What Impacts Maternal Mortality?

It’s been a while since my last post—so sorry about that! I have been working on this post for a few days, and it was prompted by a segment I saw on GMA recently about Christy Turlington-Burns’ efforts to bring awareness to maternal mortality throughout the world through her organization, Every Mother Counts. It really hit home with me—if it weren’t for great medical care, my son and I most likely would not be alive right now. (We’re so grateful!) Her work really resonated with me, and so I wanted to share it with you.

So, here’s my agenda for this post, and a few more to follow it: I want to show how easy it is to use data visualization to tell a compelling story about how cultural circumstances can have major impacts on the lives of women and children around the world. I was teaching a class last week, and when I showed a draft of this, people frowned. It’s sad stuff! No doubt about it. But it’s very real.

The first person I talked to about this was my mom. (Hi, Mom!) She’s a nurse practitioner, and she has worked in some of the very remote areas in the map below that have abysmal rates of preventable maternal deaths. I asked her—what do you think the causes are? Without hesitation, she said, “Teenagers giving birth, and the lack of skilled help during births.” That makes a lot of sense to me.

So, I got a hold of the most recent World Bank Indicators, a version of which ships with Tableau, and then spent an eon transforming it in SQL Server so that I could load only the most recent numbers for each country for the metrics in question. (More on that tomorrow!) It’s a very rich data source, and it includes economic measures that, along with literacy and health data, describes some of the living conditions in a country fairly well.

My first question is which areas of the world have higher instances of maternal death. I started with a familiar map—it’s a great way of showing disparities across the world. The countries are ranked in descending order by the likelihood that a woman will die in or after childbirth—countries with high ranks (like #1, South Sudan) are really bad places to be pregnant. (The US is in the middle…below several former Eastern Bloc countries, which is a surprise.) My friend Nelson Davis @nelsondavis recent blogged about the relationship between life expectancy and war—there have been several notable genocides and civil wars in Sub-Saharan Africa, and consequently, they are not places one should expect to live very long or in good health.

The countries are colored by percentiles (great new table calc in Tableau 8.2, along with rank) of maternal mortality rates. When you click on a country, the scatter plots below, which show correlations between the percentage of maternal deaths that are preventable and other public health measures, will highlight. The area map of our aid to those countries also filters.

The scatter plots are significant, and they prove numerically what my mother told me about the correlations between teenaged pregnancies, unattended births, and maternal mortality. I added in literacy rate—notice that it’s trend line is nearly identical to that of unattended births, though the median is a little bit lower. The relationship between percent of GDP spend on health is less significant, though the clustering is obvious—there are some outliers that I would question, like Liberia and Sierra Leone in the upper right—especially what we know about the quick spread of Ebola there recently.

Talk to me about your thoughts on this and what you think I should add in the future.