A 2014 report by the US Centers for Disease Control and Prevention (CDC) compares the infant mortality rate in the US with other nations around the world. This report is in response to data published in the Central Intelligence Agency (CIA) World Factbook for 2013, which ranked the US in 51st place for infant deaths, with fewer infant deaths occurring in most European nations, Korea, Israel, Australia, and New Zealand.
CIA Study Too Generalized
The CDC study indicates comparing all infant deaths as the CIA data does is too generalized to provide a realistic account of the infant mortality rate in the US. Especially, infant mortality after 30 days, after neonatal mortality has been accounted for, is unrelated to pregnancy care. For its study, the CDC categorized infant deaths by birth factors that include preterm delivery and gestational age, and ranks the US in 26th place instead of 51st.
Comparing Apples to Apples
Alice Chen, from the University of Southern California, took the comparison one step further. She and her research team compared infant mortality rates in the US with rates in the United Kingdom (UK), Finland, Belgium, and Austria because these nations document birth and death using much the same criteria as the US. When babies are born at very low birth weight or very prematurely, for example, some nations do not document them as live births since their chance of survival is often quite low but the US documents these most fragile of babies as live births.
Another factor in Chen’s selection of these nations is that she was given access to birth and death records for them. Access did not include personal identifying data such as name, address, and such but was limited to just the data needed for her comparative study.
Chen further narrowed the focus of study to better compare apples to apples. Instead of comparing all infant deaths by nation during her study period, she focused only on births that met all these factors:
- Singleton births.
- Born at 22 weeks gestation or later.
- Birth weight of 500 grams (1.1 pound) or more.
Weight and age at death were also factors evaluated in the study.
Infant Mortality Defined
In the broadest sense, infant mortality means death of a baby at any time before its first birthday. Circumstances of birth, such as gestational age and birth weight, are such significant influences on long-term health that infant mortality rates are often defined more clearly as:
- Neonatal mortality– Death occurring during the first 28 days of life (neonatal = new (neo) and birth (natal).
- Post-neonatal mortality– Death occurring between day 28 and 12 months.
Babies born prematurely or at term but of low birth weight often spend their first days in a neonatal intensive care unit (NICU) before going home. In the US, the mean length of NICU stay is 13 days, according to the March of Dimes Foundation.
Comparing Neonatal to Post-Neonatal Mortality
When death during the neonatal period was compared across nations, the US mortality rate was comparable to those in Chen’s study. She even suggests babies born in the US might have an advantage during the first 28 days of life over babies born elsewhere.
Things do change in the US, however, once a baby passes the one-month (28-day) mark. The post-natal death rate in the US increases significantly. Chen’s study indicates the increase in death rates in US children between one month and one year of age is greatly influenced by policy and socioeconomics rather than by medical care during pregnancy and childbirth.
Policy Influences
The medical system in the US is remarkably different than that of the other nations in Chen’s study. In Austria, Belgium, Finland, and the UK, every citizen is covered for medical care that is equally available to all, regardless of where one lives or household income.
In the US, there is no uniform distribution of health care. Healthcare policies vary by state. In some states, access to health care is abundant and almost all residents can get the medical care they need. In other states, access is sparse and coverage limited.
The provider of healthcare insurance is another factor that makes medical care in the US different. Although the Affordable Care Act (ACA) provides a foundation of coverage required of all providers, details differ according to plan.
The ACA itself offers tiered levels of coverage instead of a uniform system of coverage. The plans offered by the ACA are different from what can be purchased individually by a private insurer. Private insurers typically offer an assortment of coverage plans that provide different levels of coverage beyond the basic maternity coverage mandated by the ACA. Different still is coverage provided by an employer which, again, varies dramatically based on employer choice of coverage, state of operation, and provider options.
Socioeconomic Influences
Socioeconomic disparity in the US is a crucial factor in the infant mortality rate, too. Household income and availability of jobs are historically limited in the southern US, Rust Belt states, and sparsely populated states of the American West while other regions, especially the Northeast and Pacific Coastal states, enjoy greater affluence and access to well-paying stable jobs.
Chen’s study found that post-neonatal death rates in the affluent regions of the US are quite comparable to those of the European nations in her study. The post-neonatal mortality rates, however, were much higher in America’s impoverished regions, where access to health care is much more limited. The post-natal death rates in these regions are so high that they drive up the nationwide infant death rate enough to place the US in low standing on a global scale.
Chen concludes with the suggestion that limited access to medical care in regions of historic socioeconomic challenge costs the US many young lives that might be saved if these babies had access to similar standards of care as babies in wealthier regions. Medical access alone isn’t enough, though. She recommends public awareness campaigns, parenting classes, in-home visits, and similar interventions that could better educate parents and caregivers on how to raise healthy babies from the minute they are brought home from the hospital.
Sources:
Chen, Alice, Emily Oster, and Heidi Williams. "Why Is Infant Mortality Higher in the United States Than in Europe?" PMC. American Economic Journal / American Economic Association, 4 May 2016. US National Library of Medicine / National Institutes of Health. Web. 4 Aug. 2016.
"Special Follow-Up Care for Low Birth Weight Infants." babyMed. BabyMed.com, n.d. Web. 4 Aug. 2016.
Carroll, Aaron E. "The U.S. Is Failing in Infant Mortality, Starting at One Month Old." The New York Times. The New York Times Company, 6 June 2016. Web. 4 Aug. 2016.