The CDC: rent-seekers or cowboys?

The CDC definition of maternal  mortality is much more expansive than the rest of the world.


Because they’re a bunch of go-it-alone cowboys, who reject the value of consistent measurement internationally, thinking they know better?

Or because they intentionally choose to overstate the problem, the better to acquire more funds for their projects?

Here’s the context:

Earlier today, a Scientific American article popped up in my twitter feed, as linked to by, well, I’m not sure any longer:  “Has Maternal Mortality Really Doubled in the U.S.?“, the gist of which is that

Whereas 7.2 women died per 100,000 births in 1987, that number swelled to 17.8 deaths per 100,000 live births in 2009 and 2011. 

but that this seems to be due, in large part at least, to changes in reporting.  The article continues,

Until relatively recently most states relied on a death certificate form that was created in 1989. A newer version of the form, released in 2003, added a dedicated question asking whether the person who died was currently or recently pregnant—effectively creating a flag for capturing maternal mortality. Specifically, this recently introduced question asks if the woman was pregnant within the past year, at the time of death or within 42 days of death.

But that doesn’t seem to be the whole story.

Here’s the CDC page with a graph on maternal mortality, and here’s the graph itself:

That’s a pretty startling graph, and the climb doesn’t really seem to have much to do with any reporting changes in 2003; the bulk of the climb had occurred before then.

But here’s the odd thing:

The Scientific American article also compares the U.S. maternal mortality rate to other countries, and the U.S. comes out looking pretty poor indeed.

But here’s the definition of maternal mortality that the CDC gives on their site:

For reporting purposes, a pregnancy-related death is defined as the death of a woman while pregnant or within 1 year of pregnancy termination—regardless of the duration or site of the pregnancy—from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

And here’s the definition from the WHO:

Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Now, last I checked, 1 year is a substantially longer time period than 42 days, so any comparison of U.S. vs. non-U.S. maternal mortality is going to make the U.S. come out looking bad.

And, again:  why?

I’m guessing that this is standard operating procedure at the CDC, to use non-standard definitions.  Is it because they’re fundamentally indifferent to how the U.S. fares in international comparisons, if they think theirs is the better measure?  Or is it because they’d prefer a measure that makes the problem look worse, in order to garner funds and attention?

And did the rate really rise?  Is this reflective of a transition from a 42 day to a year reporting period, or an expansion of the causes of death that are deemed to be related to maternity vs. simply coincident to recent childbirth?

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