or not a woman gets pregnant.  But even more effective for shaping happy families for the group as a whole would be giving people a supportive social environment for combining families and work, where good childcare wasn’t so expensive that you had to wait to be able to afford it, and where employers didn’t see kids as a drag on their employees commitment to their work.  Having the school-day mimic the work-day would be a major means for realizing such a world, while also expanding kids’ learning, if done well and responsibly.  Progress is happening on these fronts as well (largely in municipalities, like NYC, DC, Miami, San Antonio, San Francisco) — & effort to improve things in Houston is underway too.  Keep it going!


Population Plunge?

  Decline in Births Among Twentysomething Women, by Race

This week the Urban Institute tackles the fertility question:  Will the birth rate drop among young women since the 2007 recession be made up by births to those same women when they’re in their 30’s & 40’s?  (20-somethings now have the lowest birth rate of any previous generation, they note — which pairs up with the wider point they don’t make, that the overall US birthrate is at an all-time low.)

Or will the US birthrate fall, parallel to falls in Western Europe & in Japan? Will the economy suffer? Will immigration rise and make up the difference?  How will people (male & female) feel about life without kids longterm?  & What about Naomi?

They don’t ask my favorite questions:

Would affordable childcare and/or a full-time school option make a difference?

& How many and what jobs will the fast-changing future of work call for, and how will  our ideas of work alter to fill and support future people’s lives in a widely mechanized world?    What are we learning about What Women Want, in an environment where they actually have a choice?  How will a population plunge affect the old folks’  funding sources and caregiver pool?  What’s holding us back from doing the obvious and investing in the education of our youngest citizens and in the infrastructure that will allow our current workers to succeed?

 Follow up article from WashPo on the potential consequences of low birth rates, maybe good & maybe bad,  down the line.


2013 Birth Rate Update

News from the CDC this January morning:

The final CDC 2013 birth rate report confirms that US birth rate continued its fall in 2013 – down 1% overall from 2012.

  • Teen births fell 10% (since last year!) to another record low
  • Birth rates also declined for women in their 20s to record lows in 2013
  • Rates rose for women in their 30s and late 40s in 2013 from 2012
  • The rate for women in their early 40s was unchanged.


US Birth Rates by Age of Mother, 2007-13


Rape in the Spotlight

Beverly McPhail and I were invited to comment on the Rolling Stone/U-Va “Jackie” story in the Houston Chronicle.

The online commenters debate the second line, that “Research reveals that one woman in five experiences a sexual assault in college, and the majority go unreported” without seeming to have read the rest of the argument.  Clearly it’s hard to be precise about unreported events.  Our point is that neither an unverified “story” by bad  journalists nor the debatability of a specific percentage number makes it less important to change the long-standing culture of silence around rape on many campuses (and by the way in the world at large). The good news is, positive change is underway.

Bad reporting of sexual assault doesn’t reduce its prevalence

by Beverly McPhail & Elizabeth Gregory

Campus rape now has a national spotlight after decades in the dark. Research reveals that one woman in five experiences a sexual assault in college, and the majority go unreported. After years of ignoring it, universities nationwide, under pressure from the Justice Department, are now actively working to radically lower assaults.

Discussing rape openly, making its unacceptability clear, holding friends accountable for reporting known or suspected assaults, and expelling those found guilty through due process can transform the campus climate.

Many perpetrators are serial offenders who have been enabled to roam freely by a culture that blames the victims and supports the view that violent or coerced sex is normal. (This is not just a campus problem. When the rape and murder of women play as popular TV “entertainment” nightly, should we be surprised that they also occur often in the real world?)

Paradoxically, an early sign of success at culture change is that reports of rape rise – signaling that more women feel comfortable coming forward for assistance. And reporting has been increasing on campuses in response to the altered policies and attitudes.

It’s against this backdrop of positive change that the controversy around the recent article in Rolling Stone magazine on a purported sexual assault at the University of Virginia has played out. A student called “Jackie” gave the reporter a horrific account of being gang-raped at a fraternity party. The reporter didn’t verify the story with those Jackie accused (to the extent that they could be identified) or with the friends Jackie said she told about the rape right after it occurred. As has been widely reported, the story hasn’t held up: There was no official party at the frat the night Jackie cited, the person she named to friends as her date turns out to have been an acquaintance from high school and not a student at UVa, and the friends report that rather than dissuading Jackie from going to the hospital as she claimed, they tried to take her there. Clearly something bad happened at some point to Jackie, either in the frat house (the friends report they’ve never seen anyone as disturbed as she was that night) or at some earlier point in her life, or maybe both. But we still don’t know what that was.

Ironically, a story that apparently aimed to give readers greater understanding of rape victims’ experience may instead re­inforce victim-blaming and heighten the level of doubt that victims encounter when they come forward.

In no other crime is a victim treated with such disbelief and scrutiny as sexual assault, and Rolling Stone’s journalistic fail could increase that skepticism. That would be a tragic outcome; it could push some victims back into the shadows who were just beginning to feel that they might safely come forward. Though it’s a common myth that women routinely lie about rape for their own purposes, one study has found that the rate of false allegations is low – between 2 percent and 10 percent.

This is further complicated by the fact that neuro­biological changes due to trauma can make memory consolidation and recall difficult, often resulting in fragmented memories that may lead to discrepancies in women’s stories. We don’t yet know whether this was a factor in Jackie’s case.

The moral of the Rolling Stone story is that bad reporting is a disservice to everyone – the public, the magazine and the story. But it does nothing to change the fact that university culture, including fraternity culture, has historically allowed too many sexual assaults to occur. We can put that history behind us now.

Jackie’s story can serve as a teachable moment of an expanded kind from what Rolling Stone intended. Through expanded training and education on sexual assault for all parties – including students, faculty, administrators, law enforcement and journalists – we can win justice for survivors while holding perpetrators accountable, we can learn to better understand the effects of trauma, and we can move toward changing the culture of violence toward women overall.

In 2012, under the leadership of Title IX Coordinator Dr. Richard Baker, the University of Houston adopted a new sexual misconduct policy using the affirmative consent standard (“yes means yes”) that was made mandatory in California universities earlier this year. The standard shifts from requiring that victims explain how they resisted to placing responsibility on the sexual initiator to gain permission for sexual acts. These and related efforts are already showing some success, and the UVa story can’t be allowed to derail such progress.

One of the first mainstream books on rape, “Against our Will: Men, Women, and Rape,” written by journalist Susan Brownmiller, ended with these words: “My purpose in this book has been to give rape its history. Now we must deny it a future.” That remains our goal today, on college campuses and beyond.