Why is Infant Mortality So Extreme in the US?

Infant mortality rates in the United States far exceed that of other developed countries. However, the cause of the problem is much deeper and more complex than many think.

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Image by Andy Thies

A baby born in the United States is three times more likely to die before its first birthday than babies born in Japan or Finland.  The list of countries that are better than the US at keeping infants alive is 43 names long and includes such economic powerhouses as The Isle of Man, Slovenia, and Macau. Per 1,000 US live births, 6.2 will die before age 1. In a country with about 4 million births per year, this means that we can expect that about 24,800 of them will not see their first birthday. The richest country in the world, on healthcare per-capita than any other country, needs to do a better job keeping its newborns alive.

The US’s infant mortality rate (IMR) of 6.2 places it between Hungary and Antigua and Barbuda according to the World Health Organization. IMR shows significant variation from state to state, with highest rates concentrating in the Southeast, and lowest rates in the Northwest and Northeast. If Alabama were a country, it would rank alongside Uruguay, and Mississippi, with an IMR of 8.24 would rank just below Ukraine. Even states with the lowest IMR including California, New Hampshire, and Massachusetts still only outrank one of the thirty highest ranked countries for human development, New Zealand.

Data from The Center for Disease Control show that socioeconomic factors also play a major role in infant mortality rates. African Americans, who as a population have less access to health care and are more likely to live in poverty than white Americans, are almost twice as likely to have a newborn die before their first birthday. Infant mortality rates for African Americans, especially in the South, reach as high as 14.55 deaths per 1,000 births.

The rates of infant mortality in the US have been burdensome for decades. Research shows that there are five main causes of infant death: birth defects, sudden infant death syndrome, maternal health complications, unintentional injuries and preterm-related causes of death. One of those factors, premature births, seems to be the biggest difference maker between the United States and other industrialized countries.

Map by Andy Thies and Braden Anderson

Pre-term births, defined as births that occur between the 22nd and 37th week of pregnancy, result in babies that very fragile. According to the World Health Organization, preterm babies have trouble staying warm, feeding, breathing, are prone to infections, and are at an increased risk for developmental problems. Preterm birth complications are the leading cause of death among children under 5 years of age.

The difference between the US and the rest of the wealthy world is not in how pre-term births are handled: the mortality rate for premature births is fairly consistent across these countries. The problem for the US is how common these pre-term births are. “In the United States, almost one in eight babies is born between 22 and 37 weeks’ gestation. That’s nearly the highest rate in the industrialized world — second only to Cyprus. The U.S. prematurity rate is double that of Finland, Japan, Norway and Sweden”, according to the 2013 report by Save the Children.

If there is an obstacle between the US and an IMR at the level of the EU, it is rooted in our understanding of what causes a child to be born prematurely. Medical professionals agree that smoking while pregnant will increase the likelihood of a pre-term birth. Even when controlling for known risk factors, there is no clear data to support why American mothers are so likely give birth too early.

In 2011, a partnership between the March of Dimes and Stanford University School of Medicine was created to “bring together scientists from disparate fields to study both the clinical causes of preterm births — what happens in the body that causes a woman to go into labor — as well as how environmental and sociological factors can impact this biology.” They are considering such disparate factors as bacteria in the mother’s gut, exposure to pollution, and emotional stress, to name a few.

Exploratory research, like the work being done at Stanford, is valuable and may result in a major lifesaving breakthrough. Education, outreach, and greater access to healthcare are other tools in the fight against infant mortality, and can potentially make a difference now. Lack of access to routine health care is a problem for millions of women in the United States, and studies show that women who get care early in their pregnancy are less likely to have complications like pre-term births. One program, called the Kaiser Permanente Northern California Early Start Program, estimated that by standardizing care to at-risk women across the country, health-care savings could amount to $2 billion.

If there is a reason to believe that things are starting to change, it is because of recent data to come from the Department of Health and Human Services’ June 14, 2016 report The Affordable Care Act: Promoting Better Health for Women. In here, they note that one Affordable Care Act initiative, Strong Start for Mothers and Newborns, has been very successful in reducing unnecessary preterm births. The report reads, “Between 2010 and 2013, there was a 70.4 percent reduction in early elective deliveries among hospitals participating in the HHS Strong Start for Mothers and Newborns Initiative. As of May 2014, more than 25,000 early elective deliveries were prevented.” More services for pregnant women and new mothers are scheduled for release through the Affordable Care Act, like one that examines how new prenatal care delivery systems might decrease preterm birth and lower the cost of medical care during pregnancy.

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