AMERICA’S DWP CRISIS: DYING WHILE PREGNANT
Over the past 20 years, the world has seen remarkable progress in medical science. Gene editing, cancer immunotherapies, improved antibiotics, and robotic surgery—these just scratch the surface of our scientific breakthroughs.
Yet discovery hasn’t always translated into improved health care. And for one group of Americans, health care isn’t just sliding backwards, it’s falling off a cliff.
I’m talking about women who are pregnant.
Earlier this month, an analysis in the Journal of the American Medical Association (JAMA)revealed a shocking truth for American women. From 1999 to 2019, maternal mortality hasn’t just stopped improving, it’s actually worsened by over 100%.
That’s right. A pregnant woman today is more than twice as likely to die as a similar woman 20 years ago. In one of the world’s richest nations, how is this even possible?
First, let’s look at the study. Researchers poured through twenty years of records and compared pregnancy related deaths to the number of annual pregnancies. They used the standard definition of maternal mortality—deaths from complications during or just after a pregnancy such as bleeding, infection, eclampsia, etc. They looked at geographic distribution, regional variation, and racial make-up.
In every corner of the country, for every ethnic group, outcomes worsened. By 2019, deaths per 100,000 pregnancies (the benchmark measure) had increased from 12.7 to 32.2. For Black and American Indian women, the picture was much worse. Their mortality skyrocketed to 55.4 and 49.2, respectively.
And this study counted deaths from medical causes only. It didn’t include pregnant women who died from firearms and auto accidents. According to an earlier analysis, homicide takes the lives of more pregnant women than any other cause. Add in those deaths, and mortality for U.S. pregnant women soars even further.
Only in America. What the hell is wrong with us?
Maybe we’ve reached the point where we should give this condition a clinical name. DWP. Dying while pregnant.
Make no mistake. American outcomes were nothing to brag about before the study began in 1999. Even then, our rates were the worst in the developed world. And since then, we’ve only lagged further and further behind.
Since the study’s 2019 conclusion, maternal mortality has risen even further. Will we as a nation have the courage to acknowledge and address the root causes of these unnecessary deaths? Or will we continue to ignore our racial, economic, gender, and geographic disparities, choosing instead to label them just an unfortunate coincidence?
Next month, thousands of future doctors and nurses will begin their training in institutions around the country. Hopefully, this new generation of professionals can address our maternal mortality crisis. But it won’t be easy.
Answers won’t be found in any laboratory. No technological breakthroughs will provide magic solutions. Progress will only come through taking a hard look at why pregnant women are dying, and what can be done to prevent it. It will require honest questioning as to why mortality is worsening even further for minorities and the economically disadvantaged. It will require a concerted effort from all of us.
But such progress won’t occur if every time an issue is raised it’s shouted down with cries of “you can’t talk about that, that’s critical race theory! That’s wokeism! That’s cultural Marxism! That’s socialism!”
No, it’s not any of those things. It’s about young women dying. And that needs to change.
And progress will be further hindered in states that prioritize embryos over the lives of mothers. Regardless of how you may feel about abortion, radical laws are being proposed throughout the country that greatly endanger women. Last year in Missouri, for example, the legislature debated whether to outlaw surgery for ectopic pregnancies (an embryo that implants in the fallopian tube instead of the uterus), even though such pregnancies are 100% non-viable. Apparently, the near-certainty of a mother’s tubal rupture, internal bleeding, sepsis, and death, wasn’t particularly important.
Make no mistake, how we deal with America’s DWP crisis may be the most important factor in determining the future health and well-being of our daughters and granddaughters. Right now, maternal mortality is headed dangerously in the wrong direction, and must be corrected. I’m optimistic that those future nurses and doctors will be up to the challenge.
The real question for the rest of us is, will we?
Terrific blog, Don.
Terrific and horrifying and sad and angrifying.
‘What the hell is wrong with us?’ indeed!!
Thank you Josh. A big part of what’s wrong with us is a fixation on mega-yachts, private jets, and private spaceships, for crying out loud, instead of women’s health. We have to do better.
Another question: Why don’t we hear from the nurse-midwives about this?
Good question. Perhaps the media ignores nursing research in favor of physician led studies? I don’t know.
I agree that maternal mortality has been a problem in this country. But isn’t this fundamentally a medical problem deserving of as much attention as other serious medical conditions such as cancer? Where has the profession been these past 20+ years?
I don’t see anyone shouting down efforts to reduce maternal mortality. Am I missing something?
The buck stops with the health care community on this issue.
Thanks, Kerry. It’s not that you’re missing anything. Maternal mortality isn’t being “shouted down” one way or the other because frankly much of America doesn’t give a damn. For millions of Americans, it’s easier to rationalize that this is just happening to “those other people, and it’s their own fault.” And in the current environment, just mentioning the word “disparity” gets shouted down as critical race theory or cultural Marxism.
Since 1999, cancer rates have decreased by 27%. Not much to shout about, I know, but we’re at least in the middle of developed countries when it comes to cancer, and not dead last as is the case with pregnant women.
Also, pregnant women tend to fly under the radar as far as many Americans are concerned. Do you honestly think that if cancer rates had doubled over the past 20 years the country wouldn’t be up in arms? Congress would be throwing a fit and holding hearings right now (well, maybe not Jim Jordan, I’m sure he’s convinced that what he’s doing would be way more important than people’s lives).
How many of the 3 million (so far) Americans who’ve been booted off Medicaid, many purely for administrative reasons, are women of childbearing age? Sure, many might get coverage once they’re pregnant, but until then their hypertension, diabetes, asthma, etc. is taking a toll on their bodies. When and if they do become pregnant, they will be at greater risk of dying regardless of what physicians like me can do. I can find no evidence that American physicians and nurses are dumber or more incompetent than doctors in Europe, Canada, and the pacific rim, where maternal mortality is not nearly as bad as ours. But they’re not hamstrung by a health care system that shovels trillions of dollars to private insurers, venture capital groups, and the pharmaceutical industry, while at the same time nickel and diming poor women.
I’m sure the health care community can do more, and we should. But the buck stops with the American people. Do they really care about this?
Kerry, a few years ago the American Academy of Emergency Physicians (the people who are getting pretty tired of treating the same trauma they saw in Afghanistan and Iraq) called for better gun control. They were immediately severely criticized by the American Rifle Association (in my opinion, yes, it amounted to being “shouted down”) and told to “stay in their lane.” The truth is, millions of Americans also feel that physicians calling for more equitable health care coverage, better housing, better nutrition, and more available women’s health are also “out of their lane.”
Physicians can look for answers and do everything we can, but until the American people want to acknowledge the root causes of these deaths, the mortality rate will likely only grow.