An estimated 2 million babies die within their first 24 hours each year worldwide and the United States has the second worst newborn mortality rate in the developed world, according to a new report.
American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.
Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.
"The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn rate is higher than any of those countries," said the annual State of the World's Mothers report.
Well yes, all "statistically" true. But not because the US has an inferior health care system like so many would like to claim (and, of course, then claim that a universal health care system would "save the babies"), but instead because while there is a standard for reporting infant mortality statistics throughout the world, it appears only the US follows it.
WHO defines the standard as follows:
According to the World Health Organization (WHO) definition, 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. The U.S. strictly follows this definition.
Switzerland, for instance, doesn't count the deaths of babies shorter than 30 cm, because they are not counted as live births, according to Nicholas Eberstadt, Ph.D., Henry Wendt Scholar in Political Economy at the American Enterprise Institute and formerly a Visiting Fellow at the Harvard University Center for Population and Developmental Studies. So, comparing the 1998 infant mortality rates for Switzerland and the U.S., 4.8 and 7.2 per 1,000 births, respectively, is comparing apples and oranges.
Why doesn't it count babies shorter than 30cm? Because they're most likely to be low-birth weight babies which statistically have a much higher probability of dying. So Switzerland simply counts such babies as "still-births" which don't impact their infant mortality rates.
Read through the explanations found here to understand why the Swiss would try to exclude this category from its statistics. You'll find that the category they exclude is the category with the highest mortality rate.
Other countries are no different. For instance, former easter bloc countries and Russia:
A UNICEF press release noted: "Under the Soviet era definition ... 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. This Soviet definition still predominates in many [formerly Soviet] CIS countries."
Other countries, such as Italy, use different definitions in various parts of their own countries. Eberstadt observes that "underreporting also seems apparent in the proportion of infant deaths different countries report for the first twenty-four hours after birth".
And of course there are many more examples. As an example, look at the statisitcal anomolies here:
In Australia, Canada, and the United States, over one-third of all infant deaths are reported to take place in the first day. ..." In contrast, "Less than one-sixth of France's infant deaths are reported to occur in the first day of life. In Hong Kong, such deaths account for only one-twenty-fifth of all infant deaths."
In other words just about every country reporting these statistics has a different standard for reporting with only the US, apparently, using the strictest.
Since the United States generally uses the WHO definition of live birth, economist John Goodman and others in their 2004 book, "Lives at Risk," conclude, "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 in the OECD [Organization for Economic Cooperation and Development]." Likewise, infant mortality rates, adjusted for the distribution of newborns by weight, are about the same.
And, ironically, US statistics are, in a way, a result of our technological advances, advances that have given more marginal babies a chance for survival than they have had at any other time in our history:
American advances in medical treatment now make it possible to save babies who would surely have died only a few decades ago. Until recently, very-low-birth-weight babies, those weighing less than 3 pounds, almost always died. Now some of these babies survive with the help of breathing assistance and other recent inventions.
While such vulnerable babies may live with advanced medical assistance and technology, low-birth-weight babies (weighing less than 5.5 pounds) recently had an infant mortality rate 20 times higher than heavier babies, according to the WHO. And these deaths count as infant deaths even though most would have been counted as stillbirths if they hadn't received the gift of life, however transitory.
Ironically, American doctors' ability to save babies' lives causes higher infant mortality numbers here than would be the case with less advanced medical treatment.
So when you hear all the wailing and gnashing of teeth in the following days, and the anguished questions of "why can't the most advanced country on earth save more of it's babies", take it with a huge grain of salt, please. We now save babies who would never have had a chance at life because of our technology, not despite it.
When and if such reports as this can certify that all reporting nations are using the same standards, then you can begin to take them seriously. Until then, feel free to ignore them.
This was a genuinely interesting counterpoint, coming from someone who believes that our infant mortality is high because we let kids die because our health care system sucks.
However, while you’ve planted a seed of doubt, you haven’t proved anything. Every statistic in the world is subject to a certain degree of deviation in the parameters used for consideration. I know for a fact that GDP is subject to the same reporting quirks, and yet I don’t hear you casting seeds of doubt about our seriously underevaluative GDP statistic.
I believe our infant mortality stat has been declining, and regardless of difficulties with comparisons, that is a serious problem. Unless you have a convenient explanation for that as well.
Before we go accusing various countries of deliberately trying to hide their true infant mortality rates, we should consider that different countries have always had different standards of reporting, even before the invention of infant mortality statistics. For example, it is known by genealogical researchers that in some countries, births recorded as stillbirths may actually have been live births where the baby died shortly after. Because this is known, infants marked as "stillborn" from these countries may have Mormon temple ordinances performed in their behalf on the off-chance that they actually had lived, while temple ordinances may not be performed for "stillborn" infants from countries where infants who died after birth were recorded as live births.
I’m sorry I don’t remember exactly which countries had the different standard. My ancestors mostly come from Catholic countries, where babies who died shortly after birth were recorded as live births followed by emergency baptisms, and stillbirths were not recorded in the baptism registers. Since there weren’t any civil registers at that time, the Catholic Church’s definition prevailed in those countries.
Glasnost, I think I can provide at least a partial explanation of declining infant mortality. One thing stuck out at me in one of the links McQ provided is that the incidence of multiples (twins, triplets, etc.) is up because fertility drug use is on the rise. Some large proportion of multiples are born prematurely, and each one of them counts toward the infant mortality statistics. And the article also mentioned that even in singleton pregnancies, the use of fertility drugs can affect infant mortality as well.
Before we go accusing various countries of deliberately trying to hide their true infant mortality rates, we should consider that different countries have always had different standards of reporting, even before the invention of infant mortality statistics.
That’s the point, Hermit. The problem is, this report, when issued, never notes those differences, hence people tend to believe it is an apples to apples comparison when, in fact, it isn’t. They also then tend to buy the implication that our health care system is inferior, when it isn’t. Lastly they aren’t aware that our technology has saved babies that wouldn’t have had a chance a few decades ago, but because we attempt to save them and aren’t completely successful, our stats seem higher.
That’s helpful information. Over in this post I call shenanigan’s on the "mother’s index" that was part of the same report from Save the Children. The first two items on the mother’s index criteria punish the U.S. for actually having babies. Hint: all of the other top 10 countries that outranked the U.S. have lower birthrates.
So here’s glasnost, who ’believes’ we "let kids die because our health care system sucks," yet he’s demanding proof to counter his ’belief.’ Isn’t that ironic?
Then he attempts to cast doubt on the messenger who offers contrary evidence to his belief by accusing him of failing to question the validity of a completely unrelated statistic! Isn’t it rich!?
I do have a convenient explanation for your belief, glasnost. You don’t genuinely care about finding the truth; you want to believe what already fits into your comfortable, if not well-founded, views. That is far easier a task than the hard thinking and change that might be required.
Damn, Chris beat me to it. -=-=-=-=-=-=- glasnost, GDP measurement has nothing to do with infant mortality. It’s a non sequitor.
And McQ did prove several things. What about
"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 in the OECD [Organization for Economic Cooperation and Development]." Likewise, infant mortality rates, adjusted for the distribution of newborns by weight, are about the same.
Lots of sniper fire today. For the record, I would love to see statistics that accurately adjust for the differing methods of calculating infant mortality in developed countries. I believe that our infant mortality here in the U.S, pardon my slip of the tongue earlier, has been rising. If so, that’s a serious problem, and I have yet to hear anyone specifically dispute this fact.
Frankly, I don’t trust the assurances listed that once you adjust, we’re "about the same" as other developed countries. What amount of deviation is acceptable? Why aren’t we leading the whole world in infant mortality? I don’t see that claim here.
GDP is not directly related to infant mortality, but it is obviously not a non-sequitur. Infant mortality is not the only global statistic reported differently by different nations. Yet I don’t hear anyone ever bring such discrepancies to light when trying to highlight our ever-so-wonderful economic growth. (Of course, you can have a legitmately high GDP and a poor economy anyway, so even if that statistic was adjusted and proved to be legit, my beef would remain..)
Sure, I’m interested in the truth. I am just not fully convinced that our unusually high infant-mortality rate can be thrown out entirely because *some countries use easier reporting standards. Are we really the only ones in the world using the WHO standard? I doubt it.
I am just not fully convinced that our unusually high infant-mortality rate can be thrown out entirely because *some countries use easier reporting standards
You still seem to missing the point glasnost - we are SAVING more babies from still birth than anyone else. Thereby giving them a CHANCE at survival. If we are able to save 1,000 babies that 20 years ago would have been still born, you now have 1,000 more children that are HIGH RISK. Many of them will die. Instead of focusing on that, I believe we should (and McQ asks us) to consider the ones that LIVE. They are a success that is worthy of praise - strive to save more and more of course, but how about we lighten up on the negative associations with it???
I’m thinking maybe we start using the Swiss method of reporting, considering all those small babies to be stillborn but still trying to save them as we already do. Maybe we’ll bring some babies "back from the dead." How’s that for a good healthcare system?
More government interference in medicine will only subject them to the unhealthy, malarious swamps of socialism – infant mortality myths notwithstanding.
Keep that in mind as you’re doing nuclear attack drills under your desk and cursing the commie reds. </sarcasm>
Seriously, can the bias here be any more evident? You can’t compare the infant mortality rate across countries with different definitions of live birth. So the proper response is to cull out the US births that are excluded elsewhere or add the non-US births that are included in the US, and then compare them. To ignore the numbers completely and leap into "malarious swamps of socialism" rhetoric is throwing the baby out with the bathwater, a non-sequitur, and an ad populum tactic.
One more thing:
You still seem to missing the point glasnost - we are SAVING more babies from still birth than anyone else. Thereby giving them a CHANCE at survival.
Of course the other industrialized nations are doing the same thing, so this does not make the US unique. The statistics would show this across the board, evening things out.
It sounds to me like the US, while one of a small number, isn’t the only country following the strict WHO guidelines like you claim. You admit that Canada, a country very comperable to the US in it’s standard of living, follows the guides too. If anything, Canadians, once you move away from the densely populated Great Lakes/St-Lawrence River area, should be at a disadvantage, since hospitals can sometimes be hours away from their homes, and yet Canada provides a lower mortality rate. Federally subsidized health care, while perhaps not the only factor, unquestionably helps Canadians keep the infant mortality rate down.
"I believe that our infant mortality here in the U.S, pardon my slip of the tongue earlier, has been rising. If so, that’s a serious problem, and I have yet to hear anyone specifically dispute this fact."
I see that you can miraculously change your beliefs into facts; can you also turn lead into gold?
So you’re saying it’s basically good that 47 million Americans don’t have health care insurance, because if they did more babies would crop it?
Are these 47 million people suffering from health related issues and unable to get assistance? I have health insurance and rarely use it. I also had a period in my life where my wife and I did not have it. The two times we needed the emergency room, we received services and worked out a payment plan with the hospital. We needed the emergency room because of an allergic reaction to bee’s. I’m guessing our service would have been even better had she been having a baby, and even higher still had the baby been premature.
Sorry McQ, but your simplistic excuses for the rising US infant mortality rates just don’t work. We all know the statistics are not going to be absolutely right, but the trend over years is clear for you to see. And you should be concerned, not dismissive.
I take exception to your comments "And, ironically, US statistics are a result of our technological advances that have given more marginal babies a chance for survival than at any other time in our history" I’m sorry McQ but you seem to think only US doctors save babies at 28 weeks. The technical advances in neo natal care are the result of research from around the world, not just the US. I think the quality of neo natal care in much of Western Europe, Canada, Australia & NZ, Singapore, Japan (and the list goes on) is at least equal to the US.
What utter nonsense. The usual US denial / world conspiracy / we are actually the "best" rant.
Even where there are statistical anomalies in data gathering, they do not change the raw figures substantially. Furthermore, neonatal care as per highlighted by someone above, is as good if not better than the US in much of Western Europe, Japan, Australia and NZ.
The reason WHY the US has a relatively high infant mortality rate compared to developed nations is not because your middle class mum has poor access to antenatal and neonatal care. Rather, it is because of significant health inequities in the system. If you look at the breakdown of the figures it is the infant mortality of poor, black and hispanic babies that pulls up the US numbers.
Though there are health inequalities in all nations, the US is in a league of its own when it comes to developed Western ones.
These figures as highly relevant, contrary to the original author of this article. Furthermore, unless the rest of the world is underreporting their infant mortality rates several fold (which is ludicrous), the US is still seriously underperforming. Let me remind you that the US spends more on health care as a percentage of GDP than any other Western nation by a large margin.
Furthermore, unless the rest of the world is underreporting their infant mortality rates several fold (which is ludicrous), the US is still seriously underperforming.
So how does one square these differences statistically?
In Australia, Canada, and the United States, over one-third of all infant deaths are reported to take place in the first day. ..." In contrast, "Less than one-sixth of France’s infant deaths are reported to occur in the first day of life. In Hong Kong, such deaths account for only one-twenty-fifth of all infant deaths."
Sorry McQ, but your simplistic excuses for the rising US infant mortality rates just don’t work. We all know the statistics are not going to be absolutely right, but the trend over years is clear for you to see. And you should be concerned, not dismissive.
Another who is content to let apples be called oranges and argue with anyone who differs with his opinion.
Don’t let’s use our own heads and think about how many people we personally know who may have, or may not have, lost a child recently.
I don’t know anyone personally that has gone through 9 or 8 or 7 months only to lose the child. I have one myself who hit the air 2.5 months early, and THAT was 20 years ago this July. I haven’t noticed a sudden rash of infant deaths in the last year... have any of you? Course we do have this influx of immigrants from countries where they were getting sterling medical care prior to slipping across our border. That might effect some of OUR numbers, but let that pass, after all, how many of those could there be when there’s only 12+ million of them wandering around outside the system.
How about another statistic though. One cherished by the forces of liberalisim and right thinking people.
What say we discuss a woman’s ’right to choose’ and worry about the number of babies that die THAT way. Ah yes, I forgot, as MK would point out to me, THOSE aren’t babies, are they.....as I recall I asked if they were perhaps puppies.
And I’ll bet Nancy Pelosi will be the first to champion THAT particular right, and no one will worry about THAT particular number of deaths, and no one in the media will fret over that, and whine about how the United States is a disgrace in that regard.
If McQ’s characterization of the statistical situation is correct, and different countries use significantly different definitions of "stillborn", this would also affect the stat "Life Expectancy at Birth". The US suffers here, also, in comparison with other advanced countries. In particular, the Japanese usually beat us by a couple of years.
OK let’s do some really simple math here. Take U.S. rate - throw out the deaths in the first day. Take France. Throw out the deaths in the first day. Now we are comparing only apples to apples.
France 2004 had 4.31 infant mortalitiy deaths per thousand. Substract 1/6th =3.59 deaths per 1000 live births
U.S. 6.63 deaths per live births. Substract 1/3rd 4.42.
France 3.59 adjusted IMR U.S. 4.42 adjusted IMR
Not a trivial difference.
Let’s try it the other way. increase French deaths instead of throwing 1st day deaths for both. 3.59+3.59/6=5.03 FR 5.03 IMR U.S. 6.63 IMR
Still not trivial. So France still has better IMR than we do.
Canada of course uses the same means we do so a direct comparison between them and us is valid. Don’t know what Canadian proximity to U.S. border has to do with it. The number of Canadians who deliver their babies in the U.S. is statisticlly insignificant; substract them from Canadian statistic and you won’t get a different result.
I live in Taiwan and there are large number of Canadians here. Those that have their kids here (and yes, some purposely choose to do so) claim that in Canada you would not get the ultrasound every month as they do here. I don’t know about the USA but apparently you can do that at home (just a joke here at Tom Cruise)
They also said they would be very, very far from neonatal heart surgery teams, etc. depending on where they live.
Do they have numbers to compare Taiwan vs. Canada vs. USA?
In any case, I would argue that your basic care would about the same in any major urban area in an industrialized country. France doesn’t have some super secret technique. I’d guess the differences could be down to education, diet, immigrants, age of women bearing children, etc., and not much to do with "the system."
Let’s just look at birthrates...a helluva a lot of German women aren’t having ANY babies. Maybe those there that choose to have babies are the truly committed and thus do better in bearing live kiddies.
And, yes, McQ is completely correct that how you make your stats will affect this greatly.
In Australia, Canada and the United States, over one-third of all infant deaths are reported to take place in the first day
can be construed to mean that only about 1/3 of US infant mortalities are reported.
The real meaning of the sentence is that in France, of all infant mortalities (deaths), one sixth occur in the first day, and in the US, of all infant mortalities, a little more then one third occur on the first day.
In any case, Canada seems to have comparable statistics. According to the CIA, they have 4.69 deaths per thousand and we have 6.43. They also live on average a year and a half longer for men and three years longer for women.
One thing to add here - the underlying assumption is that the dismal US infant mortality stats reflect our brutal health system, which tosses impoverished pregnant women onto the streets. If only we had some sort of federal program to help poor pregnant women get the prenatal care they need, our infant mortality statistics would improve!
Err, wait a minute - the Federal Medicaid program already loosens its eligibility rules for pregnant women. A lot of the states supplement with extra coverage to expand the eligibility even more. Barring that, there are tons of private charities and organizations willing to help out. Even if you’re an illegal alien, it’s pretty easy to get top notch prenatal care. Bottom line: if you’re pregnant and can’t get cheap (or free) prenatal care in America, you’re probably too busy trying to score your next hit of crack. Either that or the lawyers have driven all the obstetricians out of your county.
The other flawed assumption is that infant mortality statistics are solely a reflection of the nation’s health care system, while ignoring things like demographics, genetics, habits, culture, etc. For example, if you break it down, certain rural regions in Canada have pretty poor infant mortality stats, even worse than the evil US. (But that’s impossible!! - they have universal single payer health care!!)
I’d be willing to bet a thousand bucks that if we ever adopt a universal coverage system in the US we won’t see any significant change in our infant mortality stats.
>Uh, I believe they’re only reporting 1/6th as many so why are your subtracting?
Because I’m adjusting the statistic to compare apples with apples. I’m subtracting IM for the first 24 hours from both the U.S. and France. I’m comparing numbers infant mortality after the first 24 hours - which both the U.S. and France measure the same way. We don’t *Know* how many infants die in France within the first 24 hours according to your point. Some are reported as death; some as still births. So throw out the first 24 hours and compare mortality after that. Alternatively you could do some additional research (since you are the one challenging standard statistics) and compare infant mortality +stillbirths in France to infant mortality+stillbirths in the U.S.
You are interested in making a valid comparison right? You are not just assuming away any data that shows the U.S. as less than number one in any any area?
Maybe the hundreds of thousands of illegal immigrants who take any risk to sneak into the U.S.A. to have their babies (so they can be American citizens) and have had no prenatal care substandard nutrition an suffer from extreme physical stress from their journey . It might be interesting to see if there are “clusters” of infant mortality in the border states. Food for thought..
"I live in Taiwan and there are large number of Canadians here. Those that have their kids here (and yes, some purposely choose to do so) claim that in Canada you would not get the ultrasound every month as they do here."
What does monthly ultrasound have to do with infant mortality? There is no evidence that it actually improves outcomes to do routine ultrasound. Why not save that money and use it to pay for actual medical needs?
If you want to do U.S. vs. a other rich nation comparison of combined infant mortality and still births i.e. - neonatal+parinatal births try the pdf file linked above. Document page 29 is the start of the table. The numbers seem to be 12 per 1000 for the U.S. , around 9 per thousand for other rich nations. You have to add the second column (perninatal mortality rate) and the third from the last (neonatal mortality rate) to get your figures.
The conversation seems to have moved on from denying the existence of a discrepancy between U.S. health to explaining the gap. There has been a lot of research done this issue. So you folks might want to dig up some of the empirical studies, rather than just speculating. If you don’t have time for anything in-depth then google is your friend.
Our health care system is great for those with the insurance or the cash, but it is a strange mix of extravagent with wildly espensive emergency room services but is pennywise pound foolish for those preventive services that have proved their cost effectivenes over and over again like prenatal care.
Yeah, no ideological nonsense in that statement, is there "Freshair"? Not much truth either. But that isn’t particularly surprising given the nonsense you’re pushing at the link cited.
Not once in that cite do you address the points made in our post.
You simply use the same numbers without the context provided here to push the same sloppy thinking and lazy agenda. "Honest analysis"? You wouldn’t know it if you were sitting on it.
And, if I were a betting person, I’d bet you’re actually proud of that.