“The US has the highest maternal and infant mortality rates among the high-income countries, and among the lowest life expectancies. The result of these cutbacks in spending on health for the poor and the old would be further deterioration. Is this really politically acceptable?”—Martin Wolf, columnist, Financial Times, April 12, 2011
In his column, “The Radical Right and the US State,” Wolf, a columnist I ordinarily enjoy reading, has repeated a myth that has already been roundly dismissed by economists and debunked by medical experts, that is, the U.S. has one of the highest infant mortality rates in the developed world.
Talk about stretching a point until it snaps. Even the Organization for Economic Cooperation and Development, an international consortium of 31 countries which collects economic data, warns against these country-to-country infant mortality comparisons, because they are unfair.
"Some of the international variation in infant and neonatal mortality rates may be due to variations among countries in registering practices of premature infants (whether they are reported as live births or not)," the OECD says.
And that’s the key.
The Center for Disease Control says the U.S. ranks 29th in the world for infant mortality rates, behind most other developed nations. But this ranking ignores other statistical nuances that, if adjusted for, would show the U.S. actually has much better care for infants than these rankings allow.
The U.S. is supposedly worse than Greece, Northern Ireland, Cuba and Hungary in infant mortality rates. And the U.S. is supposedly on a par with Slovakia and Poland.
CNN, the New York Times, MSNBC, CNBC, The Economist magazine and numerous media outlets across the country routinely report the U.S. as abysmal in terms of infant mortality, without delving into what is behind this ranking (I reported this controversy to you in 2009).
Many media outlets rely on the Commonwealth Fund, a nonprofit research group, which routinely flunks the U.S. health system using the infant mortality rate.
The U.S. ranks poorly on the infant mortality list largely because this country actually counts neonatal deaths, notably premature infant fatalities, unlike other countries who don't count these infant deaths.
"In several countries, such as in the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births,” the OECD says.
Other statistical quirks give the U.S. an unjustifiably poor showing in this ranking compared to other countries.
Start with the definition of the infant mortality rate.
The World Health Organization [WHO] defines a country's infant mortality rate as the number of infants who die between birth and age one, per 1,000 live births.
WHO says a live birth is when a baby shows any sign of life, even if, say, a low birth weight baby takes one single breath, or has one heartbeat.
The U.S. uses this definition. But other countries do not -- so they don't count premature or severely ill babies as live births-or deaths.
The United States actually counts all births if they show any sign of life, regardless of prematurity, or size, or duration of life, notes Bernardine Healy, former director of the National Institutes of Health and former president and chief executive of the American Red Cross.
And that includes stillbirths, which many other countries do not count, much less report.
Also, what counts as a birth varies from country to country. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) before these countries count these infants as live births, Healy notes.
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, and are not counted, Healy says.
And some countries don't reliably register babies who die within the first 24 hours of birth, Healy notes.
Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in Norway's underweight infants who are not now counted, says Nicholas Eberstadt, a scholar at the American Enterprise Institute.
Moreover, the ranking doesn't take into account that the US has a diverse, heterogeneous population, Healy adds, unlike, say, in Iceland, which tracks all infant deaths regardless of factor, but has a population under 300,000 that is 94% homogenous.
Likewise, Finland and Japan do not have the ethnic and cultural diversity of the U.S.'s 300 million-plus citizens.
Plus, the U.S. has a high rate of teen pregnancies, teens who smoke, who take drugs, who are obese and uneducated, all factors which cause higher infant mortality rates.
And the US has more mothers taking fertility treatments, which keeps the rate of pregnancy high due to multiple-birth pregnancies.
Moreover, the U.S. is not losing healthy babies, as the scary stats imply. Most of the babies who die are either premature or born seriously ill, including those with congenital malformations.
The U.S. ranks much better on a measure that the World Health Organization says is more accurate, the perinatal mortality rate, defined as death between 22 weeks' gestation and seven days after birth. According to the WHO 2006 report on Neonatal and Perinatal Mortality, the U.S. comes in at 16th -- and even higher if you knock out several tiny countries with tiny birthrates and populations, such as Martinique and San Marino.