MMR Drops in Iran, Rises in US

Only a few countries including Iran, Vietnam, Russia and Romania have managed to reduce maternal mortality rate (MMR) efficiently over the past few years, according to new data released recently by the Institute of Health Metrics and Evaluation, a research group funded by the Gates Foundation and based at the University of Washington.

One of the biggest worldwide public health triumphs in recent years has been maternal mortality. Global death rates fell by more than a third from 2000 to 2015.

The United States, however, is one of the few countries in the world that have gone against the grain, new data show. Its maternal mortality rate has risen despite improvements in healthcare and an overwhelming global trend in the other direction, nytimes.com reported.

There were 28 maternal deaths — defined as deaths due to complications from pregnancy or childbirth — per 100,000 births in the US in 2013, up from 23 in 2005, the institute found. The rate in 2013, the most recent year for which the institute had detailed data for the US, was more than triple Canada’s. The institute is projecting that the American rate dipped in the last two years to 25 by 2015.

Increases were extremely rare among rich countries. In all, 24 countries had one from 2000 to 2015, including South Sudan and the Democratic Republic of Congo, though their rates were much higher. America’s increase put it above a number of poorer countries whose rates had declined with the global trend, including Iran, Vietnam, Russia and Romania.

In all, the American rate was up by more than half since 1990, according to the institute, which uses many data sources, including countries’ vital records systems, to calculate hundreds of health measures, reports nytimes.com.

Most people imagine maternal mortality as 19th-century-style deaths such as hemorrhage in childbirth or death from eclampsia, a condition involving high blood pressure. Those types of deaths still happen, but their rate has not changed much.

Instead, the increase in recent years has been driven by heart problems and other chronic medical conditions, like diabetes, which has increased sharply in the population. Researchers have theorized that an increase in obesity — particularly acute among poor black women, who have much higher rates of maternal mortality than whites — may be contributing to the problem.

Maternal deaths are notoriously hard to count. There is often not enough detail on a death certificate to tell if the death was related to pregnancy.

The trend has puzzled researchers and prompted a number of states to start maternal death review boards, groups of experts who sift through the deaths and consider policy changes that might reduce them. Such boards, used in Australia, Britain and a number of other European countries, are considered crucial in understanding, and potentially reversing, the trend. But only about half the states have them.