U.S. Newborn Survival Rate Ranks Low

AP Medical Writer Lindsey Tanner has a story Yahoo! News has headlined, “U.S. Newborn Survival Rate Ranks Low.”

America may be the world’s superpower, but its survival rate for newborn babies ranks near the bottom among modern nations, better only than Latvia. Among 33 industrialized nations, the United States is tied with Hungary, Malta, Poland and Slovakia with a death rate of nearly 5 per 1,000 babies, according to a new report. Latvia’s rate is 6 per 1,000. “We are the wealthiest country in the world, but there are still pockets of our population who are not getting the health care they need,” said Mary Beth Powers, a reproductive health adviser for the U.S.-based Save the Children, which compiled the rankings based on health data from countries and agencies worldwide.

The U.S. ranking is driven partly by racial and income health care disparities. Among U.S. blacks, there are 9 deaths per 1,000 live births, closer to rates in developing nations than to those in the industrialized world. “Every time I see these kinds of statistics, I’m always amazed to see where the United States is because we are a country that prides itself on having such advanced medical care and developing new technology … and new approaches to treating illness. But at the same time not everybody has access to those new technologies,” said Dr. Mark Schuster, a Rand Co. researcher and pediatrician with the University of California, Los Angeles.

[…]
The researchers also said lack of national health insurance and short maternity leaves likely contribute to the poor U.S. rankings. Those factors can lead to poor health care before and during pregnancy, increasing risks for premature births and low birth weight, which are the leading causes of newborn death in industrialized countries. Infections are the main culprit in developing nations, the report said.

[…]

While the gaps for infants and mothers contrast sharply with the nation’s image as a world leader, Emory University health policy expert Kenneth Thorpe said the numbers are not surprising. “Our health care system focuses on providing high-tech services for complicated cases. We do this very well,” Thorpe said. “What we do not do is provide basic primary and preventive health care services. We do not pay for these services, and do not have a delivery system that is designed to provide either primary prevention, or adequately treat patients with chronic diseases.”

While I’m sure that disparities in our system at least partly explain the differential rates between demographic sectors, they are unlikely to account for the United States consistently ranking so low in these studies. As I noted recently in response to another study, international comparisions, especially between developed and developing states, is highly problematic because there is a wide variance in record keeping practices.

The EU:

The infant mortality rate represents the ratio between deaths of children under one year and the number of live births in a given year. Countries, however, use different definitions for spontaneous abortion, early foetal death and late foetal death (or stillbirth). A stillbirth for example is, generally speaking, the product of a birth that shows no signs of life during and after the whole process of being born. But countries require different lengths of pregnancy to distinguish between early and late foetal deaths (ranging from 21 to 28 weeks). Some countries even require a certain minimum length (varying between 25 and 35 centimetres), some a certain minimum weight (500 or 1000 grams). Differences of definition lead to variations in the measurement of perinatal mortality.

CDC:

Comparison of mortality characteristics of different countries assists health planning and the generation and investigation of epidemiologic hypotheses. International studies, such as studies of the association of aflatoxin and primary liver cancer (4), can reveal a range of exposure levels and disease rates not found in individual countries. However, although death registration is virtually complete in these countries, reporting of cause of death is not uniform either among or within European countries or the United States (5,6). Only comparison of all-cause mortality among developed countries is likely to be accurate. Demographic heterogeneity also constrains the comparison of populations.

BioMed Central:

Despite worldwide concern, an outstanding problem is how to monitor maternal mortality and to obtain reliable and comparable data. Measuring maternal mortality accurately is notoriously difficult except where there is comprehensive registration of deaths and causes of death. Unfortunately, there are only a few countries where such registration could be characterized as complete [3] and even in these countries, poor attribution of cause of death results in significant underreporting of maternal deaths [4,5]. In addition, countries with complete death registration are countries with low maternal mortality, and, consequently, countries where it is not a public health priority. It is in countries where a reliable vital registration system is not in place where maternal mortality represents a public health problem that cannot be accurately measured.

Several alternative techniques have been developed to fill the gap caused by poorly functioning vital registration systems. Of these, the Reproductive Age Mortality Studies (RAMOS) are considered the gold standard for measuring maternal mortality because it involves identifying and investigating the causes of all deaths of women in reproductive age [6]. Another approach currently used in most developing countries derives estimates of maternal mortality from household surveys or surveys using the sisterhood method [7]. The sisterhood method is an indirect measurement technique that reduces sample size of the surveys by interviewing respondents about the survival of all their sisters [7]. Data on maternal deaths obtained through census has also been proposed as a means of estimating levels of maternal mortality [8]. Drawbacks include high costs in the case of RAMOS, large sample sizes required for household surveys and the use of estimates intrinsically referring to the past instead of the current situation in the case of sisterhood methods. Differentials in the definition of maternal death, varying efforts carried to capture maternal deaths, and the methods used to confirm the deaths as ‘maternal’ are some of the inherent discrepancies in these methods that may affect estimates and impede comparisons. Unfortunately, a measure allowing for comparisons between these methods is lacking.

WHO, jointly with UNICEF and UNFPA, has made efforts to monitor maternal mortality by producing global, regional and national estimates for 1990, 1995 and 2000 [3,9,10]. Different methodologies used to calculate maternal mortality ratios as well as the lack of national data for many of the countries have been identified as major problems in assessing the global situation as well as for monitoring trends. Estimates for 2000 suggested 529,000 maternal deaths worldwide with an average maternal mortality ratio of 400 per 100,000 live births, and accounted for 173 countries with 99% of global births. However, 62 countries (27% of global live births) had no national data available, and maternal mortality estimates for those countries were developed using a regression model based on a set of explanatory country-specific variables that are available for nearly all countries in the world [3]. An alternative model based also on country-specific variables was also proposed using the same data set [11].

Given that I know this, it’s inconceivable that professional medical researchers and/or AP’s medical writer do not. When they don’t even bother to mention this disparity, I am quite dubious of their agenda.

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Jay says:

    In this country we try to save babies born earlier than anywhere else, and count those in the mortality rate when they (largely) don’t make it. Those are ones they don’t even count elsewhere. It’s the preemie factor. Ironic, to appear worse because we are so much better we can save some newborns nobody else can.

  2. Maggie says:

    (1) The US is probably the leader in IVF/test tube babies, which also causes many multiply births, leaving some of those infants susceptible to numerous medical problems.

    (2) We keep hearing how many illegals there are in this country and how they are reproducing at greater numbers than American citizens …. what is their cultural predisposition to seeking medical help during a pregnancy? Are those numbers included in this study?

  3. ron says:

    my wife is a newborn nurse at a tx state hospital. when I asked she said that if a baby is born live it is counted as a live birth even if the baby is born at 26- weeks. I know that france and britain do not do this. also many mexicans(legal and illegal) cross the border just to give birth in an american hospital and then return home without ever having any prenatal care during the pregnancy.

  4. yetanotherjohn says:

    I am also familiar with the differences in what is a live birth across nations. What I would love to see is a comparison (even if limited to one or two other countries) that would characterize our data according to the other countries standard or the opposite. At a gut level, I don’t hear about this as a major issue. That certainly isn’t dispositive of the issue, but along with the anecdotal difference about the difference in how things are measured makes me skeptical.

    On the other hand, in discussions with liberal friends, this and the life expectancy are almost uniformly used as the measure of our national health care (and thus justification of the need for national health care). The fact that countries with national health care are both above and below our life expectancy and that countries without national health care are above and below our life expectancy don’t seem to register. What seems to prevail in their argument, and the article you site though not as openly, is that the ends (national health care) justifies the means (ignoring inconvenient facts that don’t point the way to the ends). While such reasoning can feel good for a while, in the long run they fail. Either because someone tears the arguments to shreds, enough questions get raised that any validity in the argument gets lost or they win the battle and lose the war as the reality set in showing that things have more shades of grey when it comes to the real world.