The Economist 翻译系列 NO. 4
原文请见：https://www.economist.com/news/united-states/21725832-question-harder-answer-you-might-think-pregnancy-america-much-deadlier
The question is harder to answer than you might think
这个问题可能比你想象的更难回答
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. 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.
很少有什么事比一个正在怀孕或者生孩子的妇女的死亡更为悲惨。在美国，正如在其它富裕国家一样，这种死亡事件极少发生。尽管这样，每年仍有700~800位孕产妇死亡。用某些方法衡量时，美国的孕产妇死亡率是富裕的欧洲国家的几倍高。而用另外一些方法衡量时，美国和英国的比率一样。
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.
一个问题是到底什么算作孕产妇死亡。用于国际性对比的标准定义，如国际卫生组织发布的定义，是指从怀孕起到妊娠结束后六周内由妊娠并发症引起的死亡。
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.
在富裕国家，这些死亡数据是从人口动态登记系统中取得的，而人口动态登记系统的数据来源于死亡证。然而，众所周知这些数据会低估孕产妇死亡率，部分原因因为医生们必须从成千上万的代码中选择一个死亡原因。他们更有可能会从怀孕引起的医疗问题的子集中选择，因为表格本身已经有一个判断妇女是否怀孕的勾选框。
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 erroneously—showing recent pregnancy on the death certificates of women who died in their 50s, for example.
美国2003时就在标准的死亡证上加上了这个勾选框，但是所有州真正用上这个框是在十多年后。约翰霍普金斯大学的Andreea Creanga认为，这真是让人喜忧参半。一项最近的调查表明，这个勾选框的普及使用解释了2000-14期间80%的孕产妇死亡率的突然增加。虽然许多本来有可能会被遗漏的孕产妇死亡率现在因为这个勾选框被登记了下来，但是也经常会被记错---比如说，有的死亡证上显示50多岁时去世的妇女怀着孕。
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.
根据死亡证的数据，美国的比率是每10万活产（婴儿出生存活数）中有21例孕产妇死亡。而在英国，没有使用是否怀孕勾选框的情况下，比率低了四到五倍。这个比率，英国的卫生组织认为根本不能信。
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.
因为死亡证在区分孕产妇死亡方面收效甚微，一些国家，包括美国、英国和法国，使用其它的系统来跟踪孕产妇死亡。这些系统广撒网以找到所有可能被算作孕产妇死亡的数据。它们从医院、法医、报纸甚至普通市民的建议中搜集报告。专家们评估所有找到的死亡事件的医疗记录。只有那些明显是由于怀孕引起的健康问题导致的才被计为孕产妇死亡。比如说，如果导致妇女死亡的一系列原因最初是由哮喘引起的，那么，只有在怀孕引起了哮喘或者使得哮喘恶化的情况下，才会将这例事件统计为孕产妇死亡。
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，这种由疾病控制与预防中心（CDC）运作的详细的系统，统计孕产妇死亡率时会统计到妊娠后一年内（由于怀孕导致的死亡，比如产后抑郁导致的自杀，有可能会在生育数月后发生）。在这种测量方法下，美国2011-13（有公布数据的最新期间）的孕产妇死亡率为每10万活产中有17例。使用同样方法统计时，英国2012-14的孕产妇死亡率几乎完全相同。
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.
如果说因为美国的系统需要把50个州的数据加起来而各州收集数据的能力不一，英国的系统在探测孕产妇死亡率上更为有效。但是，可以确定的是，没有人真的清楚在美国怀孕到底比在其它富裕国家危险多少。
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