经济学人丨在美怀孕更危险？| 2017.08.03 | 总第993期

FEW things are more tragic than the death of a woman in pregnancy or childbirth. In America, as in other rich countries, such deaths are extremely rare. An American woman is more likely to be struck by lightning than to die in childbirth. Nonetheless, 700-800 pregnant women and new mothers die each year. By some measures, America’s maternal mortality is several times higher than in rich European countries. By other measures, however, America has the same rate as Britain.

妇女在孕期或者生孩子的时候死亡可能是世界上最悲惨的事情了。和其他富裕国家一样，在美国这种死亡率是非常低的。对于美国女人来说，死于闪电的可能性比死于生孩子的可能性更高。虽然如此，每年还是有700-800位孕妇和新生妈妈去世。根据某种统计方式，美国的母死率比欧洲富裕国家高出好几倍；而根据另一种统计方式，两者则差不多。

• nonetheless :adv. 虽然如此

• maternal mortality  母性死亡率

One bit of the puzzle is what counts as a maternal death. The standard definition used in international comparisons, such as those published by the World Health Organisation, is a death from complications of pregnancy if the death occurs between the time a woman becomes pregnant and six weeks after her pregnancy ends.

有一点疑惑的地方是何谓孕产妇死亡？其国际比较下——例如世界卫生组织的标准定义是孕期到产后6周间死于怀孕引起的并发症。

• complication: n.并发症

In rich countries, these deaths are tallied from vital-registration systems which in turn compile data from death certificates. These, however, are known to undercount maternal deaths, partly because doctors must select a cause of death from thousands of codes. They are more likely to consider the subset reserved for medical problems caused by pregnancy when the form has a checkbox asking whether the woman had been pregnant.

在富裕的国家，孕产妇死亡的测量数据来自人口动态登记系统。然而众所周知的是，这些少计了许多孕产期死亡的案例，其一部分原因是医生要在无数信息中选取出导致死亡的原因。当表格中有女性是否怀孕的选项中，他们更可能会少考虑一些怀孕引起的并发症。

• tally 测量

• vital-registration人口动态登记

America added this checkbox to its standard death certificate in 2003, though it took more than a decade for all states to adopt it. It has been a mixed blessing, says Andreea Creanga of Johns Hopkins University. A recent study found that its growing use accounted for 80% of the steep rise in maternal mortality recorded in 2000-14. Although many maternal deaths that would otherwise go unrecorded are now tallied thanks to the checkbox, it is also often marked —showing recent pregnancy on the death certificates of women who died in their 50s, for example.（读者试译）

2003年，美国在死亡证书上增加了这一个选项，尽管如此，美国还是花了超过10年时间在全国完成推广。约翰霍布金斯大学的Andreea Creanga说，这是一个两难的措施。最近的研究表明，2000到2014年间80%被记录在案的母死率是因为新选项使用率的提升带来的。（期待您的翻译，明天将会有针对这句话的长难句解析哟~）

According to data from death certificates, America’s rate is 21 maternal deaths per 100,000 live births. In Britain, which does not use the pregnancy checkbox, the rate is four to five times lower. It is a rate that British health authorities do not consider reliable.

根据死亡证明的统计数据，美国的母死率是十万分之二十一。而在无需验孕的英国，这个比例比前者小4到5倍。英国健康机构认为本国的母死率统计不可靠。

Because death certificates do a poor job in identifying maternal deaths, some countries, including America, Britain and France, use alternative systems to track maternal mortality. These systems cast a wide net to find all deaths that might count as maternal. They gather reports from hospitals, coroners, newspapers and even tips from ordinary citizens. Experts review the medical records for all deaths that are found. Only those that are clearly a result of health problems caused by pregnancy are tallied as maternal deaths. If the chain of events that led to a woman’s death started with asthma, for example, the death would be included only if the pregnancy caused the asthma or made it worse.

因为死亡证明并不能很好地分辨死亡是否由于怀孕，一些国家包括美国、英语和法国都用备选系统来统计母死率。他们的备选系统能广泛撒网，找出所有可能是孕产期死亡的案例。他们从医院、验尸官、报纸、甚至普通市民提供的小窍门获取信息。专家也会看所有能找的死者的医学记录。只有那些明显是因孕产期导致的健康问题致死的案例才会被归结为孕产期死亡。例如，如果一系列事件让女性死于哮喘，只有当怀孕引起哮喘或者加重了哮喘才会被统计入上述数据。

• alternative:adi.备选的

• coroner:n.验尸官

In America this type of detailed system, run by the Centres for Disease Control and Prevention (CDC), counts maternal deaths that occur up to a year after pregnancy. (Deaths resulting from pregnancy, such as suicides caused by post-partum depression, can strike many months after delivery.) By that measure, America’s maternal mortality rate in 2011-13 (the latest period for which data have been published) was 17 deaths per 100,000 live births. Maternal deaths tallied in the same way in Britain for 2012-14 result in a mortality rate that is almost exactly the same.

在美国，这种精细的统计系统是由疾病控制和预防中心操作，计算产期一年以内的孕产妇死亡数。（由怀孕导致的死亡，例如产后抑郁导致的自杀能在生产后好几个月后发生。）这样算来，美国的母死率在2011到2013年（数据最后发布的年份）是17/100,000。同样这么计算孕产期死亡数的英国在2012到2014年间得出了接近的结论。

Britain’s system is better at detecting maternal deaths, if only because America’s system relies on adding up numbers from 50 states with varying capacity for the task of collecting data. What is clear, however, is that nobody really knows just how much riskier pregnancy in America may be than in other rich countries.

英国的统计系统在发现孕产妇死亡案例方面做得更好，仅仅是因为美国的系统将50个州的数据简单地加在一起，而忽略了在统计数据时各州因人数不同带来的偏差。然而可以确定的是没有人真正知道在美国怀孕比在别的富裕国家怀孕危险多多少。

翻译 ▍E-R-2

审核 ▍Rosy

图文编辑 ▍Lucy

责任编辑 ▍毛毛