Monday, February 18, 2008

Henci Goer: Can you say "projection"?

You just can't make this stuff up.

Someone asked Henci Goer about my claim that the perinatal mortality rate in the US is low. Here is her response:
I'm not sure of the context here, but if Amy Tuteur is saying that our perinatal mortality rate is low, that is just not true. They are, in fact, shamefully high for a developed country. They fall woefully short of Healthy People 2010 goals, have been stagnant for years, and are on the rise. In some areas, notably Washington, DC, where there are large populations of low-income black women, our rates rival those of developing countries. Nothing that Tuteur says can be trusted to be sound information. She is well known for selective reporting, taking things out of context, and, um, to put it politely, mistating the facts.
Let's parse that statement.

"... if Amy Tuteur is saying that our perinatal mortality rate is low, that is just not true."

Actually, it is true, and Goer either knows it or should know it. According to the World Health Organization 2006 report on perinatal mortality, rates of perinatal mortality range from 4/1000 to over 110/1000. The US perinatal mortality rate is 7/1000. That puts in ahead of the Netherlands, the UK, Denmark, Ireland, Luxembourg, and Portugal. It has the same perinatal mortality rate as France, Japan and Monaco. This is quite remarkable considering that the US has the highest risk population of any industrialized country. On a scale extending from 4-110/1000, 7/1000 most definitiely qualifies as one of the lowest rates in the world.

"They are, in fact, shamefully high for a developed country."

Another false statement. They are below average for countries in the developed world, and they are below the perinatal mortality rates for countries which are touted by homebirth advocates for their higher rates of homebirth.

"[US perinatal mortality rates] have been stagnant for years, and are on the rise."

Wrong again. Does Goer read the scientific literature? Fetal and Perinatal Mortality, United States, 2003 by MacDorman et al. is the most recent comprehensive assessment of perinatal mortality in the US (published February 2007). According to the report:
The mortality rate for perinatal definition I [infant deaths of less than 7 days of age and fetal deaths of 28 weeks or more gestation]declined by 26 percent from 1990–2003 ...
A decline of 26% is neither "stagnant" nor "on the rise".

"In some areas, notably Washington, DC, where there are large populations of low-income black women, our rates rival those of developing countries."

The perinatal mortality rates among low income women of African descent are higher than those of white women. That's because African descent is risk factor for prematurity. The perinatal mortality rates are similar for women of African descent in other industrialized countries, but we have a much larger proportion of women of African descent among our population. Goer knows, or should know, that this tells us nothing about the state of obstetrics in America.

"Nothing that Tuteur says can be trusted to be sound information. She is well known for selective reporting, taking things out of context, and, um, to put it politely, mistating the facts."

Let's look at Goer's statement in its entirety. Selective reporting, check; taking things out of context, check, mistating facts, check; and as an added bonus, outright falsehoods such as claiming that US perinatal mortality is high when it is actually low, and claiming that US perinatal mortality is rising when it has actually dropped by 26%.

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