Birth By the Numbers Fall, 2019 Is there a problem with U.S. - PowerPoint PPT Presentation

Updating the Original Birth By the Numbers Fall, 2019 Is there a problem with U.S. maternity care outcomes? Gene Declercq, PhD www.birthbythenumbers.org BirthByTheNumbers.org With initial support from: The Transforming Birth Fund

Total U.S. Births, 1990-2018 4,400,000 4,316,233 4,200,000 4,000,000 3,800,000 Net Decrease 2007-2018 3,788,235 527,998 or 12.2% 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 Source: Annual NCHS Reports on Births 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 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, 1989-2018* 70% Non-Hispanic White 60% 50% 40% Hispanic 30% 20% Non-Hispanic Black 10% Source: Adapted from NCHS Annual Birth Reports www.BirthByTheNumbers.org *2018 data is preliminary

Prematurity(<37 weeks) and Low Birthweight (<2500 grams), U.S., 1981-2018 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 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 1.4 46,956 35,587 (1.13%) Total home & (0.87%) 38,555 1.2 birth center 1.01% 1 21,041 0.8 Home 0.55% % 0.6 0.4 Birthing center 0.2 0 Source: NCHS Annual Birth Reports BirthByTheNumbers.org

Percentage of out-of-hospital births by race/ethnicity, U. S., 2004-18 3.00 Non-Hispanic white Hon-Hispanic black 2.50 Hispanic Native American 2.00 API 1.50 % 1.00 0.50 0.00 2004 2006 2008 2010 2012 2014 2016 2018 www.BirthByTheNumbers.org API= Asian or Pacific Islander. Source: Birth certificate data from the National Center for Health Statistics.

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 16 31 1 Andorra (1 per 1,000) France Spain 17 32 2 Estonia Germany Sweden 18 33 3 Iceland Hungary Bahrain (3 per 1,000) 19 34 4 Japan Ireland Croatia 20 35 5 San Marino Israel Denmark 21 36 6 Singapore Italy Greece 22 37 7 Slovenia Latvia New Zealand 23 38 8 Australia (2 per 1,000) Lithuania Poland 24 39 9 Austria Luxembourg Russian Federation 25 40 10 Belarus Monaco Slovakia 26 41 11 Belgium Montenegro Switzerland 27 42 12 Cuba Netherlands United Kingdom 28 43 United States of America (4 per 1,000) 13 Cyprus Norway 29 44 14 Czechia Portugal Bahamas 30 Source: WHO. World Health Statistics 2019 15 Finland Republic of Korea BirthByTheNumbers.org

Outcomes: Comparative Neonatal Mortality Rates Rank Country Country Country 16 31 1 Andorra (1 per 1,000) France Spain 17 32 2 Estonia Germany Sweden 18 33 3 Iceland Hungary Bahrain (3 per 1,000) 19 34 4 Japan Ireland Croatia 20 35 5 San Marino Israel Denmark 21 36 6 Singapore Italy Greece 22 37 7 Slovenia Latvia New Zealand 23 38 8 Australia (2 per 1,000) Lithuania Poland 24 39 9 Austria Luxembourg Russian Federation 25 40 10 Belarus Monaco Slovakia 26 41 11 Belgium Montenegro Switzerland 27 42 12 Cuba Netherlands United Kingdom 28 43 United States of America (4 per 1,000) 13 Cyprus Norway 29 44 14 Czechia Portugal Bahamas 30 Source: WHO. World Health Statistics 2019 15 Finland Republic of Korea BirthByTheNumbers.org

Outcomes Country 2016-18* Total Births in the five Births countries in red Andorra 543 background in 2016-18* Iceland 4,228 were 11,769 or fewer Luxembourg 6,274 than the 11,893 in South San Marino 235 Dakota in 2018 Monaco 489 TOTAL 11,769 * Country data represents the most recent single year available ranging from 2016-2018. BirthByTheNumbers.org

What’s a Fair Comparison with the US? In the most recent year available (2018): • Countries with at least 100,000 births • Countries with a total per capita GDP of at least $35,000 annually in US dollars. BirthByTheNumbers.org

Defining a Set of Countries to Compare with the U.S. 2017 2018 2017 15 Comparison Countries Total Births GDP per capita % Births by (000) U.S. $ Cesarean (SOURCE: OECD, Health Data 2019) Australia 311 54,095 *33.7 Belgium 120 50.470 20.9 Canada 376 48.262 *27.7 Czech Republic 114 39,620 *23.8 France 770 45,384 19.7 Germany 785 53,823 30.1 Israel 184 39,871 14.8 Italy 458 41,594 33.8 Japan 946 42,913 18.0 Korea 358 40,112 45.1 Netherlands 170 56,444 *16.6 Spain 391 39,971 24.4 Sweden 115 53,053 16.6 United Kingdom 755 45,637 27.3 United States 3,856 62,503 32.0 * 2016 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) , 2017, Industrialized Countries with 100,000+ Births 3.9 3.5 2.8 2.8 2.7 2.4 2.3 2.2 2 2 1.9 1.8 1.6 *2016 1.5 0.9 0 0.5 1 1.5 2 2.5 3 3.5 4 Neonatal Mortality Rate Source: OECD Health Data 2019 and NCHS, Deaths Final Data for 2017 . BirthByTheNumbers.org

Neonatal Mortality Rates (per 1,000 births) , 2017, Industrialized Countries with 100,000+ Births 3.9 3.5 3.1 2.8 2.8 2.7 2.4 2.3 2.2 2 2 1.9 1.8 1.6 *2016 1.5 0.9 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), 2017, Industrialized Countries 100,000+ Births France* 10.8 Australia 8.1 United Kingdom 6.3 Belgium* 6.0 United States 5.9 Canada 5.8 Germany 5.6 Sweden 4.6 Israel 4.5 Netherlands 4.8 Spain 4.4 Italy# 4.0 Czech Republic 3.8 #2012; *2016 Korea 2.7 Japan* 2.4 0 2 4 6 8 10 12 Source: OECD Health Data 2019 BirthByTheNumbers.org

Perinatal Mortality Rates (per 1,000 births), 2017, Industrialized Countries 100,000+ Births France* 10.8 Australia 8.1 United Kingdom 6.3 Belgium* 6.0 United States 5.9 Canada 5.8 Germany 5.6 US NHW 5.0 Sweden 4.6 Israel 4.5 Netherlands 4.8 Spain 4.4 Italy# 4.0 Czech Republic 3.8 #2012; *2016 Korea 2.7 Japan* 2.4 0 2 4 6 8 10 12 Source: OECD Health Data 2019; US NHW -- NCHS (2018) Lack of Change in Perinatal Mortality in the U.S., 2014 – 2016 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

U.S. MMR* Compared to Countries with 300,000+ births, 2014-15 15.9 U.S. # Korea 11 U.K. 9 8 France 7 Canada 6 Australia 6 Germany Spain 5 Japan 5 4 Italy 0 2 4 6 8 10 12 14 16 18 * Maternal Mortality per 100,000 births; # 2015 Estimated U.S. average Source: Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group & UN Population Division. Geneva: BirthByTheNumbers.org 2015; Petersen E. MMWR . vol.68. May 7, 2019. 1-7.

U.S. MMR* Compared to Countries with 300,000+ births, 2014-15 # 15.9 U.S. 12.8 US NHW Korea 11 9 U.K. 8 France Canada 7 6 Australia 6 Germany Spain 5 5 Japan Italy 4 0 2 4 6 8 10 12 14 16 18 * Maternal Mortality per 100,000 births; # 2015 Estimated U.S. average Source: Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group & UN Population Division. Geneva: BirthByTheNumbers.org 2015; Petersen E. MMWR . vol.68. May 7, 2019. 1-7.

Infant Mortality

Infant Mortality Rates (per 1,000 births), 2017, Industrialized Countries 100,000+ Births 5.8 United States 4.5 Canada 3.9 United Kingdom 3.9 France 3.6 Netherlands 3.6 Belgium 3.3 Germany 3.3 Australia 3.1 Israel 2.8 Korea 2.7 Spain 2.7 Italy 2.7 Czech Republic 2.4 Sweden BirthByTheNumbers.org 2.0 Japan 0 1 2 3 4 5 6 Source: OECD Health Data 2019; 2019 . Infant Mortality in the United States, 2017: Data From the Period Linked Birth/Infant Death File; BirthByTheNumbers.org

US Subgroups in Comparative Context with other Industrialized Countries US Subgroup U.S. IMR Rank 2017 (15 - 100K) 5.8 15 All BirthByTheNumbers.org Source: OECD Health Data 2019; 2019 . Infant Mortality in the United States, 2017: Data From the Period Linked Birth/Infant Death File;