This is not a new article, but I ran across it doing a search on an unrelated topic and observed that it was same shit, different day as far as reporting on obesity is concerned, so I wanted to vent about it. The article, charmingly and in totally non-alarmist fashion titled “Rates of death during childbirth soar as mothers get fatter,” appeared in the UK’s Daily Mail on December 4, 2007. The facts, as presented by the article, are that a study called the Confidential Enquiry into Maternal and Child Health found that “more than half of the 295 mothers who died between 2003 and 2005 were overweight or obese, including 15 per cent who were extremely obese,” and that the maternal death rate has risen 40% in 20 years, from about 10 per 100,000 to 14 per 100,000.

Here are my issues with the reporting. As I said, it’s same shit, different day so it’s not like I’m the first person ever to notice these particular problems with an obesity-related article in the mainstream media.

  • The report features a photograph of a seated, not-stick-thin, yet certainly not fat, pregnant woman holding a television remote and apparently watching TV. I guess we’re supposed to think that this is an example of the kind of woman who is risking her life by being pregnant; after all, a la Kelly Clarkson, if you’re not Victoria Beckham or Nicole Richie, then you must be BMI-overweight and therefore on the brink of death. So say the Doctors of the Internets, who are Just Concerned About Your Health and Not At All Motivated By Whether They Personally Would Fuck the Woman in Question and who practice at TMZ, Perez Hilton, and the links in the Big Fat Deal post, not that I recommend going to any of those places other than Big Fat Deal itself, of course. (Incidentally–this is not relevant in any way–the woman in the photo is absolutely glowing and beautiful IMO.)
  • I’m gonna say that the fact that “more than half” of the women who died in childbirth were overweight or obese probably has something to do with the fact that more than half of the UK female population is overweight or obese. This handy piece of information was actually provided in the article–which states that a quarter of UK women are obese and a further third are overweight–but reads as a further instance of scaremongering (OMG look how many women are fat! This really must be serious!) rather than presentation of a relevant fact.
  • The study notes that the scary-sounding 40% increase in maternal deaths since the previous survey is not statistically significant. Which any of us could probably have guessed without being told when we’re talking 223 vs. 295 deaths out of–for the current, 2003-2005 study–2,113,831 pregnancies. I wouldn’t characterize this as a “soaring” death rate, but the Daily Mail would, I guess.
  • We can all enjoy fun with Fat Hate Bingo as the article blames fat mothers for “[placing] more pressure on existing resources” and shares othering fat freak horror stories (Woman is too heavy to move from her house! Blood pressure cuffs not big enough for fatties! Doctors have to push TWO BEDS together to perform a C-section when woman’s bulk is too massive for operating table!) that IMO are more about inadequate training and equipment than anything else. To its credit, the article does indicate that the report “called for better communication between staff and better training in skills such as resuscitation,” but says the study “found no rise in the number of deaths relating to substandard care, however there were examples where health workers failed to identify and treat common conditions.” Um, to my mind you could make the case that any of the above instances could constitute “substandard care,” since, you know, potentially lifesaving treatments were delayed or important diagnoses missed due to provider or equipment failure. I’m not blaming the individual providers, and I know resources are tight, but it’s not like the problems described don’t have obvious solutions. Half of us are fat these days, so you might as well start taking some seminars or something on our needs rather than whining about how we break your exam tables and are hard to lift and blah blah blah. I don’t really care. Even if my weight were totally my “fault” and a result of shoveling in Suzy Q’s 24/7, I still don’t care. Jobs are hard and taking care of people is yours. Mine used to be sampling sewage. I’m sure both have their pros and cons.
  • This may or may not be important, but the study distinguishes between “direct” and “indirect” deaths. A distinction is drawn between deaths that could only occur in pregnancy and deaths occurring as a result of conditions aggravated by pregnancy. The study authors report finding a higher death rate than other studies (which, they say, typically find about 7 deaths per 100,000 pregnancies), which they seem to feel means that their numbers are more valid, or something. But the rate of “direct” deaths they find is… just over 7 per 100,000 pregnancies. Hmm. I’m certainly not saying that no “indirect” deaths (for example, suicide, heart attacks, or stroke) are attributable to pregnancy. It’s just that it seems to me that fat is particularly susceptible to that “everybody knows” syndrome where everybody knows that if you have something like diabetes or high blood pressure, it’s because you’re fat, and everybody knows if you are fat and get pregnant, you’ll die, and do I necessarily trust that all of the “indirect” deaths are attributed 100% objectively when–no matter how upstanding and well-meaning they are–this organization wouldn’t exist if death in childbirth were somehow eradicated? And do I trust that the conclusions of the report with regard to the obesity “crisis” among pregnant women derive completely from the data without resort to “common knowledge” about how dangerous it is to be fat? No.
  • The article closes by noting that if you exclude new immigrants, refugees, asylum seekers, and so-called “health tourists” from the numbers, deaths actually decreased from the previous study period. I’m not sure if it’s comparing apples to apples to exclude all such women–after all, some women in these categories obviously did factor into the previous 2000-02 results, though apparently the number more than doubled between the previous and current periods–but if the decrease does hold, then isn’t all of this basically a non-story?
  • Little is made also of the likelihood that the physical and psychological stresses of being a refugee or asylum seeker, in particular, increase the odds of a poor pregnancy outcome, which would tend to increase overall maternal deaths. The article does note that some “new arrivals,” as they are collectively classified, come to the UK in search of high-quality health care specifically due to a complicated pregnancy or medical history, which means that the pool of recent immigrants/refugees/asylum seekers probably contains a greater number of high-risk pregnancies in any case. This only strengthens the case that any increase in average weight does not appear to be having a significant impact on maternal deaths in the UK.

(I did note that although the language in the article seems non-judgmental to me on the face of it, the motivation for bringing these numbers forward seems potentially quite xenophobic–like, look at all of these foreign women sucking up our resources and driving up our maternal death rate; or let’s be sure and note that a lot of the women who died in childbirth don’t really “count” because they were not UK citizens and many were black African. To be fair, any negative “tone” on this subject appears to be confined to the Mail, whereas the study itself appears to focus more on addressing the health issues faced by this group of mothers.)

Anyway, I will say that out of 5 comments on the article, 4 of them are basically like “So?” Which is sort of encouraging. (And the fifth says, in its entirety: “Gosh – being overweight is unhealthy – so of course it’s going to be unhealthy for your child!” Um, not what the article was actually about, but nice knee-jerk “what about the children??? Being fat is child abuse!!!1!!” reaction there.) Maybe people are finally starting to spit some of this bullshit back out rather than swallowing it whole.