Is the US infant mortality ranking “shameful”? I say, “no,” but here’s the debate:

Of the over 2000 blogs I’ve posted, one of the most popular was Health Myth #1: “The U.S. has one of the highest infant mortality rates in the developed world.”. Now, in an editorial, USA Today points out that the US has now dropped “to 41st worldwide in newborn death rates.” Is it really that bad here?

USA TOday asserts, “That this is happening in a nation that spends far more per person on health care than any other is puzzling and shameful.”

After listing some of the reasons which may be behind this, such as:

  • maternal pre-pregnancy health,
  • obesity,
  • smoking,
  • diabetes,
  • hypertension,
  • racial factors,
  • Sudden Infant Death Syndrome, and
  • premature births …

… USA Today contends, “The point is that more babies can be saved. ‘We don’t have to settle for this,’ says Frances Phillips, Maryland’s deputy secretary for Public Health Services. ‘We can change this.’ Yes, we can.”

However, what the editorial fails to point out is that infant mortality rates from one country to another are “extremely misleading.”

In an opposing, and in my view, much more accurate, viewpoint in USA Today, Scott W. Atlas, MD, a senior fellow at the Hoover Institution and a professor at the Stanford University Medical Center, argues, “Infant mortality rates are extremely misleading, contaminated by factors unrelated to health care quality, and plagued by inconsistencies and gross inaccuracies, all of which specifically disadvantage the United States.”

According to Dr. Atlas, “the US has superior infant mortality rates for newborns with the highest risk of dying who actually need medical care – the best in the world outside of Sweden and Norway – even without correcting for obvious population and risk-factor differences deleterious to US statistics.”

Dr. Atlas concludes, “Ultimately, infant mortality rankings reflect deviations in terminology, reporting accuracy and populations – all of which are unrelated to health care quality and selectively disadvantage the US. The peer-reviewed literature proves it.”

Why does Dr. Atlas say all this?

  • First, the U.S. strictly adheres to the World Health Organization’s definition of live birth (any that “breathes or shows any other evidence of life”), counting even the extremely premature and most fragile. In contrast, the WHO Bulletin noted the “common practice in several (Western European) countries to register as live births only those infants who survived for a specified period.”

Because the most premature are least likely to be recorded, the effect is dramatic.

One researcher showed that the mortality rate can vary by 50% depending on the definition, while another proved that terminology caused up to a 40% variation and a 17% false reduction in non-U.S. infant mortality rates.

  • Second, three-fourths of the world’s neonatal deaths are counted by highly unreliable five-yearly household surveys, instead of by health care professionals.

Surveys in many other countries frequently misclassify what were really live births as “stillbirths,” thereby excluding most neonatal deaths.

  • Third, premature birth, the main risk factor for neonatal death, is far more frequent in the U.S. than any developed country — 65% higher than Britain, for instance.

Whether that’s due to aggressive in vitro fertilization or harmful behaviors during pregnancy, the National Center for Health Statistics concluded that premature birth is “the primary reason for the United States’ higher infant mortality rate when compared with Europe.”

  • Fourth, racial and ethnic minorities have far higher infant mortality, whether in the U.S. or under government-run systems such as Canada’s and the United Kingdom’s.

Population heterogeneity disadvantages the U.S. — not because U.S. mortality is worse, but because racial-ethnic heterogeneity in the U.S. is four to eight times higher than in countries such as Sweden, Norway, France and the U.K.

Read more about this topic here: Health Myth #1: “The U.S. has one of the highest infant mortality rates in the developed world”.

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