Over the years, the United States has gotten a bad rap over one important statistic that usually reflects the health of a society as a whole: infant mortality. A new report by the CDC puts the U.S. infant mortality rate at 6.1 out of every 1,000 live births — #27 out of 34 developed nations, and #56 worldwide. But new data, says Cari Romm, shows that these numbers don’t tell the whole story:
The researchers compared data on infant health and mortality in the U.S [6.1 infant deaths per 1,000 live births].; Austria, whose rate of 3.8 is roughly average among European nations; and Finland, whose rate of 2.3 is one of the lowest in the world. One of the biggest differences, they found, was in the definition of what could be considered a live birth. “Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries,” they wrote. Although the chance of survival for babies born before 23 weeks is low (the American Academy of Pediatrics recommends that doctors don’t resuscitate babies born before that point), they’re recorded as live births in the U.S.
“There’s a viability threshold—we basically have never been successful at saving an infant before 22 weeks of gestation,” says Emily Oster, a professor of economics at the University of Chicago and one of the study authors. “When you do comparisons, if other countries are never reporting births before that threshold as live births, that will overstate the U.S. number relative to those other places, because the U.S. is including a lot of the infants who presumably existed as live births.”
When the “non-viable” live births are excluded, the infant mortality rate comes much closer to the rates of our European counterparts: 4.2 deaths per 1,000 live births (a 40% difference). This is good news. The question is: where and when are most infant deaths happening in this country?
In order to answer this question, we need to divide “infant” mortality into three time periods of infancy: premature live births (especially the “extreme” premature births described above), neonatal or newborn babies (from birth to one month of life), and infant or postneonatal lives (from one month to one year of age). Romm drills down further and discovers that the high numbers occur not in the premature realm (when the aforementioned adjustments are made) but in the months after the neonatal period:
When the researchers broke the statistics down by age, they discovered that neonatal deaths were actually less frequent in the U.S. than in Austria and Finland. (“Neonatal” refers to infants up to a month old, while “postneonatal” includes those between one month and one year.) In other words, American babies are mostly fine while they’re in the hospital and during their first days at home—but over time, that changes.
The reason appears to be socioeconomic: states with the highest level of poverty (Alabama and Mississippi are cited by Romm as two of the poorest) have the highest infant mortality rates. What’s more, poverty in the U.S. is somehow different than poverty in developed European nations:
When the researchers took socioeconomic status into account, they found no significant difference in mortality across the three countries among babies born to wealthy, well-educated women. Lower down the socioeconomic ladder, though, the differences became stark; children of poor minority women in the U.S. were much more likely to die within their first year than children born to similar mothers in other countries.
“I don’t think we have a deep understanding of what’s going on there,” Oster admits.
More research will undoubtedly focus on these differences. However, one stark difference between the U.S. and Europe is the degree to which mothers, infants, and children have access to medical care — both prenatally and postnatally. Unless the U.S. improves (and ultimately ensures) access for all — healthcare policy that American citizens still cannot agree upon — the discrepancy of infant mortality among nations is likely to continue to be glaring.