Global rates for maternal mortality have fallen by close to one-half, except in the U.S., where the number of women who die related to their pregnancy has significantly increased.1
In a similar fashion, infant mortality rates are higher than any of the other 27 wealthy countries reported by the Centers for Disease Control and Prevention (CDC).2
Cost for medical care in the U.S. is the highest in the world. Unfortunately, high medical expenditures do not translate into better outcomes for mothers and infants. In fact, the number of infant deaths in the U.S. for every 1,000 live births is higher than in Bosnia, Slovenia, Cuba and Belarus.3
According to data released from the Institute of Health Metrics, there are 28 maternal deaths for every 100,000 births in the U.S.4 This number is a drastic 22 percent increase, up from 23 deaths in 2003.5,6 Compared to 1990, the maternal death rate in the U.S. has more than DOUBLED.7
Why Are so Many New Mothers Dying?
In this short interview at the Women in the World summit in New York City, Dr. Priya Agrawal discusses the growing problem of maternal mortality in the U.S.
The increase in the number of new mothers dying puts the U.S. above a number of other poorer countries, whose numbers had declined, including Russia, Romania, Iran and Vietnam.8
While the overall U.S. rate was up by more than 50 percent since 1990, it is important to note the estimated rate increase for 48 states was up by 27 percent, and in Texas the rate doubled.9
In analyzing the data, it appears the death rate from hemorrhaging during birth, and eclampsia, a maternal condition involving dangerously high blood pressure, has remained stable over the years.10 Instead, the number of deaths related to chronic disease, such as cardiovascular disease, diabetes and obesity, has risen.11
“The really scary thing to us is all the deaths from cardiovascular disease and heart failure. It’s a quarter of all deaths. There were almost none in the remote past.”
Maternal deaths are counted even if the new mother dies six months after she’s given birth and the death is related to the pregnancy. Some argue the increase in number is related to better tracking. However, Callaghan, who is intimately familiar with the statistics, believes the rise is real.
Prevention and Treatment of Chronic Conditions Vital to Reducing the Number of Maternal Deaths
The director of maternal and child health research at the Institute of Health Metrics and Evaluation, Dr. Nicholas Kassebaum, originally believed the statistics were an error in the data processing, but now believes the U.S. may be experiencing the fallout of obesity ahead of other countries.14
U.S. hospitals and healthcare systems have become quite adept at handling life-threatening situations, but fall short in adequately dealing with chronic health conditions. The American College of Emergency Physicians (ACEP) reports a rising number of freestanding emergency centers.15
The growing number of independent freestanding emergency departments and off-site hospital-based emergency care speaks volumes about the direction medicine takes toward treating the emergencies chronic health conditions create.
The rising epidemic of obesity fuels cardiovascular disease, diabetes and stroke in new mothers and the general population. To make a significant impact on the number of maternal deaths, it is essential that evaluation and prevention of chronic health conditions be put at the forefront of public health policy.
Statistics for maternal mortality include women from age 15 to 49 years. Kassebaum reported an increase in the number of women over 40 who were achieving pregnancy, but found this new trend was not the driving force behind the increasing maternal mortality rate.
Follow-Up Care Impacts Infant Mortality Rates
Infant mortality rates have so significantly risen that the U.S. now ranks dead last on a list of 27 countries created by the CDC.16 Despite the cost of healthcare being higher in the U.S. than most other countries, a child in America is less likely to see his first birthday than a child from Korea, Israel or Hungary.
However, while the overall U.S. rate of infant mortality is 5.96 per 1,000 live births in 2013, the individual state rates vary. For instance, the infant mortality rate in Alaska is 3.57 deaths per 1,000 live births, while the rate in Mississippi is 9.62.17
In a collaborative paper between the University of Chicago, University of Southern California and Massachusetts Institute of Technology (MIT), lead author Alice Chen, Ph.D., notes the infant mortality gap between the U.S. and other nations has been consistent.18
According to their analysis, factors that are important in the rate of infant mortality in the U.S. include reporting differences in extreme preterm births and a striking disadvantage in the U.S. in post-neonatal mortality, or those deaths that occur after the child has been discharged from the hospital.
The mortality gap between infants in the U.S. and those in Austria and Finland appeared to grow steadily the first week after birth.19 Both countries enjoy overall infant mortality rates approximately half of the U.S. rate.20
The paper also pointed out a disparity in mortality between babies born to poor mothers and those born to wealthier mothers.
While the mortality rate of babies born to wealthier moms in the U.S. approximated the total number of deaths in Finland and Austria, poor babies in those countries had the same likelihood of survival as those born to wealthy families in those countries.21
The differences between the U.S. and these two countries appear to be access to healthcare after discharge from the hospital.
While the U.S. healthcare system ranks a lowly 37th in terms of overall quality,22 America’s neo-natal intensive care ranks high, which may help explain why the U.S. infant mortality rate is similar to that of Finland and Austria during the first few weeks of life.
However, after discharge, infants born to poor families have a more difficult time accessing care that may prevent or treat illnesses. This may become one measurement of the success rate of the Affordable Healthcare Act — whether the infant mortality rate declines in response to better healthcare access.
Preterm Infants and Birth Defects Increase Infant Mortality
Chen and her colleagues commented on the different reporting requirements between countries.
They noted countries that don’t report a preterm birth prior to 30 weeks gestation as a live birth, even when the baby is born alive, may account for a small portion of the increased rate in the U.S., as those births are reported on U.S. statistics.23
“In 2013, infants born at 37 to 38 weeks of gestation (early term) had mortality rates that were 63 percent higher than for full-term (39 to 40 week) infants. In 2013, 36 percent of infant deaths were due to preterm-related causes of death and an additional 15 percent were due to causes grouped into the sudden unexpected infant death category.”
Dr. Edward McCabe, chief medical officer for the March of Dimes Foundation, says there are three reasons why babies are born preterm, including unplanned pregnancies, unavailable healthcare and doctors who ignore guidelines and induce labor before 39 weeks.26
According to McCabe, many obstetricians feel 37 weeks is safe, although a full-term baby is born between 39 and 40 weeks’ gestation. Taking away those two extra weeks can be significant and place the baby at an unnecessary risk.
Mothers who live in underserved communities may experience daily stressors that research demonstrates increases your risk of preterm birth.27 High levels of stress also trigger high blood pressure and heart disease, which are risk factors for delivering a preterm baby.28 Obesity, teen birth rates and poor access to healthcare also contribute to preterm births.
Stimulating Maternal Immune System Found to Increase Risk to Growing Babies
The mother’s immune system plays a critical role in the development of her unborn baby, including the baby’s neurological and immunological systems. Prenatal infections activate the maternal immune system and trigger an inflammatory response. While researchers have identified specific infections that trigger damage to an unborn baby, ANY immune activation can trigger a response.
Brain function and behavior of your child are impacted by prenatal insults to your immune system.29 Activation of the maternal immune system upregulates inflammatory cytokines in the brain of the baby, and infection and activation of the maternal immune system have been linked to schizophrenia, cerebral palsy and autism in the child.30,31
This is a unique health risk attributed to even the virus that causes the common cold.32 Interestingly, active replication of the virus in the mother’s body is not necessary for the inflammatory response that triggers the damage. It is the mother’s immune system, not the pathogen, that is responsible for the changes in the baby’s brain.33
The inflammatory response in the maternal body is also associated with preterm birth and low birth weight babies. Multiple studies have associated both inflammation34,35 and specific infections36,37,38 with these outcomes. Both of these factors contribute to the infant mortality rates in any country.
This leads directly to the doorstep of vaccinations. A vaccine works by triggering your immune system. According to the National Vaccine Program Office in the U.S. Department of Health and Human Services:39 “Vaccines teach the immune system by mimicking a natural infection.”
Vaccines Negatively Affect Infant Mortality Rates
This 15-minute video explains what’s in the vaccines being given to our children, why some vaccines are given simultaneously and how you can report an adverse side effect.
Natural infections trigger an inflammatory response in the mother’s body, which in turn trigger potential neurological and immunological deficits in the unborn child and increase the risk for low birth weight or preterm birth. Low birth weight not only increases your child’s risk of mortality in the first year, but has also been associated with a number of different health conditions in later life.
According to the March of Dimes, babies born weighing less than 5 pounds 8 ounces are at higher risk for metabolic syndrome, diabetes, heart disease, high blood pressure and obesity.40 Unfortunately, the March of Dimes also reports that 1 of every 12 babies born in the U.S. have low birth weight.
Before routinely accepting the CDC recommendations for vaccination during pregnancy,41,42 it is important to understand the risks to yourself and your unborn child. Researchers found the number of childhood immunizations given in the first year of life had predictive value on infant mortality rates. A higher number of childhood immunizations given resulted in higher rates of infant mortality.43
The U.S. vaccination schedule specifies 26 doses of vaccination before age 1, the most of any other country. Using linear regression, scientists compared results from 34 countries and found those countries with the lower number of vaccines given also had the lowest rates of infant mortality.44 Of the 34 countries, 33 had lower infant mortality rates than the U.S.
There are steps you can take before you become pregnant, during your pregnancy and after your child is born to optimize your health and the health of your baby. Steps are outlined in my previous two articles, “No-Nonsense Guide to a Naturally Healthy Pregnancy” and “Top Foods to Eat When You’re Pregnant.”
Vitamin D is particularly important for infant and maternal health. Having a vitamin D level of at least 40 nanograms per milliliter (ng/ml) has been shown to reduce the risk of premature birth by 50 percent. For a refresher, please see my previous article, “New Campaign Aims to Resolve Vitamin D Deficiency Among Pregnant Women and Children.”