birth by the numbers 2014 part i: is there a problem? gene declercq, phd with support from: the...

Birth By the Numbers 2014

Part I: Is there a problem?

Gene Declercq, PhDwww.birthbythenumbers.org

With support from: The Transforming Birth Fund

BirthByTheNumbers.org

3,952,93712,104

1,296,070

52,734,000,000


50,761

6,972

9.2%

Total U.S. Births, 1990-2013

19901992

19941996

19982000

20022004

20062008

20102012

3,800,000

3,900,000

4,000,000

4,100,000

4,200,000

4,300,000

4,400,000

3,957,577

4,316,233

Net Decrease 2007-2013358,656 or 8.3%

Source: Adapted from CDC VitalSTATS. http://www.cdc.gov/nchs/VitalStats.htmBirthByTheNumbers.org

U.S. Fertility Rates (per 1,000) by Race/Ethnicity, 1989-2012

50

60

70

80

90

100

110

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

AllWNHBNHHisp

Fertility rates computed by relating total births, regardless of age of mother, to women 15-44 years. SOURCE: adapted from NCHS Annual Birth Reports.

Prematurity and Low Birthweight, U.S., 1981-2012

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

6

7

8

9

10

11

12

13

Prematurity

Low Birthweight

9.8%Decrease 2006-12

%

Year


Percent of all births at home, or in a birthing center, United States, 1990-2012

19901995

20002005

20102012

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Total home & birth center

Home

Birthing center

46,956(1.13%) 35,587

(0.87%)

50,761(1.28%)

43% Increase 2004-2012

35,184

15,577

BirthByTheNumbers.orgSource: NCHS Annual Birth Reports


Is the U.S. really doing as badly as it seems in

international comparisons?


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

Outcomes: Comparative Neonatal Mortality RatesRank Country Rank Country Rank Country

1 Andorra (1/1,000) 14 Germany 27 Belarus

Iceland Ireland Netherlands

Japan Israel Greece

Luxembourg Italy Cuba

San Marino Lithuania Lithuania

Singapore Monaco New Zealand7 Austria (2/1,000) Norway United Kingdom

Belgium Portugal Switzerland

Cyprus Rep. of Korea Croatia

Czech Republic Slovenia 37 United States (4/1,000)

Estonia 24 Sweden Bahrain,Bosnia,Brunei

Finland Australia (3/1,000) Canada, Hungary, Qatar,

13France

26Belarus

Montenegro, Serbia, Slovenia, Uruguay

Source: State of the World’s Children2014. BirthByTheNumbers.org

Outcomes

Total Births in the five countries in red background in 2012 were 11,429 or fewer than the 12,104 in South Dakota in 2012

Country 2012Births

Andorra 757

Iceland 4,146

Luxembourg 6,034

San Marino 285

Monaco 207

TOTAL 11,429



What’s a Fair Comparison with the US?

In the most recent year available (2011):

• Countries with at least 100,000 births

• Countries with a total per capita annual expenditure on health of at least $1,500 annually in US dollars.

Defining a Set of Countries to Compare with the U.S.17 Comparison Countries (SOURCE: OECD, Health Data 2012 & State of World’s Children)

2011 Total Births

(000)

2011Total exp. health –

PC, US$ PPP

2011% Births by

Cesarean

Australia 302 *3,800 *31.2

Belgium *129 4,061 *19.7

Canada 377 4,521 *26.1

Czech Republic 109 1,966 23.3

France 792 4,118 20.2

Germany *678 4,495 31.4

Greece 106 2,361 NA

Israel 166 2,239 19.9

Italy *557 3,012 37.7

Japan 1,051 *3,213 18.0

Korea 471 2,198 34.6

Netherlands *184 5,099 *15.6

Portugal 97 2,619 33.3

Spain 471 3,072 24.9

Sweden 112 3,925 16.2

United Kingdom 808 3,406 24.1

United States 3,954 8,508 32.8

BirthByTheNumbers.org* 2010


IOM chose 16 peer countries. 13 are same as the one’s we’ve used. They use 3 countries (Denmark, Finland, Switzerland) that have <100,000 births. We include Belgium, Czech Republic, Greece and Israel

How is the U.S. doing relative to comparison countries?

Neonatal Mortality Rate

Infant Deaths in First 27 days

X 1,000_____________

Live Births

Perinatal Mortality Rate

Fetal deaths + deaths in the first week

X 1,000 _______________Live births + fetal

deaths


Neonatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries with 100,000+ Births

1.11.4

1.7

1.7

2.12.2

2.2

2.22.2

2.3

2.42.4

2.7

2.7

33.7

4.04

0 1 2 3 4 5

Japan

SwedenCzech Republic

Korea

Spain

Greece

Israel

Italy*

Belgium*

France

Germany

PortugalNetherlands

AustraliaUnited Kingdom

Canada*United States

Source: OECD Health Data 2014 and NCHS, Deaths Preliminary Data for 2011. BirthByTheNumbers.org

*2010 rate


Neonatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries with 100,000+ Births

1.11.4

1.7

1.7

2.12.2

2.2

2.22.2

2.3

2.42.4

2.7

2.7

33.45

3.7

0 1 2 3 4

Japan

SwedenCzech Republic

Korea

Spain

Greece

Israel

Italy*

Belgium*

France

Germany

PortugalNetherlands

AustraliaUnited Kingdom

U.S. WNH

Canada*

Source: OECD Health Data 2014 and NCHS, Deaths Preliminary Data for 2011. BirthByTheNumbers.org

*2010 rate



Perinatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries 100,000+ Births

JapanKoreaSpain

PortugalCzech Republic

Italy#Israel

GreeceSweden

GermanyNetherlands

Canada#Belgium#

United States*United Kingdom

AustraliaFrance

0 2 4 6 8 10 12 14

2.83.1

3.73.83.9

4.34.54.64.7

5.55.5

6.16.56.5

7.58.4

12.1

*2006; #2010

Source: OECD Health Data 2014

Perinatal Mortality Rate


Perinatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries 100,000+ Births

JapanKoreaSpain

PortugalCzech Republic

Italy#Israel

GreeceSweden

United States* WNHGermany

NetherlandsCanada#Belgium#

United KingdomAustralia

France

0 2 4 6 8 10 12 14

2.83.1

3.73.83.9

4.34.54.64.7

5.35.55.5

6.16.5

7.58.4

12.1

*2006; #2010

Source: OECD Health Data 2014

Maternal Mortality Ratios

Maternal Mortality Ratio

Maternal Deaths* all causes X 100,000

_______________Live births

* Deaths in pregnancy and up to 42 days postpartum


Maternal Mortality Rates, (per 100,000 births), 2011, Industrialized Countries with 300,000+ births

2.9

3.0

3.4

4.1

4.7

6.6

7.6

8.9

16.8

17.2

2.0 18.0

Italy*

Spain

Australia*

Japan

Germany

United Kingdom

Canada#

France*

United States^

Korea

Sources: OECD Health Data 2014; ^California Maternal Quality CareCollaborative (CMQCC) 2014; NCHS. 2009. Deaths, Final Data, 2007.

U.S. 2007:Black non-Hispanic 28.4White non-Hispanic 10.5Hispanic 8.9


*2010; #2009; ^CMQCC Estimate


Maternal Mortality Rates, (per 100,000 births), 2011, Industrialized Countries with 300,000+ births

2.9

3.0

3.4

4.1

4.7

6.6

7.6

8.9

10.5

17.2

2.0 18.0

Italy*

Spain

Australia*

Japan

Germany

United Kingdom

Canada#

France*

United States^

Korea

Sources: OECD Health Data 2014; NCHS. 2009. Deaths, Final Data, 2007.

U.S. 2007:Black non-Hispanic 28.4White non-Hispanic 10.5Hispanic 8.9


*2010; #2009; ^2007

Are things Getting Better or Worse?


Yes


YesThings are getting better in

the U.S., but at a slower pace than comparable

countries

Examining Trends over Time

Neonatal Mortality Rate (per 1,000 births), 2000-2011, U.S., & Ave. for Industrialized Countries*

2.0

3.0

4.0

5.0

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Rate

per

1,0

00 l

ive b

irth

s

Source: OECD Health Data, 2014 & MacDorman MF, et al. Recent declines in infant mortality in the United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.

U.S.

* Countries with 100,000+ births (2009): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Israel, Italy, Japan, Netherlands, Portugal, Spain, S. Korea, Sweden, U.K.

2.3

4.0

4.6

3.1

Industrialized Countries

23% decrease

13% decrease

Neonatal Mortality Rate (per 1,000 births), 2000-2011, U.S., & Ave. for Industrialized Countries*

2.0

3.0

4.0

5.0

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Rate

per

1,0

00 l

ive b

irth

s

Source: OECD Health Data, 2014 & MacDorman MF, et al. Recent declines in infant mortality in the United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.

U.S.

* Countries with 100,000+ births (2009): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Israel, Italy, Japan, Netherlands, Portugal, Spain, S. Korea, Sweden, U.K.

2.3

4.0

4.6

3.1

If the U.S. neonatal mortality rate equaled the current average rate of the other countries in 2011, that would mean about 6,972 fewer deaths to babies 28 days or younger annually.

Capacity – 68,756


Perinatal Mortality Rates, 2000-2011 , U.S., & Ave. for Industrialized Countries*

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20115

5.5

6

6.5

7 U.S. 6 %

decrease


14% decrease

* Countries with 100,000+ births (2011): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Israel, Italy, Japan, Netherlands, Portugal, S. Korea, Spain, Sweden, United Kingdom

Sources: OECD Health Data 2014; NCHS. 2012. Fetal & Perinatal Mortality,

2006.

Maternal Mortality Ratios (per 100K births), 2000-2011, U.S. & Comparable Countries *

4

8

12

16

20

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Dea

ths

per

100

,000

live

bir

ths


5 % Decrease

U.S.71%

Increase

* Countries with 300,000+ births (2011): Australia, Canada, France, Germany, Italy, Japan, S. Korea, Spain, United Kingdom

NOTE: 2008-2010 US rates unofficial^

Sources: OECD Health Data 2014; ^California Maternal Quality Care Collaborative (CMQCC) 2014; NCHS. 2009. Deaths, Final Data, 2007.

Case Ascertainment?


What about process?

US Cesarean Rates, 1989-2013

20

22

24

26

28

30

32

34

% Tot US 23 22. 22. 22. 21. 21. 20. 20. 20. 21. 22. 23 24 26 28 29 30 31 32 32 33 33 33 33 33

'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13

%

Source: National Center for Health Statistics Annual Birth Reports

%

1,294,128

If the 2013 cesarean rate was the same as in 1996, there would have been 475,000 fewer cesareans in the U.S. in ’13.

Primary Cesarean and VBAC Rates, U.S., 1989-2011

5%

10%

15%

20%

25%

30%

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

Prim Ces Rate

VBAC

r = -.95

Source: NCHS. Annual Birth Reports & Vital Stats

Note: 2005-2011 unofficial

9.2%

15.6%16.2%

18.0%19.8%19.90%20.2%

23.3%24.1%

24.9%26.1%

34.6%37.7%

32.8%31.4%

33.4%

30.8%

10% 45%

*NetherlandsSweden

JapanIsrael

*BelgiumFrance

Czech RepublicUnited Kingdom

Spain*Canada

*AustraliaGermany

United States*Portugal

KoreaItaly

Sources: OECD Health Data 2014; U.S. Natality Data; Japan – sample; Lancet 6736(09)61870-5.

Cesarean Rates in Industrialized Countries* with 100,000+ Births, 2011

*2010

* No data on cesarean rates in Greece

VBAC Rates, Selected Countries, 2004

0 10 20 30 40 50 60

NetherlandsNorwayFinland

SwedenGermany

Czech RepDenmark

FranceBelg-Flanders

ScotlandSpain-Valencia

SloveniaMalta

EstoniaCanada

LithuaniaLatvia

U.S. VBACs

51

41

45

5155

25

2732

3539

41

919

24

25

25

20

8

Source: Adapted from EuroPeristats, US & Canadian Data


Do High Rates of Intervention Matter?

1. Outcomes 2. Costs

Gestational Age, U.S. All Births, 1990

2% 1%

7%

20%

14%

11%

22% 23%

0%

5%

10%

15%

20%

25%

30%

<32 32-33 34-36 37-38 39 40 41 42+

* Only births occurring at home. Source: Martin JA, Hamilton BE, Osterman MJK, Curtin S and Mathews TJ. Births: Final data for 2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health Statistics. 2014.

Gestational Age, U.S. All Births, 2012

2% 1%

8%

25%

30%

20%

9%

6%

0%

5%

10%

15%

20%

25%

30%

<32 32-33 34-36 37-38 39 40 41 42+


Gestational Age, U.S. All Births, 1990 & 2012

2% 1%

20%22%

14%

11%

25%

30%

7%

23%

9%6%

2% 1%

8%

20%

0%

5%

10%

15%

20%

25%

30%

<32 32-33 34-36 37-38 39 40 41 42+

19902012


Gestational Age, U.S. All Births & Planned Home Births*, 2012

2% 1%

8%

25%

30%

20%

9%6%

0% 0%2%

31%

19%

10%

15%

24%

0%

5%

10%

15%

20%

25%

30%

35%

<32 32-33 34-36 37-38 39 40 41 42+

All

Home


Economics of Childbirth in the U.S.

LEADING MAJOR DIAGNOSTIC CATEGORIES by

NUMBER OF HOSPITAL DISCHARGES, U.S., 2012

1,428,045

1,428,060

1,671,380

2,192,941

3,242,725

3,251,134

3,549,166

4,796,1754,160,286

3,933,511

0

1,00

0,00

0

2,00

0,00

0

3,00

0,00

0

4,00

0,00

0

5,00

0,00

0

6,00

0,00

0

7,00

0,00

0

Infectious & Parasitic Diseases

Mental Diseases & Disorders

Kidney & Urinary Tract

Nervous System

Digestive System

Musculoskeletal System & Conn Tissue

Respiratory System

Newborns & Other Neonates

Pregnancy, Childbirth & The Puerperium

Circulatory System

AHRQ. 2014. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 3/1/2014.

MEDIAN FACILITY LABOR & BIRTH CHARGES BY MODE OF BIRTH, U.S., 2012

$9,705

$16,465

$11,539

$19,358

$0

$20,000

Vaginal noComplications

Cesarean NoComplications

VaginalComplications

CesareanComplications

Sources: AHRQ. 2011. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 3/1/14;

NOTE: Hospital charges; no physician costs

70%

Estimated Total Charges, Hospital Birth, U.S., 1993-2012 (000,000)

0

10,000

20,000

30,000

40,000

50,000

60,000

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

Vag no Compl.

Vag w Compl.

Ces no Compl.

Ces w/ Compl.

Sources: AHRQ. 2009. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 3/1614.

$ 55,771

$ 14,039

http://hcupnet.ahrq.gov/

Is it hopeless?

What can be done


•Evidence – keep an open mind and ask different questions.

• Advocacy – work for change.


www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

Safe Prevention of Primary Cesarean Delivery

Rethinking the Evidence

http://www.choicesinchildbirth.org/

Childbirth Advocacy Led by Mothers

BirthByTheNumbers.orgwww.thebusinessofbeingborn.com/


https://www.childbirthconnection.org/


http://orgasmicbirth.com/online-resources


www.ourbodiesourselves.org/

Follow Birth by the Numbers on Social Media:

RSS (blog): www.birthbythenumbers.org

www.facebook.com/BirthByTheNumbers

Twitter: @BirthNumbers

Email: [email protected]

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birth by the numbers 2014 part i: is there a problem? gene declercq, phd with support from: the...

Documents

births countries

outcomes total births

live births

comparison countries

countries denmark

peer countries

set of countries

united kingdom8083