Graph of the Day: Maternal Mortality

Source: National Center for Health Statistics, by way of The Virginia Mercury

by James A. Bacon

When writing about “systemic racism” in health care, journalists routinely cite the disparity in health outcomes between White and Black Women. Here in Virginia, the maternal death rate per 100,000 for Black women in 2018 was 37.3 — nearly twice the rate of 14.9 for White women. The disparity has grown even wider since then. That disparity often is presumed, without the need for further proof, to reflect racism.

But could there be other explanations? Virginia health officials will be working over the next two years to understand the disparity by digging into the details of individual cases to get a clearer idea of the factors that might have contributed to the deaths, reports the Virginia Mercury.

Among other factors the team will examine is “noncompliance with appointment.” Is it possible that women who died from pregnancy- or birth-related issues were more likely to have missed their prenatal medical appointments? Could some mothers, for instance, have had difficulty accessing transportation to the doctor’s office or been unable to break free from their jobs? (Or could they have just forgotten about their meetings or otherwise blown them off?)

I’ve never heard this mentioned as a possible factor before. Depending on the findings, the inquiry could change the complexion of the debate. Difficulty in finding transportation is a very different problem than, say, physician racial bias.

The graph above raises other interesting questions. For instance, if systemic racism is the issue, how is it that Hispanic women have a lower incidence of maternal mortality than White women? Is health care systemically racist toward African-Americans but not Hispanics? And what about Asians? Why aren’t they included here? Would the graph show that they have the lowest rate of maternal mortality of all?

Another question: Why did COVID drive up the mortality rate so dramatically for Black women, significantly but less so for Hispanic women, and barely at all for White women? Is mis-trust of the healthcare system a factor? Did closing hospitals to discretionary procedures during the COVID-19 pandemic result in pregnant women skipping their prenatal consultations? There’s a lot to unpack here.

An aside about Bon Secours… If anyone seriously wants to pursue the “systemically racist” angle, they should consider the revelation, reported by The New York Times and followed up by The Virginian-Pilot and Richmond Times-Dispatch in the past day or two, about how Bon Secours Mercy Health under-invests in its Richmond Community Hospital located in the impoverished, predominantly Black East End, even though it is the most profitable hospital in its system. It turns out that Bon Secours exploits the 340B program, which requires pharmaceutical companies to give discounts to hospitals serving low-income populations in the expectation that they will reinvest in those communities. Bon Secours uses Community Hospital essentially as a shell to generate the discounts for pharmaceuticals used in suburban hospitals, charging its suburban customers the full freight, and pocketing the difference.

Instead of applying the profits toward upgrading Community Hospital, critics charge, Bon Secours has plowed the money into its more lucrative suburban operations. The company recites a list of investments it has made in the hospital and community, but it strikes me as thin gruel.

Not surprisingly, this case stems from an ill-designed government program — a boondoggle, if you will. These are the kinds of tangible matters we should be looking into rather than chasing phantasms in the statistics.

The Department of Health initiative is exactly what we need. Hopefully, this investigation will identify the tangible causes of the disparity in maternal outcomes and develop recommendations that will actually improve (or save) women’s lives in a way that is not possible by issuing unfalsifiable charges of racism.

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57 responses to “Graph of the Day: Maternal Mortality”

  1. walter smith Avatar
    walter smith

    Wow. The entire medical system is whack-a-mole. They hide costs in so many places because there is no transparency and so many market disruptions in pricing, and now, unfortunately, in delivery (CDC and licensing tyranny). You hit one piece and it goes to hide under another.
    Meanwhile, as to Covid and Covid policies, gee, the rates rose for every group. Is it possible the Covid policies were failures?

    Sorry, had to pick myself up from ROTFLMFAO…

    And finally for the racist anti-racists who suggest everything is racist – no – insist everything is racist in their Godless religion – human agency matters.
    Don’t get fat. Walk. Walk a lot. Get sun. etc…

  2. Eric the half a troll Avatar
    Eric the half a troll

    “Is trust vs. mis-trust of the healthcare system a factor?”

    No, I doubt that Conservatives are actually directly (if partially) to blame for increased maternal morality….

    1. DJRippert Avatar

      While I almost always disagree with your comments I usually understand those comments. Not this time. Care to elaborate?

      1. Eric the half a troll Avatar
        Eric the half a troll

        JAB first asked “Why did COVID drive up the mortality rate…?” and threw out the idea that possibly it was due to an increase in “mis-trust of the healthcare system” during the pandemic. I am simply pointing out that the Conservative campaign throughout the pandemic was to sow and cultivate doubt and mistrust in our healthcare system. If there actually was a resultant increase in maternal mortality, that would be where the blame would lie.

        You should read sarcasm in my original post, btw…

        1. DJRippert Avatar

          So, apparently – Black women are listening to the Conservative messaging while Hispanic and White women are not?

          Given the recent march by armed Black protesters demanding 2nd amendment rights and closed birders in Austin, TX you may be right about Black Americans starting to listen to Conservative messaging.

          I read sarcasm in almost all of your posts. I just try to understand them.

          1. Eric the half a troll Avatar
            Eric the half a troll

            Black women may very well be more susceptible to the EFFECTS of losing trust in our healthcare system (i.e., listening to Conservatives) than others. Why may be a very good question…

        2. The mistrust many blacks have in our healthcare system is longstanding and has nothing to do with Covid – or conservatives.

          1. Eric the half a troll Avatar
            Eric the half a troll

            You mean today’s Conservatives, I presume…?

          2. I’m not sure what you’re driving at. “Progressive” doctors came up with the idea for the federally funded Tuskegee experiment, and democrats controlled the house, senate and presidency throughout the majority of the time during which that abomination was going on. They were also responsible for another unethical VD study in Guatemala. In Guatemala they actually intentionally infected unsuspecting patients with venereal diseases and then failed to treat them instead of ‘merely’ failing to treat people with an existing condition.

          3. James McCarthy Avatar
            James McCarthy

            Publicly available info indicates some 400 Black men were infected at Tuskegee. Over 5,000 were sterilized under VA’s eugenics program, some 3,000 females and 2,000 males.

          4. Virginia’s sterilization and lobotomy programs were equal opportunity operations. They’d do anyone who fell into the clutches of our mental “health” system, and that happened to black and white alike.

          5. James McCarthy Avatar
            James McCarthy

            It must be assumed then that the Racial Integrity Act also adopted in 1924 was a mere coincidence. It is true that sterilizations were predominantly upon institutionalized individuals deemed to suffer from hereditary disabilities.

          6. Once again you comment on things you know little about yet you freely ascribe causality.

            I was working in programs that received people discharged from Virginia’s state mental facilities when court ordered deinstitutionalization happened in the ’70s-’80s.

            Almost all the women, and some men, had “appendectomies”. Many men had curious dents in their foreheads where they had been operated on to cure “headaches”, and some women had them too. They were both black and white with the majority white.

            For many years it was easy to be committed in Virginia. In addition to publicly initiated commitments husbands could commit wives and parents their children. “hereditary disabilities” were just some of the reasons people went to the loony bin. Once there you were fair game for the scalpel and drill. It was not one of Virginia’s better eras.

            The court case that got deinstitutionalization rolling was in New York. Y’all were not above reproach either.

          7. Eric the half a troll Avatar
            Eric the half a troll

            Taliaferro Clark was a southern white man … hardly progressive.

          8. And he studied eugenics (a “progressive science”) at UVA.

            Do you care to argue that Dr. Thomas Parran, Dr, John Heller and Dr. Raymond Vonderlehr were “hardly progressive”?

            By the way, how do you know Dr. Clark was “hardly progressive” just because he was a “southern white man”?

          9. Eric the half a troll Avatar
            Eric the half a troll

            They were all southern white men and therefore were conservatives and hardly progressive as we understand it. Even by Progressive Era definition, most Progressives were northern or mid-westerners – actually by Tuskegee, the Progressive Movement was about over. UVa was hardly a liberal hotbed in those days… Democratic, yes, but not liberal.

          10. They were all southern white men and therefore were conservatives and hardly progressive as we understand it.

            So now you can read the minds of dead people?

    2. Nancy Naive Avatar
      Nancy Naive

      Any disparity in any outcomes, e.g., health, education, income, seen in any data collected is the result of any combination of the following; Democrat lies, wokieness, bad data collection, bad modeling, bad displays, refusal to worship Trump, Jefferson, and/or Stonewall Jackson.

      1. Eric the half a troll Avatar
        Eric the half a troll

        You forgot Marxism…

        1. Nancy Naive Avatar
          Nancy Naive

          Any number of Redd Foxx routines will tell you the difference between white medicine, black medicine, men’s medicine and women’s medicine.

          You’ll have to find them on your own because if I link one and JAB follows it, there will be lilly-white brain tissue everywhere.

          1. James McCarthy Avatar
            James McCarthy

            Or a Bacon cartoon.

      2. At least they have more than one answer.

        “Progressives” have only systemic racism to work with…

        1. James McCarthy Avatar
          James McCarthy

          Nah!!! There is socialized medicine; Marxism; bleeding heartism; liberalism; presentism; snowflakery, among a few.

      3. At least they have more than one answer.

        “Progressives” have only systemic racism to work with…

  3. DJRippert Avatar

    The US Medical-Industrial Complex is a hulking fiasco. Like higher education, there is little transparency as to what is happening in health care.

  4. DJRippert Avatar

    I would think that the age of the mother would have to be accounted for.

    1. Nancy Naive Avatar
      Nancy Naive

      And number of previous pregnancies, etc., etc.

  5. DJRippert Avatar

    “Not all of those deaths are necessarily due to a problem with pregnancy, since the review team looks at every death that occurs within 365 days of pregnancy.”

    Hmmm ….

    1. Nancy Naive Avatar
      Nancy Naive

      It’s a cutoff. Doesn’t mean the death wasn’t caused by something else and attributed to pregnancy. It does mean that if an injury/situation results from a pregnancy and the woman dies 367 days later then it might not be counted.

  6. Nancy Naive Avatar
    Nancy Naive

    Just in case anyone is wondering why Republicans are pushing the “Christian Nation” declaration, it’s so they can toss any regilious freedom exceptions but their own.

  7. Eric the half a troll Avatar
    Eric the half a troll

    A couple points:

    This is your characterization (straw man)>>> “Such a disparity is presumed, without further investigation, to reflect racism.”

    I noted that there is a significant difference between US maternal mortality rates and those in developed countries with universal government-run healthcare systems. May be a related issue…. may be not…

    In the UK, they also see in increase in maternal mortality rates for black mothers vs. white (4-fold) but also asian (2-fold). They also see a 3-fold discrepancy between the poor and affluent regardless of race. They see an increase risk to those with “multiple disadvantages” and cite such complications as mental illness and domestic abuse as being potential factors. I will note that they use the term “systemic biases” rather than “systemic racism”. I have no issue with that phrase if it would make you guys feel better….

    Finally, it looks like those states that have new bans on abortion also have much higher maternal mortality rates (something like 25 vs 15 per 100,000). I would suspect those numbers will climb.

    1. DJRippert Avatar

      The “linked to” article in Jim’s post had a “linked to” article. The second link pointed at this:

    2. walter smith Avatar
      walter smith

      Thanks for the display of confirmation bias Troll.
      “They’re all gonna die cause they can’t kill their babies!!!!!”
      Maybe poverty is a factor. Maybe race is. Maybe health choices. Maybe quality of medical care. Lots of variables.

      I’ll do this just to trigger you and Larry – the single best factor for improving that statistic will be to discourage illegitimacy. Babies only out of marriage and a two parent family. Less poverty. Less dropouts. Less incarceration. Works for all “races”

    3. Pregnancy is a health risk factor. Unquestionably it kills some women. Fewer women who are not pregnant die than those who are. Historically black women have had a majority of abortions. Therefore, restrictions on abortion will cause more black women to die than white. An abortion will improve the health prospects of any woman.

      The Brit finding that there is a 3 fold change in deaths due to income is significant. The interesting graph to see would be rates filtered by income then race. If that flattens out the differences, as it seems it might, it is a simple answer to the question of why there are differences.

      In addition to putting emphasis on the question of how to improve health care for poor people, it could also get us back into questions of historical racism, the accumulation of wealth and a host of other woke issues.

      1. Nancy Naive Avatar
        Nancy Naive

        “First paragraph” — hence the need for the State to stay out of women’s healthcare decisions ENTIRELY.

        1. DJRippert Avatar

          Fundamentally, you must believe that life begins at birth. That’s the only way you can consider an unborn child as a “woman’s healthcare decision” with the state having no reason to intervene on behalf of the unborn child. Do you support partial birth abortions?

          1. Nancy Naive Avatar
            Nancy Naive

            Yes, my religion holds that life begins at birth. In addition, I believe that women will not frivolously fritter away the potential life she has carried 20+ weeks e.

          2. James McCarthy Avatar
            James McCarthy

            “Unborn child” is a non-term if one does not believe life begins at conception. Whether life begins at conception is more a religious view than scientific one. A woman’s health care decision may include her own health and that of a dead fetus or ectopic pregnancy during the course of a pregnancy.

          3. Matt Adams Avatar

            “James McCarthy DJRippert • 16 minutes ago
            “Unborn child” is a non-term if one does not believe life begins at birth. Whether life begins at birth is more a religious view than scientific one. A woman’s health care decision may include her own health and that of a dead fetus or ectopic pregnancy.”

            I think you need to revisit your comment, because I think you’re going to be hard pressed to find anyone that doesn’t believe life begins at birth. I assume you mean conception, which is a religious argument, but that’s not what you typed.

          4. James McCarthy Avatar
            James McCarthy

            Ouch!!! A momentary lapse of cognition. Indeed, I was referring to conception not birth. An unborn child can, in fact, be a health care decision for a woman as circumstances dictate. Thanx. Edited as criticized.

          5. Matt Adams Avatar

            Understood, I just wanted to make sure you said what you meant.

            I agree, while I caveat my concurrence with specific carve outs beyond viability. It’s their body, they should do as they please as long as they cover the costs.

          6. James McCarthy Avatar
            James McCarthy

            Covering costs for some is an impossibility. A few recent news reports indicated multi-thousands of dollars of medical bills unsuccessfully to save the life of newborns. Covering the costs for abortions for low income women involves similar issues. I do not believe life saving measure or abortion yield to cost-benefit analysis. That apparently was an ingredient in the Bon Secours flap.

          7. Matt Adams Avatar

            I would presume that for those could not cover the costs their could be measures in place to ease their financial burden, especially in the case of an unintended loss.

            NICU care is very costly, that is for certain.

          8. James McCarthy Avatar
            James McCarthy

            Despite such measures and fed/state laws and regs requiring charity care, not for profit hospitals, secular and religious, have been found to refer such patients to collection agencies. By doing so, they are paid pittance on the dollar and sometimes a share of recovery. On tax returns, such losses are deducted from net income to improve the balance sheet and support fund raising efforts.

          9. Matt Adams Avatar

            Alas, the results of big Insurance who don’t really provide much to anyone except a monthly bill.

            The Hospital Administrations see their return is guaranteed, so they keep raising the prices while the employees doing the work don’t see a dime.

          10. James McCarthy Avatar
            James McCarthy

            The hospital monoliths cooperate with insurers. It’s the premium payers and charity cases that suffer. Donors are suckered by rigged balance sheets while hospital execs earn hefty salaries for financial decision making.

          11. Matt Adams Avatar

            Employee’s suffer as well.

        2. “the need for the State to stay out of women’s healthcare decisions ENTIRELY.”

          Precisely. That was also Doug Wilder’s position as Gov. He observed at the time it was a conservative position too.

  8. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    It is too bad that the Bon Secours scandal is being overshadowed by the discussion on maternal mortality. Richmond Community produces the highest profits of any hospital in the state–about $100 million a year. Yet, Richmond Community is the stepchild of the Bon Secours system. Bon Secours closed the ICU at Richmond Community. Lung specialists, cardiologists, and other specialists left. Its MRI machine breaks often and was out of service for several weeks this summer.

    A patient came in showing signs of septic shock. He needed to be put in the ICU, but Richmond Community had no ICU. It took several hours to transport him to another hospital. Why would it take several hours to get this patient either to MCV or to St. Mary’s, another hospital in the Bon Secours system? Those two facilities are no more than 30 minutes from Richmond Community. On the way to the other hospital, he deteriorated and later died of sepsis. There are other similar stories.

    Compare Richmond Community to St. Francis, the Bon Secours hospital in western Chesterfield County. St. Francis is truly impressive. Walking through the front entrance doors, you could easily imagine yourself in the lobby of a high-end hotel. There is no doubt that a patient coming there presenting symptoms of septic shock would get immediate treatment and would not have to wait hours to be transported to another hospital.

    Richmond Community is the cash cow for the Richmond Bon Secours system. But, the revenues are used for other Bon Secours facilities in the suburbs. Almost ten years ago, Bon Secours promised to build a medical office building next to Richmond Community. It did not break ground until early this year on the project and, even then, only after criticism from one of the city’s major private businessmen over the delay.

    In its defense, a Bon Secours spokesman pointed out that Bon Secours had spent nearly $10 million on improvements at Richmond Community since 2013. Of course, less than a year ago, Bon Secours began a $108 million expansion of St. Francis and recently broke ground on a free-standing emergency room affiliated with St. Francis.

    Of course, the disparate treatment of Richmond Community, compared to other hospitals in the Bon Secours network, has nothing to do with the fact that Richmond Community is located in Richmond’s East End, home of the city’s largest Black population and a lot of its patients come from the housing projects, while St. Francis, St. Mary’s, and other Bon Secours facilities are largely located in the white suburbs.

    The New York Times article is damning.

    1. I agree, the NY Times article is damning (as was the article I published on Bacon’s Rebellion a year ago questioning the hyper-profits and under-investment at Richmond Community). But we do have to be careful.

      For example, as you point out, Bon Secours recently broke ground on a $108 million expansion of St. Francis Hospital in Chesterfield County. That expansion might have been financially justifiable on its own terms, regardless of what Bon Secours was doing with the Richmond Community profits. We don’t know.

      The fact is, we don’t know what Bon Secours has done with the Richmond Community profits. Perhaps, one could argue, it used the money to purchase failing hospitals in Virginia’s low-income, Black-majority rural hinterlands. We don’t know.

      What we do know is that Bon Secours has not plowed the Richmond Community-generated profits back into the East End of Richmond.

      The company has not been open and transparent about what it’s doing. And given its nonprofit status, the community has a right to know more.

      1. James McCarthy Avatar
        James McCarthy

        Drawing inferences from limited data/info has not caused a pause in Moderator commentary in other discussions.

    2. Nancy Naive Avatar
      Nancy Naive

      The profitable nonprofit. Catholic hospital, too. So, not all procedures may be available.


      Our Mission extends the compassionate ministry of Jesus by improving the health and well-being of our communities and brings good help to those in need, especially people who are poor, dying and underserved.

      They seem to have forgotten that little dust-up at the temple.

  9. Bob X from Texas Avatar
    Bob X from Texas

    When everything is RACIST, nothing is really racist.

  10. Nancy Naive Avatar
    Nancy Naive

    Now here is something fascinating. A digital prenancy test. I know how sensitive BR’ers are to E-waste, e.g., solar panels. I wondered if it’s one use and in the trash it goes. I went looking and found this…

    “We are aware of videos circulating about Clearblue pregnancy tests and the tablet found inside.
    Clearblue pregnancy tests do NOT contain Plan B.
    All our tests contain a small desiccant tablet which is included to absorb moisture and should not be eaten.
    If accidentally ingested please seek medical advice and for any further questions contact our careline at 1-800-321-3279.”


      1. how_it_works Avatar

        8-bit, 64 bytes of RAM. It’s a typical $1 microcontroller.

  11. African American pregnant women get free doulas. The idea is that doulas increase the chances of safe outcomes so I understand where that is coming from. But I would argue that that’s very racist. Doula services costs range from about $800-1500. The program offers doula services based on race, not on income. I find that offensive.

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