November 29th, 2007

Haring baby

Why Is Infant Mortality So High in the United States?

I know the simple, and simple-minded, answer: because we have a grossly inefficient health care delivery system that denies care to large numbers of USAmerican citizens. But I'm thinking more of just how and why we have rates of infant mortality that are higher than most of the developed world.

First of all, definitions: the infant mortality rate is the number of deaths of babies under one year divided by the number of births in a given year. That's then expressed as the number of deaths per 1000 births (because typically it's small enough that percentages don't make sense to use). The U.S. infant mortality rate was 6.8 in 2004, the latest year for which figures are available. A partial list of countries with lower (i.e. better) infant mortality rates: Czech Republic, Cuba, Greece, Portugal, Australia, Austria, Canada, Denmark, Ireland, Italy, Luxembourg, Netherlands, New Zealand, Spain, United Kingdom, Belgium, Finland, France, Germany, North Korea, South Korea, Norway, Switzerland, Iceland, Japan, Sweden. In the case of the last three, the rate is less than half that of the U.S.

So the US continues to lead the developed world in high rates of infant mortality. The rates have gone down over the years, and even in recent years. In 1950 the rate was 29.2, in 1960 26.0, in 1970 20.0, in 1980 12.6, in 1990 9.2. Rates are much higher for babies born to black mothers than to white mothers, higher for the poor than the wealthy. Race and income definitely affect infant mortality but in in all racial and socioeconomic categories the rate is going down.

So, like I said the simple - and perhaps simple-minded - answer is our health care delivery system: without universal health care and universal insurance we have a number of bad outcomes and infant mortality is one. But I'm not sure how that works, or how to factor in (if it's true) the impression one gets that in this country money and effort is spent on saving lives of infants that would not be expended in a lot of countries (the "extraordinary measures" argument). Maybe extraordinary measures just don't work very often, and that's why they're not reflected positively in infant mortality figures although they are reflected negatively in our health care costs.

The leading causes in this country of infant mortality are birth defects and complications resulting from pre-term birth. Those two groups account for more than half of infant mortality in the United States.

How would better access to health care reduce infant mortality? What would happen that would make babies less likely to be born early or born with congenital problems? If lack of prenatal care is an issue, how does it lead to premature birth or birth defects?

Could it be that in some countries greater access to prenatal testing and abortion keeps the rate low? I note that the big drop in 10-year rates in the US happened when abortion became legal. Were a lot of women forced previously to give birth to babies that could not survive? Is that still happening in the US in places where abortion is hard to get, or where women don't have prenatal testing to know of congenital abnormalities? And why does the US rate - although high compared to other countries - keep going down at a time when the numbers of uninsured are increasing?

Thoughts? Discuss amongst yourselves.

ETA: Someone anonymous pointed out that I forgot to mention that the rate is expressed in terms of deaths per 1000 births. So I changed that. S/he also pointed out that different countries may count differently.