One reason the US maternal overdose death rate is so high is because multiple states criminalize drug use during pregnancy. Almost no other nation does this because it both places pregnant people under a different legal category and is bad public health policy. There are so many cases of women asking for help for their addiction and then being arrested. This has led to many pregnant people avoiding help or even avoiding hospitals altogether because they are afraid of being arrested if they test positive for drugs.
I wrote my dissertation about the topic focusing on Alabama, which has become the worst state for this, but it happens throughout the country. It's getting worse because the Dobbs decision has made courts more likely to treat fetuses as legal children and thus to treat drug use the same as poisoning a child.
Pregnancy Justice is the main advocacy group that collects research on this and provides legal aid to people affected by these laws. I highly suggest checking them out for anyone who is interested in this topic.
I only focused on Alabama but I did find that arrests were concentrated among the Appalachian portion of the state. This is also broadly true in Tennessee so I've wondered if that's true in other parts of the nation.
The link below is Pregnancy Justice's report on national trends including North Carolina and West Virginia. Each had less than 5 cases. Pregnancy Justice has the most comprehensive dataset out there but it's still very much an undercount. Most states have fewer cases because it's only a couple of states that have consistently allowed these arrests (Alabama, Tennessee, and South Carolina being the states where the majority of these arrests occur).
Honestly, one of the biggest "findings" I had was that the data to try to study this is very limited including the maternal mortality data issues you noted in this series. I had a difficult time getting access to the maternal death files and found them to be in much worse shape than I'd expected. Even after Alabama started to use the check box (they were one of the last states to do so), use was sporadic. There were clear errors (pregnancy checked in cases where it was impossible for the decedent to be pregnant) and many cases were the descendent had died of maternal-related causes yet were not marked as pregnant.
Thanks for sharing that report and yes makes a lot of sense (unfortunately) that the data would be challenging to get and when it is available that it might be faulty. Your comment inspired me to look up some things about NAS in states that have punitive measures. I just posted a note about it you might be interested in
When it comes to the big picture this has been a very informative series of posts.
On the other hand, when it comes to making sense of the details, I'm bewildered, because there appear to be several different definitions of "maternal mortality" in use by several different agencies, researchers etc... And as I'm trying to follow along it's often very unclear which methodology or source is being cited for the various comparisons being made.
Anyways, it doesn't detract from the overall message, which was unique and interesting and new to me as well as tragic, of course. But I was struggling to get a deep sense of the meaning of each individual detail.
The way that the CDC measures maternal mortality is while pregnant, during birth, or 42 days after birth. As I mention in the first post, that way of measuring things is problematic for several reasons - the most important of which is that it doesn't count what happens after 42 days to 1 year (which is where another 1/3rd of deaths come from) and it doesn't include homicides.
So while the official measure is what I said above, some states and agencies have tried to expand it, which is what I recommend in the Path Forward
I did understand that much, which is what I took away as the big picture and the point I'll likely remember as time goes by. The trouble I was having was that throughout the article, various rates are cited, and I kept getting confused about which way of measuring was being used for each measurement.
Anyways, like I said, I think I got the major takeaways and that's the most important thing. I just wasn't able to easily dig deeper alongside my reading.
One reason the US maternal overdose death rate is so high is because multiple states criminalize drug use during pregnancy. Almost no other nation does this because it both places pregnant people under a different legal category and is bad public health policy. There are so many cases of women asking for help for their addiction and then being arrested. This has led to many pregnant people avoiding help or even avoiding hospitals altogether because they are afraid of being arrested if they test positive for drugs.
I wrote my dissertation about the topic focusing on Alabama, which has become the worst state for this, but it happens throughout the country. It's getting worse because the Dobbs decision has made courts more likely to treat fetuses as legal children and thus to treat drug use the same as poisoning a child.
Pregnancy Justice is the main advocacy group that collects research on this and provides legal aid to people affected by these laws. I highly suggest checking them out for anyone who is interested in this topic.
Definitely share any good stats from the dissertation! Do you have any good info on West Virginia or North Carolina on this front?
I only focused on Alabama but I did find that arrests were concentrated among the Appalachian portion of the state. This is also broadly true in Tennessee so I've wondered if that's true in other parts of the nation.
The link below is Pregnancy Justice's report on national trends including North Carolina and West Virginia. Each had less than 5 cases. Pregnancy Justice has the most comprehensive dataset out there but it's still very much an undercount. Most states have fewer cases because it's only a couple of states that have consistently allowed these arrests (Alabama, Tennessee, and South Carolina being the states where the majority of these arrests occur).
https://www.pregnancyjusticeus.org/resources/pregnancy-criminalization-from-2006-to-dobbs-roe-reversal/
Honestly, one of the biggest "findings" I had was that the data to try to study this is very limited including the maternal mortality data issues you noted in this series. I had a difficult time getting access to the maternal death files and found them to be in much worse shape than I'd expected. Even after Alabama started to use the check box (they were one of the last states to do so), use was sporadic. There were clear errors (pregnancy checked in cases where it was impossible for the decedent to be pregnant) and many cases were the descendent had died of maternal-related causes yet were not marked as pregnant.
Thanks for sharing that report and yes makes a lot of sense (unfortunately) that the data would be challenging to get and when it is available that it might be faulty. Your comment inspired me to look up some things about NAS in states that have punitive measures. I just posted a note about it you might be interested in
Great article based on statistics combined with logical reasoning.
Glad to hear it
When it comes to the big picture this has been a very informative series of posts.
On the other hand, when it comes to making sense of the details, I'm bewildered, because there appear to be several different definitions of "maternal mortality" in use by several different agencies, researchers etc... And as I'm trying to follow along it's often very unclear which methodology or source is being cited for the various comparisons being made.
Anyways, it doesn't detract from the overall message, which was unique and interesting and new to me as well as tragic, of course. But I was struggling to get a deep sense of the meaning of each individual detail.
The way that the CDC measures maternal mortality is while pregnant, during birth, or 42 days after birth. As I mention in the first post, that way of measuring things is problematic for several reasons - the most important of which is that it doesn't count what happens after 42 days to 1 year (which is where another 1/3rd of deaths come from) and it doesn't include homicides.
So while the official measure is what I said above, some states and agencies have tried to expand it, which is what I recommend in the Path Forward
Thanks,
I did understand that much, which is what I took away as the big picture and the point I'll likely remember as time goes by. The trouble I was having was that throughout the article, various rates are cited, and I kept getting confused about which way of measuring was being used for each measurement.
Anyways, like I said, I think I got the major takeaways and that's the most important thing. I just wasn't able to easily dig deeper alongside my reading.
Got it yes. I agree that going back and forth the way I did could get confusing so I appreciate the note.