Tuesday, January 13, 2009

Infant mortality rates in the United States

A coworker highly respected for his encyclopedic knowledge of a number of subjects recently contradicted my statement that the US has one of the highest rates if not the highest rate of infant mortality in the western world.

I challenge him or anyone else to dispute the findings of exactly that by the CDC.



Micas said...


While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless.[3] And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country."[4] However, all of the countries named adopted the WHO definition in the late 1980s or early 1990s.[5]

Micas said...

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[9]

Nels said...

Micas, the U.S. News & World Report article the Wikipedia article alludes to has no reference to it in the refs section.

In fact, the "suggestion" that you cite in the Wiki article (reference 3) has no actual citation at all.

Instead, doing a search on Google, reveals this October 15, 2008 U.S. News & World Report article on infant mortality:


The only article I found was an opinion piece published by the health editor U.S. News & World Report in 2006. The health editor, Bernadine Healy, is a cardiologist and lifelong Republican who ran for the U.S. Senate in 1994 and lost. She wrote her "report" to rebut what she obviously perceives as critics of the US health care system:


I found no other similar article on the U.S. News website to second her ideas and she has no references in her report whatsoever.

Look, we're not talking about undeveloped, politically corrupt countries trying to make illusions about their own health care systems compared to the US. We're talking about Western countries like Sweden, Denmark, New Zealand, Australia, Germany and France. What you are telling me is that the CDC, CIA and Unicef are all accepting non-WHO-compliant statistical data, or not doing due diligence to confirm the counts.

You're wrong. In fact, your own quotation in your first comment ends with "all of the countries named adopted the WHO definition in the late 1980s or early 1990s."

How else can the infant morality disparities between ethnic groups in our own country be explained if not with economic disparities?

Unless you can come up with actual information that backs up the claim that other countries (such as the ones I've mentioned) skew their infant mortality rates by counting stillbirths more often than the United States, then you have nothing but one uptight, politically-biased, wanna-be Republican Senator, U.S. News health editor/cardiologist's say-so.

It seems you have been misled.

Worse than that, you are perpetuating a lie that is, intentionally or not, being used to defend against a critique of the health care system in the United States. A critique which, if true, warrants swift and decisive action to correct endemic problems that are indicated by such evidence. Action which, if delayed by false argumentation, can do nothing to help prevent needless and uncountable health complications and deaths in this country.

In other words, people like you have a moral obligation to seek out the truth, and support the claims that you make with corroborated data. To do otherwise amounts to conciliatory inaction.

In any case, the worst case scenario of actually pursuing a better health care system in the US compared to other leading countries is a better health care system with an imaginably higher price tag (although even that is debatable.)

By the way, I'll be petitioning to exclude the information you quoted from Wikipedia unless real information can be found to back up such claims.

Good job reading Wikipedia (and quoting entirely straight from it) though. It's a good starting point. Try being a little more critical though.

Micas said...


Well yes, all "statistically" true. But not because the US has an inferior health care system like so many would like to claim (and, of course, then claim that a universal health care system would "save the babies"), but instead because while there is a standard for reporting infant mortality statistics throughout the world, it appears only the US follows it.








The infant mortality rate in the United States has declined 76 percent since 1950.


In conclusion, it seems to me that the higher infant mortality rate in the U.S. compared to some other developed countries is not a direct result of inferior medical care in the U.S., but due to societal factors that are outside the scope of the medical profession. Paul Krugman, therefore, is wrong to bring this up in his op-ed pieces.

Nels said...

Micas, I have to say, at first glance, some of these articles are very impressive. However upon closer inspection, almost every single one of them fails to deliver any kind of sourced information on which they base their claims. One even has a conclusion directly opposite from your point.

The article from qando.net, as a means to support its claim that foreign countries do not count neonatal deaths as much as the US does, links to an article in the Orange County register on infant mortality statistics. There are no reference citations in the OC article whatsoever. All it says is, "Switzerland doesn't count the death of very small babies" according to Nicholas Eberstadt. I'd like to know where Eberstadt gets his information, since he does not appear to be an expert on Swiss demographics, but rather on demographics in "Korea, East Asia, and countries of the former Soviet Union".

The article from coyoteblog.com has a quote that states that "According to the way statistics are calculated in Canada, Germany, and Austria", but it gives no information for where that quote came from, so it impossible to check the validity of the claim.

At highbeam.com, I disagree that a report about parts of the old Soviet Union not reporting correctly their infant mortality stats in the 1990s has any bearing on our discussion.

Nor do I care much for the use texpat@lonestartimes.com makes of Dr. Linda Halderman's article, which contains zero references for the claims she makes about Switzerland.

Your link to the article at thebluebanner.net cites one Dr. Bernadine Healy, the wanna-be Republican Senator as its source for its conclusion that, "The simple fact of the matter is that infant mortality rate and socialized medicine in the United States just does not go together." I have already shown that her conclusions are groundless and incorrect.

At Cafe Hayek blog, Boudreaux suggests some excellent hypotheses for explaining the relatively poor IMR data in the US. Most of those hypotheses are sociological, however, and would require extensive surveys to confirm them, and Boudreaux is quick to state just that.

Micas, all these articles are suggesting is that the neonatal counts are lower in some European countries because of the way those countries define a successful birth. These articles make such claims without references to any studies in or any policies describing counting methods for those countries, and no corroboration of their information. Unless you can point me at a credible source for these allegations, then there is no reason to believe that there is any significant difference in the way that other countries count the deaths of neonatal children in their infant mortality reporting.

In the meantime, the user "Ampersand" at "Alas, a blog" (that you linked to) actually refutes the argument of invalid infant mortality statistics for comparison made by all the other articles you have also listed. Ampersand includes a link to a WHO study to back up such conclusions. Ampersand says: "If it's true that the U.S. does just about as well as other wealthy countries in infant mortality, and we only do worse because other countries move count as stillborn cases that we count as an infant death, then that should show up in higher stillbirth rates for those countries than for the U.S. This is something we can check; a World Health Organization report issued earlier this year (pdf link) gathered statistics for stillbirths." Which showed that, "Even when stillbirth deaths are included, the US is still doing significantly worse than countries credited with low infant morality rates."

The article from the Hoover Institution also has nothing to do with this debate and its data isn't even all that remarkable considering that the US was apparently ranked 6th in 1949 and has improved at a rate significantly below the rates of other countries, falling to 23rd in 2001 according to an article in the Journal of Nutrition.

The half-sigma article does make a good point about multiple births affecting the number of neonatal deaths in America. However, that indicates that the way the US measures their infant mortality statistics includes pregnancies that would not have happened without hormone and other fertility treatments. Multiple birth statistics are available and the CDC statistics can be adjusted. It is clear that the US needs to adjust the way their statistics are gathered to account for their advances in solving the worsening fertility problem in the US. In fact, the CBO report linked to in the half-sigma post states, "Alternative measures of infant mortality may provide better information but cannot completely compensate for differences among countries in the overall rates of reporting of adverse pregnancy outcomes."

As the CBO report suggests, the method of counting infant deaths does mitigate the differences between some developed countries and the united states, but does not fully explain them.

Furthermore, you still have not offered any explanation by way of factual information that would account for the disparities in infant mortality rates between African-Americans and other ethnic groups, particularly whites (non-Hispanic Caucasians) here in America.