Maternal Mortality, Boosting Birth Rates, "Civil War," and More
Plus: What I'm Reading...
Whatever Happened to America’s “Maternal Mortality Crisis”?
Last year, the CDC issued an alarming report showing that the US rate of maternal mortality had risen by an incredible 89% between 2018 and 2021: from 17.4 to 32.9 per 100,000 over just three years. What’s going on? Could it be that 2021 was just a terrible outlier? Apparently not, because when CDC looked at the longer-term trend, the rate had more than doubled over the last twenty years: from 9.65 in 1999-2002 to 23.9 in 2018-2021. Maternal mortality, by the way, is the death of a woman due to her pregnancy—that is, “while pregnant or within one year of the end of pregnancy from any cause related to or aggravated by the pregnancy.”
These findings gave rise to scary media headlines. The WP: “America Has a Maternal Mortality Crisis. Biden Push Aims to Change That.” And the NYT: “What We See in the Shameful Trends on U.S. Maternal Health.” The AMA issued an “alarming” press release as well, and suggested in a follow-up press release that the growing peril of giving birth in America constituted one more reason to protect the relatively safer option of abortion.
Now comes a study by twelve health scholars in the American Journal of Obstetrics & Gynecology showing that this entire rise is illusory. The perceived rise, they conclude, originated in a new “pregnancy checkbox” that the CDC added to the death certificate in 2003. Some coroners checked this box, while others didn’t—causing confusion about whether pregnancy in fact caused the death and in any case creating a discontinuity in the data over time. The scholars retabulated all the data using only the prior method (that is, ignoring the check box) and found almost no growth in the death rate. The recalculated rate turns out to be 10.2 in 1999-2002 and 10.4 in 2018-2021. See this excellent Rutgers summary of the research as well as this longer account in Science about the controversy—and the counterblast by the CDC—that it unleashed.
Not all the news in this study is good. While the researchers find that deaths directly related to labor and pregnancy have fallen over time (pointing to improvements in medical treatment), they also find that this decline was canceled out by a rise in deaths related to pre-existing conditions like hypertension and diabetes (pointing to less healthy lifestyle behaviors). The researchers show that the death rate for Blacks has fallen over the last twenty years. But they also show that it remains much higher than for Whites or Hispanics (23.8 versus 8.22 or 7.46, respectively).
Nor, it must be added, does the US maternal mortality rate compare favorably with most other high-income countries. We may be doing a bit better than Portugal (12) and Canada (11). But take a look, for example, at maternal deaths per 100,000 capita in France (8), South Korea (8), Italy (5), Japan (4), Australia (3), or Norway (2). In maternal mortality, as in so many other health performance indicators, America achieves mediocrity—if you squint your eyes.
Colorectal Cancer Rising Among Millennials
As a general proposition, age is not good for your health: As people grow older, their incidence rate and mortality rate for most diseases—including cancer—rises along an exponential arc. Over time, we westerners have come to expect that improvements in lifestyle, public health, and medical treatment will steadily bring that arc down proportionally for all age groups.
Well, something novel has happened over the last couple of decades: Those rates of disease and death are still declining for the elderly, but they have reversed direction and are beginning to rise for the under-65 set, and especially for the under-50 set. Why is US life expectancy lower today than it was back in 2014? Not due to higher mortality among the elderly—they’re still getting healthier—but rather due to higher mortality among the nonelderly. I have written variations on this theme many times: See “Adults Under Age 65 Driving Decline in US Life Expectancy,” “Breast Cancer Mortality Rates are Rising Among Women Under 40,” “Millennials at Higher Risk for Obesity-Related Cancers,” “Strokes Rising Among the Young,” “Millennials’ Worsening Health Indicators,” and so on.
Now add this to the list: The trend, highlighted by the American Cancer Society’s “Cancer Statistics, 2024” report (see NYT summary here), toward steadily higher incidence rates and mortality rates for colorectal cancer among young adults. Specifically, Millennials born around 1990 have twice the risk of colon cancer (and four times the risk of rectal cancer) as Boomers born in the 1950s had at the same age. Back in 2019, we reported on a JAMA study of Canadians that pointed out rising colorectal cancer incidence among young adults. Now we have a lot more data, and more recent data, on US residents. In 2021, in response to this rising incidence, the US Preventive Services Task Force recommended screening for colorectal cancer starting at age 45 rather than 50.
What’s driving this trend? Most health experts point to the same shifts suspected to be driving other adverse Millennial health trends: more obesity, diabetes, and untreated hypertension; more stress; less exercise and less sleep. And specifically for colorectal cancer, we can also point to adverse changes in diet: more red meat, more ultra-processed foods, and more sugary drinks. Some experts suspect rising reliance on NSAID painkillers (like Ibuprofen) and proton-pump inhibitors for treating heartburn (like Omeprazole). “Forever chemicals” in the environment (like PFAS) have also been implicated. No one is certain.
What Works Better to Boost Birth Rates: Policy or Culture?
Here is another incisive and elegantly illustrated story by John Burn-Murdoch in the Financial Times. His thesis is two-fold. Number one: Expensive pronatalist policies that attempt to bribe people into having kids (cash payouts, tax subsidies, free childcare, and so on) don’t work very well. This is hardly news to most demographers. But his graphic speaks a thousand words.
