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Methodological Issues in Maternal Mortality Research

Marian MacDorman seeks to develop new instruments to analyze U.S. maternal mortality rates

Maternal mortality is a sentinel public health indicator, and a catastrophic event for children and families. The National Center for Health Statistics (NCHS) is the official source of United States’ data on maternal mortality. To address previous underreporting of maternal deaths, NCHS added a pregnancy question to the 2003 revision of the U.S. standard death certificate. The question has been successful in improving the ascertainment of maternal deaths. However, there have been delays in states adopting the pregnancy question, which have made it difficult to determine the extent to which observed increases in U.S. maternal mortality rates are due to improved ascertainment, versus real increases in maternal mortality risk. Due to this problem, the United States has not published an official U.S. maternal mortality rate since 2007.

Dr. MacDorman's project will yield at least three papers. The first paper will develop, test, and evaluate methods for trend analysis of these data, while taking into account changes in data collection instruments; the second paper will use the methods developed in paper number one to analyze maternal mortality trends for detailed race and ethnic groups. Previous studies have identified maternal mortality as having some of the widest race and ethnic disparities found in health care, so identifying ways of narrowing these disparities is a public health priority; the third paper will analyze maternal mortality data by detailed causes of death, with a view towards identifying deaths from preventable causes.

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