A slew of news articles this week have focused on two recent reports about the number of women who die during pregnancy or in childbirth around the world every year.
The reports don’t exactly agree, and with public health experts and heads of state meeting at the United Nations this week to discuss maternal and child health issues, it is no surprise that some squabbling over the data has emerged. Unfortunately, reporters have not provided much detail or clarity about either the squabbling or the data.
On Wednesday, The New York Times gave its lead front-page slot to a study published in the medical journal The Lancet, where, “For the first time in decades, researchers are reporting a significant drop worldwide in the number women dying each year from pregnancy and childbirth, to about 342,900 in 2008 from 526,300 in 1980 … The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of “skilled attendants” — people with some medical training — to help women give birth.”
So far, so good, but the Times’s Denise Grady, who wrote the article, quickly flipped the focus of her piece by adding that “some advocates for women’s health tried to pressure The Lancet into delaying publication of the new findings, fearing that good news would detract from the urgency of their cause, [the journal’s editor] Dr. [Richard] Horton said in a telephone interview.”
Horton also disclosed (and rightly criticized) the requests to hold off from publishing in a long comment piece attached to the research article in The Lancet—but neither there nor in the Times does he say exactly where (or who) the pressure came from. That is his decision, and probably a wise one. What is frustrating, however, is that Grady chose to emphasize this angle in the top of her story, but found nobody to substantiate the impression that it is a significant issue.
In fact, most articles took a pass on Horton’s comments about pressure from advocacy groups. One exception was the Associated Press, which mentioned it right in the lede (although, curiously, a headline on an early version of the story that read “Politics of aid seen in clash over maternal deaths” was later changed to “Lancet: Sharp drop in maternal deaths worldwide”).
Unfortunately, the AP had nothing to add on the extent to which advocates are actually concerned about the political (read: financial support) ramifications of the statistics presented in The Lancet. What the article, by Maria Cheng, does mention is that “A separate report by a group headed by the United Nations reached a very different conclusion on maternal mortality, saying the figure remains steady at about 500,000 deaths a year.”
The problem is “a group headed by the United Nations” did not produce that report. Farther down in her article, Cheng reports that it came from the Partnership for Maternal, Newborn and Child Health, a global alliance hosted by the U.N. World Health Organization. In fact, it came from an advocacy group called Countdown to 2015, which does not appear, from its Web site, to be affiliated with the U.N. Furthermore, the AP’s assertion that the group found that maternal mortality has “remained steady” at half a million deaths per year seems suspect. After making that statement in the second paragraph, Cheng eventually goes on to specify that 350,000 to 500,000 women still die in childbirth every year. (And that is an improvement on the same paragraph in the earlier version of the article, which used the weaker specification, “up to 500,000.”)
Cheng’s confusion seems to stem from a press release about the Countdown to 2015 analysis released by the Partnership for Maternal, Newborn and Child Health. It is ironic that she should mistakenly use that group, in particular, as the supposed foil for the maternal mortality statistics published in The Lancet. In The New York Times article, Grady quotes its director, Dr. Flavia Bustreo, saying that the statistics represented “hope at last,” and that her organization was not one of those that tried to delay release of the findings.
Given Bustreo’s quote, Grady clearly tried to find a health advocate who would go on the record with his or her concerns that the Lancet study would affect the ability to win support for maternal mortality reduction projects. Nobody appears to have been willing to do that, however, which is why it’s surprising that she didn’t even mention the competing analysis from Countdown to 2015. The group’s name comes from the U.N. Millennium Development Goals of reducing maternal and newborn/child mortality by 75 percent and 66 percent below 1990 levels, respectively, by 2015—and, judging from the press release, the main point of its analysis was to stress a lack of progress and an estimated $20 billion funding gap for meeting U.N goals.
(Countdown to 2015’s report got much less attention than the Lancet study, but oddly enough, the AP covered it in a separate article from the one where Cheng misidentified its origins. Agence France-Presse covered it, too, but also called it a U.N. report and flubbed a number of other details as well.)
That’s not to say that Countdown to 2015 would have advocated postponing publication of the mortality study published in The Lancet (which came from the University of Washington and the University of Queensland in Brisbane, Australia, and was funded by the Bill and Melinda Gates Foundation). But getting into the group’s analysis might have led Grady to include the important caveat (missing from her article) that there was a high degree of uncertainty associated with the sanguine statistics presented in The Lancet.
While Horton, the journal’s editor, stressed that the study published there was well designed and that “the overall message, for the first time in a generation, is one of persistent and welcome progress,” he added that “concerns about uncertainty estimates, in particular, were common” during the peer-review process and that “these results will provoke intense debate among the global health measurement community.”
Ultimately, Horton concluded, “given the dramatic difference” between the results of the Lancet study and those reported by the U.N. in 2008 (pdf), which found that little progress had been made toward reducing maternal mortality, “a process needs to be put in place urgently to discuss these figures, their implications, and the actions, global and in country, that should follow.” That perspective, as well a mention of uncertainties in the maternal mortality data, should have been included in the Times’s story.
Readers should not have to read half a dozen articles and still be left with only a vague sense of the whole story. With a host of meetings at the United Nations and elsewhere focused on women’s and child health in coming months, we need more comprehensive and insightful explanations of the data and political battles related to maternal mortality.