Here’s a letter of mine that will appear in tomorrow’s print edition of the Washington Post:
The Aug. 20 editorial “Too many new moms are dying” reported that “over the past two decades, most countries have made great strides in maternal health, bettering outcomes for mothers and children. The most glaring exception to this trend is, disappointingly, the United States.”
This conclusion is premature. Between 2003 and 2017, U.S. states adopted a new procedure for recording maternal deaths — namely, a pregnancy status checkbox on the U.S. Standard Certificate of Death.
A 2020 study published by the Centers for Disease Control and Prevention “found that the use of the standard pregnancy status checkbox item to classify deaths as maternal has an impact on maternal mortality measures in the United States by increasing the number of deaths identified as maternal. Use of the checkbox resulted in the tripling of the number of deaths identified as maternal in the 47 states and the District of Columbia that were using the standard checkbox item in 2015 and 2016. … Calculating maternal mortality rates in 2015 and 2016 in a consistent manner for the entire United States without using the standard checkbox item yielded rates similar to the maternal mortality rates calculated from vital statistics before the standard checkbox item was introduced.”
At least some, and perhaps all, of the apparent increase in recent years of maternal mortality rates in the United States is an artifact of a change in death certificate recording.
Donald J. Boudreaux, Fairfax
