Hello, New York Times, Way to Grind My Gears

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Ugh. So just when you think you’re having a nice morning, you read an article that you came across this morning while doing your usual internet browsing about how Japan is behind on OB/GYN care (the article is about that, not that I spend my mornings looking for articles on Japanese OB/GYN care – though I did this morning). While the article does make some important and valid points about the lack of OB/GYNs in Japan, it opens up as citing a low-level of pain relief and genetic testing as proof that OB/GYN care in Japan is lagging behind in OB/GYN care.

But let’s take a look at a few things. First of all, infant mortality. In the article, they compare epidural rates to France and the United States. So for sake of argument, we’ll compare stats with those (where I can find them). So infant mortality in the US is between 6-7 per 1000 live births. In Milwaukee, in 2010 the infant mortality rate was 9.5 per 1000 live births. In France, the infant mortality rate is between 3-4 per 1000 live births. In Japan, the infant mortality rates is between 2-3 per 1000 live births. Hmm, so Japan has a lower infant mortality rate than my hometown, the US, and France (by a bit) but yet, their OB/GYN care is lagging behind the rest of the world.

Well what about maternal mortality you might say? Does Japan have a large number of mothers dying in childbirth? That could make a difference right? In the US, maternal mortality rate is 21 per 100,000. In France, maternal mortality rate is 8 per 100,000. In Japan, the maternal mortality rate is 5 per 100,000. Oh hmm, that’s interesting. Japan has a maternal mortality rate lower than both the US and France, but yet their OB/GYN care is lagging behind the rest of the world.

Well maybe they have a lot of babies born prematurely. That’s worth investigating right? The percent of babies born preterm in the US is 12 percent. France is 6.7 percent of babies. Japan is 5.9 percent of babies. So Japan has a lower rate of premature births. Fascinating.

And okay, why should the rate of epidurals be a determining factor in poor OB/GYN care? They should be available, of course, I’m not against people using them, but they’re not mandatory for birth. You don’t need to have pain meds to have a baby. I had no pain meds, by choice. In fact, I know several people who had no pain meds by choice and even some people who had home births. Not having pain meds does not mean you are receiving substandard OB/GYN care and in a culture that thinks of suffering as not necessarily a bad thing, is it any surprise? Certainly, like I said, they should be available to people who want them, but they are not mandatory to have a baby.

And let me touch on genetic testing. You do not have to have genetic testing to have a baby either. The author of the article clearly thinks that genetic testing is a good thing, but not everyone feels the same way. There are many people who decline genetic testing because they know that no matter what they are going to love and keep that baby. Not to mention, amniocentesis  one of the tests the author mentions, carries risks. Amniocentesis carries a risk of miscarriage between  1 in 200 and 1 in 400 depending on circumstances. Perhaps there are less genetic screenings for these reasons.

And in his last sentence he talks about this lack of quality OB/GYN care being a reason Japan’s birth rate is falling. I find that a little hard to believe. Among The Economist, BBC News, and Japan Economic Currents not one lists poor maternity care as the reason Japan’s birth rate is falling. Instead, they list reasons such as the high cost of weddings, lower marriage rates, companies discouraging women from returning to work after becoming a mother, high unemployment, low wages for young people, social attitudes about family life, and the cost of raising and having children.

Lastly, the article spends the majority of the time talking about an OB/GYN shortage in Japan. This is a real problem, yes, but not one unique to Japan. Several sources predict a coming shortage of OB/GYNs or say one is already here in the United States including T̶h̶e̶ ̶O̶B̶/̶G̶Y̶N̶ ̶N̶u̶r̶s̶e̶-̶N̶P̶/̶P̶A̶, (link now broken as of 2/8/14), Parents.com, ACOG (they say one of their legislative goals is to support federal funding to address OB/GYN shortages)Massachusetts Medical Society, and USA Today.

I think saying that Japan has “poor” OB/GYN care is having the wrong conversation. I think the conversation we ought to be having is about maternity care in the US. But that’s just my opinion.

Sources:

Wikipedia: List of Countries by Infant Mortality Rate
City of Milwaukee – Infant Mortality
CIA: Country Comparison: Maternal Mortality Rate
WHO data on preterm births by country
American Pregnancy Association – Amniocentesis 

 

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