More Bad News on Maternal Mortality (Back to the Future, Part 18)

The  "U.S. Maternal Mortality Crisis" (The Commonwealth Fund Report, 14 December 2022), Back to the Future, Part 18 

A few days ago, the Commonwealth Fund published a new report on the status of maternal mortality in the United States. Dated 1 December 2022, the comparative study, authored by Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, had a shocking, but not surprising, title: "The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison." 

I say "shocking" for obvious reasons. I say "not surprising," because maternal mortality rates in the U.S. have long been exceedingly bad. As Gunja, Gumas, and Williams note, "The maternal mortality rate in the United States has for many years exceeded that of other high-income countries. Data from the Organisation for Economic Co-operation and Development and the Centers for Disease Control and Prevention show rates worsening around the world in recent years, as well as a widening gap between the U.S. and its peer nations."* 

Despite the urgency of the findings, I put off writing about the report--it was too depressing. But, today, the Commonwealth Fund has issued an even more urgent report, "The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions."**

Together, these two publications present a devastating healthcare reality for women in the United States. 

Just one chart from the Commonwealth's "U.S. Maternal Mortality Crisis" is eye-opening: 

And, as the authors of the study note, "Data show that the maternal mortality rate in the United States — more than three times the rate in most other high-income countries — is getting worse, and the rate for Black women is nearly three times higher than for white women."

As for the "health divide" for women living in the U.S.? It will surprise no one that maternal (and infant) health is far worse in states where abortion has been made illegal or so seriously restricted that it may as well be illegal: "Compared to states where abortion is accessible, states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers; more maternity care 'deserts'; higher rates of maternal mortality and infant death, especially among women of color; higher overall death rates for women of reproductive age; and greater racial inequities across their health care systems."

Moreover, "Making abortion illegal makes pregnancy and childbirth more dangerous; it also threatens the health and lives of all women of reproductive age."

Because of course it does. So much for the "we value every single precious life" forced-birth crowd. What a load of crap.

*For data, see this CDC report on maternal mortality rates in 2021. And for earlier discussions of maternal and infant mortality rates in the United States in this blog, click "Global Gender Report" in the labels, below.

**The Commonwealth Fund report is authored by Eugene Declercq, Ruby Barnard-Mayers, and Laurie Zephyrin, Kay Johnson

Update: Here's more on maternal health, if you can stand it, from Axios.

Update, 16 December 2022: And still more, from the Washington Post, "Can Politics Kill You?" No mystery--the answer to that question is yes. The majority of the piece is about the way COVID has taken a heavy toll on Republicans and conservatives, but there's this:

With abortion services no longer legal nationwide, university researchers have estimated that maternal deaths could increase by up to 25 to 30 percent, worsening the nation’s maternal mortality and morbidity crisis. Americans live shorter lives than people in peer nations, in part because it is the worst place among high-income countries to give birth.

Update, 17 December 2022: And even more, from the Texas Tribune's Eleanor Klibanoff, "Why Are Pregnancy and Childbirth Killing So Many Black Women in Texas?" (click here). Here's just a bit:

A decade ago, when Texas first formed the Maternal Mortality and Morbidity Review Committee, Black women were twice as likely as white women, and four times as likely as Hispanic women, to die from pregnancy and childbirth.

Those disparities haven’t improved, according to the committee’s latest report, published Thursday.

In 2020, pregnant Black women were twice as likely to experience critical health issues like hemorrhage, preeclampsia and sepsis. While complications from obstetric hemorrhage declined overall in Texas in recent years, Black women saw an increase of nearly 10%.

Update, 19 March 2023: In a piece titled "US Maternal Death Rate Rose Sharply in 2021 . . . and Experts Worry the Problem Is Getting Worse, CNN reports on the new data just released by the National Center for Health Statistics (see the link in *, above). According to the CDC's Center for Health Statistics, "The number of women who died of maternal causes in the United States rose to 1,205 in 2021. . . . That’s a sharp increase from years earlier: 658 in 2018, 754 in 2019 and 861 in 2020." Check out the report--the graphs will stun you.

And CNN refers to the Commonwealth Fund's report (discussed above), published at the end of 2022: "The US has the highest maternal death rate of any developed nation."

Are we all ready for those "We're Number One" bullshit cheers we here so often? All that "greatest country in the world" claptrap? Yeah, I thought so . . . 

Update, 19 July 2023: Here is Veronica Gillispie-Bell's heartbreaking New York Times op-ed, "More Mothers Are Dying. It Doesn't Have to Be This Way." Gillispie-Bell links to the 3 July "Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States" (JAMA 330, no. 1 [2023]: 52-61; for the online abstract, click here.)

Update, 12 September 2023: For ways to address the problem of maternal mortality, see Mara Gay's NYT opinion piece, "America Already Knows How to Make Childbirth Safer" (click here).

Back to the Future, Part 15: Here We Go Again

Back to the Future, Part 15: Here We Go Again

I've put off writing about this year's Global Gender Gap Report--I just didn't have the heart for it. But with today's publication by the CDC of "Maternal Mortality Statistics," I was reminded of something my son once wrote when he was forwarding a link to me: "Mom, here's more good news for the woman who loves bad news."

On to the World Economic Forum's Global Gender Report 2020.* First, some good news: "This year the progress has not only been larger than in the previous edition, but also more widespread: out of the 149 countries and economies covered both this year and last year, 101 have improved their score and 48 have seen their performance unchanged or reduced."

But before we in the U.S. get too excited, the U.S. is among those countries that have seen their performance fall--the U.S. ranks 53rd (of 153 countries), down two spots from the last year's calculations. By way of contrast, our two nearest neighbors rank much higher, Canada at 19, Mexico at 25. 

The report examines four key areas in assessing gender: economic participation and opportunity; educational attainment; health and survival; and political empowerment. Again, here's a bit of good news: "The time it will take to close the gender gap narrowed to 99.5 years in 2019. While an improvement on 2018 – when the gap was calculated to take 108 years to close – it still means parity between men and women across health, education, work and politics will take more than a lifetime to achieve." Yup, that's about as good as the news gets . . . 

While political "empowerment" is "on the rise," it remains the "the worst-performing dimension": "it will take 95 years to close the gender gap in political representation, with women in 2019 holding 25.2% of parliamentary (lower-house) seats and 21.2% of ministerial positions." 

At the same time, women's economic situation is still not showing improvement: "In contrast to this positive progress in the lofty world of leadership, women’s participation in the wider labour market has stalled and financial disparities are increasing."

And the disparities in political power and their economic situation are all the more distressing because women have reached parity (almost) in health and, most important, education: 

So, it will take only 99 years instead of 108 to close the gap . . . If you're a glass-is-half-full kind of reader, you may find something to cheer about in the full report.

I am not a glass-half-full kind of reader, however. (Nor am I a glass-half-empty reader--I'm a why-in-the-hell-are-there-only-two-glasses? kind of reader.) Even so, it took today's new maternal mortality statistics to knock me out of my funk. 

Perhaps the most shocking thing in the just-published CDC report** is that the National Center for Health Statistics has not published maternal mortality figures since 2007--yes, over a decade ago! Thirteen years without official data . . . It has taken all that time (well, since 2003, actually) for a new "coding method" that would allow the NCHS to "resume the routine publication of maternal mortality statistics."

The figures are not good: "The maternal mortality rate for 2018 was 17.4 deaths per 100,000 live births, and the rate for non-Hispanic black women (37.1) was 2.5 to 3.1 times the rates for non-Hispanic white (14.7) and Hispanic (11.8) women."

As reporter Julia Beluz notes, "If you compare the CDC figure to other countries in the World Health Organization’s latest maternal mortality ranking, the US would rank 55th, just behind Russia (17 per 100,000) and just ahead of Ukraine (19 per 100,000)."

But whether there are "official" counts or not, it's not as if maternal mortality rates in the U.S. are a big secret--click here for a recent USA Today report, and here for the World Health Organization's Trends in Maternal Mortality: 2000 to 2017.

Update, 13 February 2020: As if the news about maternal mortality rates weren't bad enough, ProPublica reports that there are "gaping holes" in the research:

In order to come up with a number that allows the United States to be compared with other countries, the National Vital Statistics System was required to use the World Health Organization’s definition of maternal mortality: “the death of a woman while pregnant or within 42 days of termination of pregnancy … from any cause related to or aggravated by the pregnancy or its management.” The global standard encompasses the traditional, acute, obstetric causes of maternal death — hemorrhage, infection, blood clots, strokes — but excludes “accidental or incidental” causes. . . 

The 42-day cutoff for calculating maternal mortality excludes many maternal deaths:

In the U.S., as many as 24% of pregnancy-related deaths are happening from 43 days to 365 days after delivery, according to a CDC report last fall. In Texas, the proportion is closer to 40%. Even the new NVSS data [see below, **] confirms an enormous number of such deaths. Hidden in its report is a calculation for late maternal mortality for 2018: an additional 277 deaths. That brings the CDC estimate for maternal deaths up to a year postpartum to a much higher figure than it reported in the official U.S. rate: a total of 935 lives lost.

Causes of maternal deaths that are not included in the CDC report include heart-related conditions (which is the leading cause of uncounted maternal deaths), accidental overdoses, suicide, complications that lead to the deaths of older mothers, and, most horrifically, homicide (a study co-authored by [Joia] Crear-Perry, of the National Birth Equity Collaborative, shows that in Louisiana, homicides were the leading cause of death for pregnant and postpartum women from 2016-17).

In other words, "Since 2007, the government had held off on releasing an official estimate of expectant and new mothers who died from causes related to pregnancy and childbirth. It waited for the data to get better. But the new, long-anticipated number falls short."

For Nina Martin's piece in ProPublica, click here.

*In previous years, the December publication was dated for the year in which it was published. This year, instead of the report being titled "2019" when it was published on 17 December 2019, it was titled "2020." For my previous posts on the "report, click here (2016), here (2017), and here (2018). Rereading what I wrote in 2018, I said then that I "didn't have the heart" for a writing a whole post about it--talk about "back to the future"!!! 

**As if the gaps in this report were not enough (see "Update, 13 February 2020" note, above), the link to the report now (February 2021) takes you to "Resource Not Available. The page you requested cannot be found at this time. It may be temporarily unavailable or it may have been  removed or relocated. I’ve updated my links to take you to the original document, preserved by the Internet Archive’s Wayback Machine. As I've noted elsewhere in this blog, one real issue during the Trump administration has been ACCESSING IMPORTANT INFORMATION.

Back to the Future, Part 12: More Great News on Pay Equity!

Back to the Future, Part 12: More News on Pay Equity (or, More Good News for Women--How Can You Stand All the Winning?)

The Institute for Women's Policy Research has just issued a reassessment of the gender wage gapp. In Still a Man's Labor Market: The Slowly Narrowing Gender Wage Gap, researchers Stephen J. Rose and Heidi I. Hartmann have undertaken a "multiyear analysis" of wage data that "provides a more comprehensive picture of the gender wage gap and presents a more accurate measure of the income women actually bring home to support themselves and their families."

In the "Highlights" section of the report (really, that is just about the worst title imaginable), Rose and Harmann note their findings: 

• Women today earn just 49 cents to the typical men’s dollar, much less than the 80 cents usually reported. . . . Progress [in achieving pay equity] has slowed in the last 15 years relative to the preceding 30 years in the study. 
• The penalties of taking time out of the labor force are high—and increasing. . . . 
• Strengthening women’s labor force attachment is critical to narrowing the gender wage gap. . . . 
• Strengthening enforcement of equal employment opportunity policies and Title IX in education is also crucial to narrowing the gender wage gap further. . . . 

So, yay! Did you see the great news! Instead of, on average, women earning 80 cents for every dollar made by men, in actuality, they earn less than half of what men do!

Rose and Hartmann outline what makes this report distinctive, emphasizing its more comprehensive analysis:

In 2017, the most recent year for which year-round earnings data are available for full-time workers, the gender earnings gap was 20 percent; that is, women earned 20 percent less than men. . . . This figure is based on the ratio of women’s to men’s median earnings for full-time, year-round work and is derived from the annual Census Bureau report on income and poverty that is released every fall using data from the Current Population Survey. . . . This commonly used annual figure, however, understates the problem, especially for women workers, since it leaves so many of them out of the picture. The authors’ 2004 report, which pioneered the analysis of the earnings gap over 15-year periods, found an earnings gap of 62 percent for all women compared with all men (of prime working age) in the period studied, meaning that women made just 38 percent of what men made. . . . The current analysis updates and revises the analysis from the authors’ 2004 report and finds that a wide disparity exists between all workers and the smaller group of workers who work full-time, year-round. Although the earnings gap across the most recent 15 years for those who generally work full-time, year-round in this study is similar to the more commonly used one-year numbers from the same years (23 percent), the earnings gap across all 15 years for all women and men with some earnings is very different, a gender earnings gap of 51 percent (meaning that women earn only 49 percent of what men do across a 15-year period). Among women workers in this study, 43 percent had at least one year with no earnings, while only 23 percent of men did, indicating that being out of work for a year is still a common experience for women but unusual for men. (p. 1)

And, of course, "The long-term gender earnings gap has narrowed since 1968, but it has by no means disappeared." 

This year just keeps on getting better! And we still have a month to go!

For more on issues of pay equity and the gender wage gap, click on the label "pay equity," below. And for more in this Back to the Future series, click on the label below.

Update, 19 December 2018: In yet more depressing news on this front, the World Economic Forum has just published its annual Global Gender Gap Report (2018). I've posted about this report before, in 2017 and in 2016, and you can read those comments by following the links here (for 2017) and here (for 2016).

I don't have the heart for a separate post today, although I will note that this "gender gap" report goes beyond pay equity to examine the gender gap in four areas: economic participation and opportunity; educational attainment; health and survival; and political participation.

You can find the Global Rankings on pp. 10-11. The US ranks 51st in the 149 countries listed. Here's happy conclusion:

. . . if current rates were to be maintained in the future, the overall global gender gap will close in 61 years in Western Europe, 70 years in South Asia, 74 years in Latin America and the Caribbean, 135 years in Sub-Saharan Africa, 124 years in Eastern Europe and Central Asia, 153 years in the Middle East and North Africa, 171 years in East Asia and the Pacific, and 165 years in North America. 

Read it and weep.

Oh, Yay! More Great News for Women! 2017 Edition!

The World Economic Forum's 2017 Global Gender Gap Report

The World Economic Forum has just published its annual Global Gender Gap Report. Published every year since 2006, the report "benchmarks 144 countries on their progress towards gender parity across four thematic dimensions: Economic Participation and Opportunity, Educational Attainment, Health and Survival, and Political Empowerment."

Of course, we'd like to believe that women are closing the gap--that, all over the world, despite the obstacles they face, women are making progress. 

Unfortunately, that is not the case. Last year, assuming "[a]ll things held equal," the global gender gap was projected to close in 83 years. But things did not hold equal--today, "with current trends, the overall global gender gap can be closed in exactly 100 years [emphasis added] across the 106 countries covered since the inception of the Report" (viii).

Let's start with the good news, or at least the sorta good news: "On average, the 144 countries covered in the Report have closed 96% of the gap in health outcomes between women and men." This is the "smallest gap," but the numbers remain unchanged since last year. Still, "the gap is larger than it stood in 2006" (25), when the first Global Gender Gap Report was published.

And now, the bad news: 

on current trends, the education-specific gender gap could be reduced to parity within the next 13 years. The widest gender gap, in the political dimension, is also the one exhibiting the most progress, narrowing by 9% since 2006, despite a slowdown in progress this year. On current trends, it could be closed within 99 years [emphases added]. (25)

And now (because that's the kind of woman I am), the worse news:

Some of the most challenging gender gaps remain in the economic sphere. At the current rate of change, and given the continued widening of the economic gender gap already observed last year, it will now not be closed for another 217 years [emphasis added]. This year, the economic gender gap has reverted back to where it stood in 2008, after a peak in 2013. (25)

As for the U.S.? Don't look for them in the "top ten"--that is, the countries which have succeeded in "closing more than 80% of their overall gender gap" (14-15). Those countries? Iceland, Norway, Finland, Rwanda, Sweden, Nicaragua, Slovenia, Ireland, New Zealand, and the Philippines.

Where is the U.S.? It's ranked at 49 among the 144 countries in the global report--right below Bangladesh and Peru, right above Zimbabwe and Jamaica. 

If you want to see the complete list of rankings, look for Table 3 (10-11). And you can see the "country score card" for the United States, found on p. 334.

For my blog post on last year's Global Gender Gap Report, click here.

More Really Great News on the Gender Pay Gap--This Time on a Global Scale

The World Economic Forum's 2016 Global Gender Gap Report

The World Economic Forum has just published its eleventh annual Global Gender Gap Report--this report has been published since 2006 and measures women's progress in 144 countries. *

Here's one way to make lemonade out of lemons . . . 

In its analysis, the index focuses on fourteen variables in four areas: economic participation and opportunity; educational attainment; health and survival; and political participation.

The differences between men and women are enormous. Over all, women are worse off than men by 31.7%. 

Here's the good news, according to the report. On average, "the 144 countries covered in the Report have closed 96% of the gap in health outcomes between women and men, unchanged since last year, and more than 95% of the gap in educational attainment, an improvement of almost one full percentage point since last year and the highest value ever measured by the Index" (7).

But here's the bad news: 

However, the gaps between women and men on economic participation and political empowerment remain wide: only 59% of the economic participation gap has been closed—a continued reversal on several years of progress and the lowest value measured by the Index since 2008—and about 23% of the political gap, continuing a trend of slow but steady improvement. Weighted by population, in 2016, the average progress on closing the global gender gap stands at a score of 0.683—meaning an average gap of 31.7% remains to be closed worldwide across the four Index dimensions in order to achieve universal gender parity. (7)

And here's the worse news (because I'm a glass-half-empty kind of person): "Out of the 142 countries covered by the Index both this year and last year, 68 countries have increased their overall gender gap score compared to last year, while 74 have seen it decrease. It therefore has been an ambiguous year for global gender parity, with uneven progress at best."

And now the worst news of all: at the rate things are going, it will take 83 years to close this gender gap. But that's for all four areas--the pay gap won't close for another 170 years! Or so . . . 

And don't assume that the U.S. scores high on this index--the U.S. saw a 17 point drop on last year’s score. And it places only 45th in the global table. 

And when it comes to those pesky kinds of unpaid labor--like household tasks and childcare, for example--women still do much more than men.

* This blog post used to contain links to all the relevant data in and quotations from the 2016 report, but as of January 2021, those links no longer worked ("Error establishing a database connection"). However you can still read and download the entire report at the World Economic Forum by clicking here.