Thank you for highlighting this. I am a pediatrician with a degree in health services research. Hoping this is a safe space, I will admit to some despair, accumulating over the past twenty years, related to how irrelevant my advanced training in cost-effectiveness and health outcomes across systems has been to health care practice and operations. There is nowhere this dynamic has been more clear than in the question of maternal health in the United States.
I recently worked in one of the ten largest urban areas of the US, in a major academic children’s hospital, half a block down the street from a major academic adult hospital with a labor a delivery ward amongst the most technologically sophisticated in the world. And I will never forget that my colleagues were called to the room of one of our newborn patients not for the infant but because her mother had been “found down” in the room. This new mother became a statistic. And her daughter will grow up motherless.
There are few, if any, interventions more societally cost-effective than saving the life of a mother. There are few, if any, interventions more ethically profound than saving the life of a mother, the existence of a family.
Our macro-level statistics, in health care and in economics, often mask these profound differences in how our fellow citizens, how our communities, are living. As you wrote so eloquently, it calls “into question any notion of belonging to a community of fate.”
Is it any wonder that when those of us who care, who have studied, who know these realities, who work in the most prestigious systems designed to help prevent these tragedies, and who are therefore supposedly in positions of relative power, are, in reality, unable to make a difference . . . Is it any wonder that those we would hope to vote with us are losing faith that we can actually make their lives . . . Better? A profound moral and material question of our age.
Your attention to this topic is appreciated, Adam, but medical research for all of women's health has been an intentionally back-burner non-priority for all my life (I'll be 70 Wednesday). The less equal research on women's health seems intentional, and you only hear about men's health issues around male reproduction, like the endless TV advertising for erectile dysfunction and meds therefor, along with really infuriating, endless ads for Peyronie's Disease (crooked dick) or Viagra, Cialis, and most recently BLUE CHEWS, where young attractive women exhibit excitement over these erectile dysfunction chews for their ostensibly older sex partners. Alternately, the nightmare experienced by Tennis star Sabrina Williams during her life threatening birthing experience has been lost to the ether. I wouldn't be exaggerating to say that women, the normal, open minded, dare I say more educated women, are spitting-furious about the diminished direction our place in society has taken, although we are the majority gender. I will be interested to see where you go with this topic. Thank you.
The data are stark, and not shocking given how life expectancy has eroded and income inequality has soared. I do recall the source the of the quote/observation but it goes along the line lines of “show me how a society treats its children and old who are most vulnerable, and that it tells all about that society.” That does not tell me good things about the US at all.
The trouble with the Western dualist worldview (democracy vs autocracy) is one becomes blind to one’s own shortcomings. Genocide only happens when Turks do it, not when Israelis do it.
My current unifying field theory of all things related to human behavior is the critical role of tribalism in Homo sapiens avoiding extinction. In Europe the population of any given country can feel part of the tribe for the nation state and therefore extend care and empathy for the population at large. In the U.S. we are a private equity firm made up of competing tribes. Hence, the reluctance to enact public policy that benefits the entire population. For the most part in the U.S. rich white people get pretty good medical care. As for the others, “Not my tribe.” I devote a significant part of my retirement swimming against this tide, but the waves keep crashing (See November 5th).
It is also notable that US and Canada both have significant disparities compared to other OECD nations with maternal mortality and they both of have higher incidence of opioid overdose deaths compared to other OECD nations. 2024 did see decreases in overdose deaths, probably largely due to a decrease in the potency of fentanyl in the illicit opioid supply, but our overdose deaths in the US are still higher than prepandemic levels. Would be interesting to see where the US stands once we take into account the opioid crisis. I suspect we will still be worse than other OECD, but not quite as disparate. Clearly there needs to be more focus on all the contributors to the opioid crisis, particularly among pregnant women.
When a woman has "a maternal death related to mental health", what does that cash out to in practice? Should I imagine a woman gives birth and then kills herself? If that's the case then maybe underlying mental health issues are getting confused with maternity issues.
Thinking out loud: I wonder what the % is for women who experience post-natal depression, have previous mental health concerns/issues? And of those, who do harm themselves? I would hazard it’s a larger % who’ve never had previous issues, so it doesn’t get caught, and given the unequal access to healthcare in the US + latent attitudes towards women’s (mental) health is not treated properly even when identified.
I asked AI your question, 68.5% of women who get postpartum depression have a prior history of clinical depression. It seems intuitively like if someone has already rotten their brain with tiktok and covid lockdowns, then adding postpartum depression in addition to that is worse than if somebody with previously solid mental health is exposed to risk of postpartum depression. If that's right, then the wave of mental health issues can also make maternal health worse.
Here's the Q&A with AI : of women who experience postpartum depression, what percent have a prior mental health diagnosis
Approximately **68.5%** of women experiencing postpartum depressive symptoms at 9 to 10 months postpartum had a prior history of depression, according to a recent study analyzing postpartum mental health. This suggests that a significant majority of those with postpartum depression may have had previous mental health diagnoses, highlighting the importance of screening for prior mental health issues in pregnant and postpartum women[2].
I will be the first to admit that our healthcare system sucks. If you can afford it, great. If you can't, or in a job that doesn't provide insurance you are out of luck. That's said I'd like a little more data on the mortality rate. I suspect US women are much older than many other nationalities when giving birth. So wonder if that impacts the data ?
In general it it pretty unlikely to give birth after, say, 45. Giving birth is of course a very strenuous activity but it's also not one that elderly people generally do so its a little hard to imagine that age of the mother could be a factor in maternal mortality rates (though it can be for fetal and newborn fatality rates).
My mom was a social worker in the 1950-70 period in New York. At the time NY was a firmly liberal high social spending state. All good, but prenatal care and post natal support depend to a large extent on the mother's awareness and her commitment to having a healthy baby. There was plenty of medical and counseling support, but the mom to be had to be an active and willing participant
Of course qualities of planning and concerns for health are not necessarily compatible with being a teenager, having few opportunities, and frequently an unstable family structure in the first place.
60 years later the poverty factor still exists, often exacerbated by Racism, and "benign neglect" seems to be a acceptable policy.
We do a few things very well, for example integrating skilled immigrants into our way of life.
Others, not so fine, seem to be a part of our national character.
So it seems spending so much on expensive if unnecesary care (think American teeth) leads to massive underspending on basic care even when total spend is some 18% of GDP (last time I looked) compared to 12% in Europe.
AND even less care is spent on filling out forms (or their design).
If you're just now arriving at the conclusion that those governing the US are at best indifferent to the health and well-being of its citizenry, then you just haven't been paying attention.
The overall life expectancy statistics for the US are absolutely shocking for the materially wealthiest country in recorded history, to say nothing of the scandalous gap in health and life expectancy outcomes across its income and wealth distributions.
My reading of the debate is that the original numbers understated maternal mortality. When the US moved to an internationally accepted definition, numbers rose. So the increase is illusory, but the level is right
Thank you for highlighting this. I am a pediatrician with a degree in health services research. Hoping this is a safe space, I will admit to some despair, accumulating over the past twenty years, related to how irrelevant my advanced training in cost-effectiveness and health outcomes across systems has been to health care practice and operations. There is nowhere this dynamic has been more clear than in the question of maternal health in the United States.
I recently worked in one of the ten largest urban areas of the US, in a major academic children’s hospital, half a block down the street from a major academic adult hospital with a labor a delivery ward amongst the most technologically sophisticated in the world. And I will never forget that my colleagues were called to the room of one of our newborn patients not for the infant but because her mother had been “found down” in the room. This new mother became a statistic. And her daughter will grow up motherless.
There are few, if any, interventions more societally cost-effective than saving the life of a mother. There are few, if any, interventions more ethically profound than saving the life of a mother, the existence of a family.
Our macro-level statistics, in health care and in economics, often mask these profound differences in how our fellow citizens, how our communities, are living. As you wrote so eloquently, it calls “into question any notion of belonging to a community of fate.”
Is it any wonder that when those of us who care, who have studied, who know these realities, who work in the most prestigious systems designed to help prevent these tragedies, and who are therefore supposedly in positions of relative power, are, in reality, unable to make a difference . . . Is it any wonder that those we would hope to vote with us are losing faith that we can actually make their lives . . . Better? A profound moral and material question of our age.
It is both chronic and becoming more acute. However, nobody of influence and authority cares.
Your attention to this topic is appreciated, Adam, but medical research for all of women's health has been an intentionally back-burner non-priority for all my life (I'll be 70 Wednesday). The less equal research on women's health seems intentional, and you only hear about men's health issues around male reproduction, like the endless TV advertising for erectile dysfunction and meds therefor, along with really infuriating, endless ads for Peyronie's Disease (crooked dick) or Viagra, Cialis, and most recently BLUE CHEWS, where young attractive women exhibit excitement over these erectile dysfunction chews for their ostensibly older sex partners. Alternately, the nightmare experienced by Tennis star Sabrina Williams during her life threatening birthing experience has been lost to the ether. I wouldn't be exaggerating to say that women, the normal, open minded, dare I say more educated women, are spitting-furious about the diminished direction our place in society has taken, although we are the majority gender. I will be interested to see where you go with this topic. Thank you.
The data are stark, and not shocking given how life expectancy has eroded and income inequality has soared. I do recall the source the of the quote/observation but it goes along the line lines of “show me how a society treats its children and old who are most vulnerable, and that it tells all about that society.” That does not tell me good things about the US at all.
The trouble with the Western dualist worldview (democracy vs autocracy) is one becomes blind to one’s own shortcomings. Genocide only happens when Turks do it, not when Israelis do it.
My current unifying field theory of all things related to human behavior is the critical role of tribalism in Homo sapiens avoiding extinction. In Europe the population of any given country can feel part of the tribe for the nation state and therefore extend care and empathy for the population at large. In the U.S. we are a private equity firm made up of competing tribes. Hence, the reluctance to enact public policy that benefits the entire population. For the most part in the U.S. rich white people get pretty good medical care. As for the others, “Not my tribe.” I devote a significant part of my retirement swimming against this tide, but the waves keep crashing (See November 5th).
There are many shameful contributors to health disparities in the US and how it affects pregnancy. That being said, the maternal mortality piece can be more fully understood through the lens of the opioid crisis. One of the leading causes of maternal mortality in the US is opioid use and opioid overdose. https://www.ama-assn.org/press-center/press-releases/ama-report-overdose-crisis-pregnant-and-postpartum-people https://ldi.upenn.edu/our-work/research-updates/opioid-crisis-is-a-major-contributor-to-maternal-mortality/#:~:text=Drug%20overdose%20is%20a%20leading,1.5%20to%208.2%20per%201%2C000.
It is also notable that US and Canada both have significant disparities compared to other OECD nations with maternal mortality and they both of have higher incidence of opioid overdose deaths compared to other OECD nations. 2024 did see decreases in overdose deaths, probably largely due to a decrease in the potency of fentanyl in the illicit opioid supply, but our overdose deaths in the US are still higher than prepandemic levels. Would be interesting to see where the US stands once we take into account the opioid crisis. I suspect we will still be worse than other OECD, but not quite as disparate. Clearly there needs to be more focus on all the contributors to the opioid crisis, particularly among pregnant women.
Very well illustrated and also a good basis for questions that I can ask my lecturers. Thank you very much!
When a woman has "a maternal death related to mental health", what does that cash out to in practice? Should I imagine a woman gives birth and then kills herself? If that's the case then maybe underlying mental health issues are getting confused with maternity issues.
Thinking out loud: I wonder what the % is for women who experience post-natal depression, have previous mental health concerns/issues? And of those, who do harm themselves? I would hazard it’s a larger % who’ve never had previous issues, so it doesn’t get caught, and given the unequal access to healthcare in the US + latent attitudes towards women’s (mental) health is not treated properly even when identified.
I asked AI your question, 68.5% of women who get postpartum depression have a prior history of clinical depression. It seems intuitively like if someone has already rotten their brain with tiktok and covid lockdowns, then adding postpartum depression in addition to that is worse than if somebody with previously solid mental health is exposed to risk of postpartum depression. If that's right, then the wave of mental health issues can also make maternal health worse.
Here's the Q&A with AI : of women who experience postpartum depression, what percent have a prior mental health diagnosis
Approximately **68.5%** of women experiencing postpartum depressive symptoms at 9 to 10 months postpartum had a prior history of depression, according to a recent study analyzing postpartum mental health. This suggests that a significant majority of those with postpartum depression may have had previous mental health diagnoses, highlighting the importance of screening for prior mental health issues in pregnant and postpartum women[2].
Citations:
[1] What is the Risk of Postpartum Depression in Women with No ... https://womensmentalhealth.org/posts/risk-postpartum-depression-women-no-psychiatric-history/
[2] Timing of Postpartum Depressive Symptoms - CDC https://www.cdc.gov/pcd/issues/2023/23_0107.htm
[3] Major Depressive Disorder with Peripartum Onset | NAMI https://www.nami.org/about-mental-illness/mental-health-conditions/depression/major-depressive-disorder-with-peripartum-onset/
[4] Mapping global prevalence of depression among postpartum women - Translational Psychiatry https://www.nature.com/articles/s41398-021-01663-6
[5] Identifying Maternal Depression https://archive.cdc.gov/www_cdc_gov/reproductivehealth/vital-signs/identifying-maternal-depression/index.html
[6] Prevalence of postpartum depression and interventions utilized for its management https://pmc.ncbi.nlm.nih.gov/articles/PMC5941764/
[7] Family History of Psychiatric Disorders as a Risk Factor for Maternal ... https://pmc.ncbi.nlm.nih.gov/articles/PMC9386615/
[8] Perinatal Depression: Challenges and Opportunities https://pmc.ncbi.nlm.nih.gov/articles/PMC7891219/
I will be the first to admit that our healthcare system sucks. If you can afford it, great. If you can't, or in a job that doesn't provide insurance you are out of luck. That's said I'd like a little more data on the mortality rate. I suspect US women are much older than many other nationalities when giving birth. So wonder if that impacts the data ?
In general it it pretty unlikely to give birth after, say, 45. Giving birth is of course a very strenuous activity but it's also not one that elderly people generally do so its a little hard to imagine that age of the mother could be a factor in maternal mortality rates (though it can be for fetal and newborn fatality rates).
Yea, just wondering about the large number of women giving birth in mid / late 30's. And if that makes a difference on mortality. Thanks.
My mom was a social worker in the 1950-70 period in New York. At the time NY was a firmly liberal high social spending state. All good, but prenatal care and post natal support depend to a large extent on the mother's awareness and her commitment to having a healthy baby. There was plenty of medical and counseling support, but the mom to be had to be an active and willing participant
Of course qualities of planning and concerns for health are not necessarily compatible with being a teenager, having few opportunities, and frequently an unstable family structure in the first place.
60 years later the poverty factor still exists, often exacerbated by Racism, and "benign neglect" seems to be a acceptable policy.
We do a few things very well, for example integrating skilled immigrants into our way of life.
Others, not so fine, seem to be a part of our national character.
Scary crisis
So it seems spending so much on expensive if unnecesary care (think American teeth) leads to massive underspending on basic care even when total spend is some 18% of GDP (last time I looked) compared to 12% in Europe.
AND even less care is spent on filling out forms (or their design).
If you're just now arriving at the conclusion that those governing the US are at best indifferent to the health and well-being of its citizenry, then you just haven't been paying attention.
The overall life expectancy statistics for the US are absolutely shocking for the materially wealthiest country in recorded history, to say nothing of the scandalous gap in health and life expectancy outcomes across its income and wealth distributions.
My reading of the debate is that the original numbers understated maternal mortality. When the US moved to an internationally accepted definition, numbers rose. So the increase is illusory, but the level is right