What Explains Our High Infant Mortality Rate?

This is Sally Pipes, writing in the Wall Street Journal:

Doctors in the U.S. are much more aggressive than foreign counterparts about trying to save premature babies. Thousands of babies that would have been declared stillborn in other countries and never given a chance at life are saved in the U.S…. Unfortunately, some of the premature babies that American hospitals try to save don’t make it. Their deaths inflate the overall infant mortality rate. But most premature babies are saved, largely because America’s medical research community is exceptionally innovative.

But Aaron Carroll quotes directly from the international study:

When compared to peer countries, the United States was the absolute worst with respect to still births, infant mortality, and low birth weight. Some have tried to blame this on “coding” differences. In other words, they will claim that other countries will refuse to define a premature birth as we do, resulting in artificially high numbers in the US. But when this report recalculated the rates to exclude such births equally in all countries, we still ranked last.

Comments (15)

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  1. Evan Carr says:

    The contrasting evidence is certainly curious. The answer as to why our mortality rate is so high still seems to elude us. My guess would be that it involves overall lower health statuses of U.S. mothers coupled with the fact that many nations around the globe still rely on a preponderance of natural births and many hospitals in America do not provide high quality care.

  2. Sadat says:

    “When this report recalculated the rates to exclude such births equally in all countries, we still ranked last,” interesting, so what is attributing to this difference. I am guessing the US is being compared to other OECD countries, and even there, the US has the largest population, so our high numbers can be attributed to the high mortality since we probably have more births.

  3. Joe S. says:

    I believe it’s basically our heterogeneous population. Black women have twice the infant mortality rates of white women at every level of education.

  4. Trent McBride says:

    Actaully, it’s mostly due to our composition of births by birth weight/age (i.e. we have a much higher prevalance of premature births. When corrected for this in a subset of OECD countries, our rankings increase a lot. (See: http://www.cdc.gov/nchs/data/databriefs/db23.pdf) And see my more detailed comment on Carroll’s post (currently awaiting moderation):

  5. Andrew O says:

    I don’t much of the suggestions given here are valid. There could be tons of reasons we haven’t thought about, but until real evidence is given, we can’t be certain. What really troubles me is the fact that the fact that we are last is not pervading news outlets and forcing policymakers to address this issue.

  6. Angel says:

    I believe it’s because too many mothers opt not to get medical care because they can’t afford it.

  7. James Lansberry says:

    If Angel is correct (and she may be…and because of low reimbursements from state medicaid for prenatal care) then organizations like the Morning Center (www.morningcenter.org) would be an important, private step towards lowing that IM rate.

  8. Yaj Reizarb says:

    Worth reading through the comments below the Incidental Economist post…

  9. Floccina says:

    There are also more people getting fertility treatments in the USA than in other countries. This produced more multiple births and more low weight births.

  10. Al says:

    Aaron Carroll on his blog says “We’re giving our data to these studies.” accusing others of cherry picking. That is exactly what I have seen on his blog where alternative opinions are repressed. I would like his explanation of why the US is the best at treating low birth weight infants and relatively similar to the best when treating normal birth weights yet we do so poorly when we add the numbers together. [Nicholas Eberstadt. 1995. The Tyranny of Numbers: Mismeasurement and Misrule. The AEI Press, Washington, DC. Pp43-73.] It doesn’t add up and neither do Aaron’s conclusions.

  11. Milton Recht says:

    US has highest teenage birth rates. Also, US had highest level of working women with many deferring childbirth until their careers are established and are older. Need to age adjust data and compare infant mortality by mother’s age. I suspect much of the mortality difference for infants will disappear if births per similar mothers’ age groups were compared against each other.

  12. MarkH says:

    JoeS is on it. When you break down where the infant mortality is occurring in this country, you see it has nothing to do with coding, and everything to do with poverty and poor prenatal care. Go to state health facts and play with the maps and stats and you see, wealthy states like New York, Massachusetts, California have infant mortality rates equivalent to the best performing states in the world. However, poorer states, states that typically receive more in taxes than they pay out like Louisiana, Mississippi, and Alabama, have infant mortality rates comparable to the top end of the third world. It’s not coding differences between New York or Massachusetts and Mississippi. It’s money, which means greater access to prenatal care, and the ability of citizens to take advantage of the technology that’s been responsible for decreasing infant mortality over the last century.

  13. Maria Jimenez-Herrera says:

    Unfortunately, Mark is correct. Poor people deliver pre-term children more often than rich people.
    Here is a CDC pamphlet that one of my social worker friends showed me: http://www.cdc.gov/media/subtopic/matte/pdf/CDCMatteReleaseInfantMortality.pdf

  14. James Lansberry says:

    I’ll again, put in a plug for the Morning Center (www.morningcenter.org). We will be using mobile health care practitioners in the inner city to increase the % of pre-natal care given to the poor, using completely private charitable dollars. Our pilot launch is this year in Memphis, (the US city with the highest infant mortality rate), trying to minister to the thousands of women there who give birth without ever having a pre-natal visit before they show up at the hospital to deliver. Our goal is to offer the urban (and eventually the rural) poor something better than, and more personal than Medicaid.

    James Lansberry
    National Director
    the Morning Center

  15. Al says:

    Maria Jimenz-Herrera says: ” Poor people deliver pre-term children more often than rich people.”

    That is correct, but the mistake Aaron Carroll makes here and elsewhere is blaming these types of things on our health care system when the cross country differences we see in infant mortality rates (and other things) are mostly due to social-economic problems.

    As an aside, some countries let small or very low weight new borns die on the table and call them miscarriages. That markedly improves their infant mortality rates.