Birth By the Numbers Fall, 2020 Is there a problem with U.S. - PowerPoint PPT Presentation

Birth By the Numbers Fall, 2020 Is there a problem with U.S. maternity care outcomes? Gene Declercq, PhD www.birthbythenumbers.org With initial support from: The Transforming Birth Fund BirthByTheNumbers.org

Total U.S. Births, 1990-2019* 4,316,233 4,400,000 4,200,000 4,000,000 3,800,000 Net Decrease 2007-2019 570,693 or 13.2% 3,745,540 3,600,000 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Source: Annual NCHS Reports on Births *2019 data is preliminary BirthByTheNumbers.org

U.S. Fertility Rates (per 1,000) by Race/Ethnicity, 1989-2018 110 All WNH 100 BNH Hisp 90 80 70 60 50 9 1 3 5 7 9 1 3 5 7 9 1 3 5 7 8 9 9 9 9 9 0 0 0 0 0 1 1 1 1 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 Fertility rates computed by relating total births, regardless of age of mother, to women 15-44 years. www.BirthByTheNumbers.org

Fears of a “Majority/Minority” of births are unfounded…for now Proportion of all U.S. Births, 1989-2019* 70% Non-Hispanic White 60% 50% 40% Hispanic 30% 20% Non-Hispanic Black 10% 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Source: Adapted from NCHS Annual Birth Reports www.BirthByTheNumbers.org *2019 data is preliminary

Prematurity(<37 weeks) and Low Birthweight (<2500 grams), U.S., 1981-2018 & 2019 13 Prematurity (LMP) 12 11 Prematurity (OE) 10 % 9 8 Low Birthweight 7 6 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 Year LMP – based on last menstrual period BirthByTheNumbers.org OE – based on obstetric estimate

Percent of all births at home, or in a birthing center, United States, 1990-2018 80% Increase 59,596 (1.57%) 2004-2018 1.6 46,956 1.4 35,587 (1.13%) Total home & (0.87%) 38,555 1.2 1.01% birth center 1 21,041 % 0.8 Home 0.55% 0.6 0.4 Birthing center 0.2 0 1990 1995 2000 2005 2010 2015 2016 2017 2018 Source: NCHS Annual Birth Reports BirthByTheNumbers.org

Is the U.S. really doing as badly as it seems in international comparisons? BirthByTheNumbers.org

Is the U.S. really doing that badly? How Do we Compare Outcomes? Neonatal Mortality Rate Infant Deaths in First 28 days X 1,000 ________________ Live Births BirthByTheNumbers.org

Outcomes: Comparative Neonatal Mortality Rates Rank Country Country Country 17 33 Andorra Cuba Bahrain 1 18 34 Belarus Czechia Canada 2 19 35 Cyprus Germany Croatia 3 20 36 Estonia Hungary Denmark 4 21 37 Finland Ireland France 5 22 38 Iceland Israel Greece 6 23 39 Japan Italy New Zealand 7 24 40 Luxembourg Latvia Poland 8 25 41 Norway Lithuania Romania 9 26 42 Republic of Korea Monaco Russian Federation 10 27 43 San Marino Montenegro Serbia 11 28 44 Singapore Netherlands Slovakia 12 29 45 Slovenia Portugal Switzerland 13 30 46 Australia Spain United Kingdom 14 47 United States 31 Austria Sweden 15 32 Source: WHO. World Health Statistics 2020 Belgium Antigua and Barbuda 16

Outcomes: Comparative Neonatal Mortality Rates Rank Country Country Country 17 33 Andorra Cuba Bahrain 1 18 34 Belarus Czechia Canada 2 19 35 Cyprus Germany Croatia 3 20 36 Estonia Hungary Denmark 4 21 37 Finland Ireland France 5 22 38 Iceland Israel Greece 6 23 39 Japan Italy New Zealand 7 24 40 Luxembourg Latvia Poland 8 25 41 Norway Lithuania Romania 9 26 42 Republic of Korea Monaco Russian Federation 10 27 43 San Marino Montenegro Serbia 11 28 44 Singapore Netherlands Slovakia 12 29 45 Slovenia Portugal Switzerland 13 30 46 Australia Spain United Kingdom 14 47 United States 31 Austria Sweden 15 32 Source: WHO. World Health Statistics 2020 Belgium Antigua and Barbuda 16

Outcomes Total Births in the six Country 2018-19* countries in red Births background in 2018-9* Andorra 539 were 12,957 or thousands Antigua & Barbuda 1,015 fewer than the 16,787 in Iceland 4,452 Hawaii in 2019 Luxembourg 6,230 San Marino 232 Monaco 489 TOTAL 12,957 * Country data represents the most recent single year available ranging from 2018-2019. BirthByTheNumbers.org

What’s a Fair Comparison with the US? In the most recent year available (2019): • Countries with at least 100,000 births • Countries with a total per capita GDP of at least $40,000 annually in US dollars. BirthByTheNumbers.org

Defining a Set of Countries to Compare with the U.S. 2018 2019 2018 Total Births GDP per capita % Births by 15 Comparison Countries (000) U.S. $ Cesarean (SOURCE: OECD, Health Data 2020) Australia 309 54,765 *33.9 Belgium 118 53,746 21.1 Canada 376 50,967 *27.7 Czech Republic 114 42,242 23.1 France 759 47,868 19.5 Germany 788 55,795 29.6 Israel 184 40,261 14.9 Italy 440 43,901 33.2 Japan 918 42,477 18.5 Korea 358 43,445 45.1 Netherlands 169 59,636 *15.7 Spain 371 41,903 24.5 Sweden 116 55,095 17.0 United Kingdom 731 48,226 28.5 *2017 United States 3,746 65,281 32.0 BirthByTheNumbers.org

IOM chose 16 peer countries. 13 are same as the one’s we’ve used. They use 4 countries (Denmark, Finland, Portugal, Switzerland) that have <100,000 births. We include Belgium, Czech Republic, and Israel BirthByTheNumbers.org

How is the U.S. doing relative to comparison countries? Neonatal Mortality Perinatal Mortality Rate Rate Infant Deaths in Fetal deaths + deaths in the first week First 27 days X 1,000 X 1,000 _______________ _____________ Live births + fetal Live deaths Births BirthByTheNumbers.org

Neonatal Mortality Rates (per 1,000 births) , 2018, Industrialized Countries with 100,000+ Births 3.8 United States 3.5 Canada 2.8 United Kingdom 2.7 France 2.5 Netherlands 2.4 Australia 2.3 Germany 2.2 Belgium# 2 Israel 2 Italy* 1.9 Spain 1.6 Czech Republic 1.6 Korea 1.3 Sweden *2017 #2016 0.9 Japan 0 0.5 1 1.5 2 2.5 3 3.5 4 Neonatal Mortality Rate BirthByTheNumbers.org Source: OECD Health Data 2019 and NCHS, Deaths Final Data for 2017 .

Neonatal Mortality Rates (per 1,000 births) , 2018, Industrialized Countries with 100,000+ Births 3.8 United States* 3.5 Canada 3.1 US White* 2.8 United Kingdom 2.7 France 2.5 Netherlands 2.4 Australia 2.3 Germany 2.2 Belgium# 2 Israel 2 Italy* 1.9 Spain 1.6 Czech Republic 1.6 Korea 1.3 Sweden *2017 #2016 0.9 Japan 0 0.5 1 1.5 2 2.5 3 3.5 4 Neonatal Mortality Rate BirthByTheNumbers.org Source: OECD Health Data 2019 and NCHS, Deaths Final Data for 2017 .

Perinatal Mortality Rates (per 1,000 births), 2018, Industrialized Countries 100,000+ Births France# 10.6 Australia 7.6 United Kingdom 6.2 Belgium* 6.0 United States 5.9 Canada 5.8 Germany 5.6 Israel 5.2 Netherlands 4.9 Sweden 4.7 Spain# 4.4 Italy# 4.1 Czech Republic 3.4 #2017; *2016 Korea 2.8 Japan* 2.2 0 2 4 6 8 10 12 Source: OECD Health Data 2020 BirthByTheNumbers.org

Perinatal Mortality Rates (per 1,000 births), 2018, Industrialized Countries 100,000+ Births France# 10.6 Australia 7.6 United Kingdom 6.2 Belgium* 6.0 United States 5.9 Canada 5.8 Germany 5.6 Israel 5.2 U.S. White* 5.0 Netherlands 4.9 Sweden 4.7 Spain# 4.4 Italy# 4.1 Czech Republic #2017; *2016 3.4 Korea 2.8 Japan* 2.2 0 2 4 6 8 10 12 Source: OECD Health Data 2020 BirthByTheNumbers.org

Maternal Mortality Ratios Maternal Mortality Ratio Maternal Deaths* all causes X 100,000 _______________ Live births * Deaths in pregnancy and up to 42 days postpartum BirthByTheNumbers.org

Maternal Mortality Ratios (per 100,000 births), 2017-18 Poland Norway Countries in Italy Belarus United Arab Emirates Israel Greece green have fewer Finland Czech Republic Sweden Spain Iceland than 100,000 Denmar k Switzerland Slovakia Netherlands Luxembourg Lithuania births. Japan Ireland Belgium Austria Montenegro Let’s do a more Malta Cyprus Australia United Kingdom Turkmenistan reasonable Slovenia Macedonia Germany Singapore Portugal comparison France Croatia Qatar New Zealand Estonia Kazakhstan Canada Bulgar ia Bosnia and Herzegovina South Korea Serbia Kuwait Hungary Chile Bahrain Albania Iran United States 0 2 4 6 8 10 12 14 16 18 Source: WHO. Trends In Maternal Mortality, 2000-2017 . (Geneva, 2019) www.birthbythenumbers.org

U.S. MMR ( per 100,000 births ) Compared to Countries with 300,000+ births, 2018 Spain 1.9 Germany 3.2 Italy* 3.5 Japan 3.6 Australia 4.8 * 2017 U.K.* 6.5 France# 8 Canada 8.6 Korea 11.3 U.S. 17.4 0 2 4 6 8 10 12 14 16 18 20 Source: OECD Database 2020. # France from WHO. Trends In Maternal Mortality, 2000-2017 & U.S. U.S. Hoyert DL etal. National Vital Statistics Reports; vol 69 no 2. Hyattsville, MD: NCHS. 1/30/2020. www.birthbythenumbers.org