Monday, April 19, 2010

How does the infant mortality rate in the US compare?

So many times, healthcare "reform" supporters tout the high level of infant mortality (and the disparities between ethnicities) as evidence of the United States' poor health care system. According to the CDC, "The U.S. ranks 29th worldwide in infant mortality, tying Slovakia and Poland but lagging behind Cuba." But what is the truth behind this oft-used statistic? Differing methods of live birth measurement between countries, advances in medicine, and rates of low-birth-weight pregnancies all affect the "discrepancy." All babies showing any signs of life, such as muscle activity, a gasp for breath or a heartbeat, should be included as a live birth, according to the World Health Organization (WHO). The United States abides by this definition; however, many other countries do not.
  • Switzerland doesn't count babies shorter than 30 cm
  • Italy doesn't have a standard definition for the whole country
  • Austria and Germany, fetal weight must be at least 500 grams before these countries count these infants as live births.
  • In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless.
  • Some countries don't reliably register babies who die within the first 24 hours of birth
  • In many ex-Soviet CIS countries (who still use the Soviet era definition), "breathing is the only criterion for life. In addition, infants who are born at less than 28 weeks, weighing less than 1,000 grams or measuring less than 35 centimeters are not counted as live births if they die within seven days" according to UNICEF. "The communist system stressed the need to keep infant mortality low, and hospitals and medical staff faced penalties if they reported increases in infant deaths. As a result, they sometimes reported the deaths of babies in their care as miscarriages or stillbirths."
When the distribution of low-birth-weight babies are adjusted, infant mortality rates start to equalize. Teenage pregnancy, which is three times higher in the US than in Canada, produces more premature, low birth-weight babies. A 2007 (NEBR) paper (table 2 to the left) found that "[W]ithin birth weight specific categories, mortality rates in the U.S. are lower than Canada’s in the three lowest birth rate categories where mortality rates are highest and the same or slightly higher in the two highest weight categories." If the US had the Canadian birth weight distribution, the infant mortality rate would decrease to 5.4, which is less than Canada's 5.5. "Taking into account such data-reporting differences, the rates of low-birth-weight babies born in America are about the same as other developed countries," concluded economist John Goodman in his book, "Lives at Risk." Also, aside from counting discrepancies, US medicine has advanced to the point where heroic attempts to save low-weight infants' lives, which had previously been considered impossible, are now possible and considered to be the standard of care. Often these infants have a high risk of mortality and would have otherwise been considered miscarriages or stillbirths and not a live birth [see above] had an attempt not been made. Unfortunately, since these infants are counted as live births AND have high rates of mortality, it can only adversely affect the infant mortality rate. So, no, the US health care system doesn't fail infants. On the contrary, we're pretty on par with the rest of the world. Case closed on this failed usage of this statistic.

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