America’s maternal health is the worst in the developed world, and Texas is often cited as the symbol of the problem: With a reported 32.5 maternal deaths per 100,000 live births, its situation was long believed to be the worst in the country. When a much-cited paper published in 2016 in the journal Obstetrics and Gynecology noted that maternal mortality in Texas had seen a dramatic increase—40% more—between 2010 and 2012, America woke up to the urgency of addressing the maternal health crisis.
Since 2016, awareness about the scourge of maternal mortality has grown exponentially, with media (Quartz included), health officials, and the medical community trying to solve the puzzle of how the most expensive maternal care system in the world could lead to such poor results.
However, a new study raises significant questions on the magnitude of the problem. In an update published on Apr. 9, the Texas Department of State Health Services (DSHS) has significantly revised the previously circulated data referring to 2012, pinning the actual number of maternal deaths at about a third of what was believed.
However, according to the update just published, only 56 of the reported 147 cases of maternal deaths that occurred in Texas in 2012 were accurate—the remaining 91 were misreported.
“Dozens of women were identified on their death certificates as being pregnant at the time of their deaths, when they were not,” writes the DSHS.
Currently, the record of maternal deaths is kept by registering the cause of death listed in the death certificate, which have recently adopted a checklist indicating whether the woman was pregnant at the time of death. The DSHS explains that “most likely occurred because people certifying the deaths selected the wrong pregnancy option in the electronic system used to register deaths,” which means that one (or rather, several dozens) checking mistakes led to a completely skewed understanding of the health of mothers in Texas.
The mistakes were found by cross checking the data, and it not only led to finding numerous false positives, but also a few false negatives—women who died while pregnant or postpartum who had not been recorded.
While it is a relief to know that the number of maternal deaths was much lower than believed, this is an occasion for concern, too. Consistently with the general poor health of maternal data, the very fact that such a massive mistake could be made in data collection, and that the health community could operate for years without disproving it, shows the low priority that has long been given to maternal health—in Texas as well as other states—as it does the cluelessness surrounding maternal deaths.
The same review panel who corrected the 2012 data will now look back at earlier data, eventually delivering a more accurate picture of the situation of maternal mortality in Texas through the years. As things are, then, the state has lost its record of having the highest mortality—but this raises the fair suspicion that other states may be operating with similarly defective data, and how much of the research conducted so far will eventually have to be discarded, or severely revised, once better attention is finally paid to collecting accurate details on maternal deaths.