Infant Death Statistics Misleading

by Amy Spangler
November 01, 2011

Every year 3.3 million babies worldwide die before their one-month birthday. Although 99 percent of those deaths occur in developing countries (1 of every 19 Afghan babies dies within the first month), the newborn death rate in the U.S. (1 of every 233) is greater than 40 other countries including Japan (1 in 909), France (1 in 455), Lithuania (1 in 385), and Cuba (1 in 345), prompting experts to question the validity of the statistics.

A recent commentary in USA Today describes U.S. infant mortality rates as inexcusable but an expert response uses another word: distorted. Which should we believe?

“Twenty years ago, the United States was doing better than countries such as Cuba, Poland, and Estonia in keeping newborn babies alive,” says USA Today’s Editorial Board. “Not any more. As other nations improved this key indicator of women’s and infants health, the U.S. lagged, dropping to 41^st worldwide in newborn death rates, behind these three countries and 37 more.”

The USA Today essay was accompanied by a response from Dr. Scott W. Atlas, senior fellow at the Hoover Institution and professor at Stanford University Medical Center.

“Infant mortality rankings selectively disadvantage the U.S.,” says Atlas, citing four factors contribute to the distortions:

1. Definition of live birth. The U.S. follows the World Health Organization’s (WHO) definition of live birth (any that “breathes or shows signs of life”) while several Western European countries register as live births only those infants who survive for a specific period of time. As a result, extremely premature infants are often not included in the calculations, causing an estimated 40 percent variation and a 17 percent reduction in non-U.S. infant mortality rates.
2. Survey method. Unreliable household surveys are used to compute three-fourths of the world’s neonatal deaths. These surveys often misclassify live births as stillbirths.
3. Premature birth rate. Premature birth, the primary risk factor for neonatal death, is far more frequent in the U.S. than in any developed country. Factors that contribute to prematurity include greater use of fertility treatments, harmful behaviors during pregnancy, and ethnicity. According to the National Center for Health Statistics, premature birth is the main reason the U.S. has a higher infant mortality rate than Europe.
4. Diversity of population. Racial and ethnic minorities have higher rates of infant mortality, putting the U.S. at a disadvantage compared to countries where populations are less diverse such as Sweden, Norway, France, and the United Kingdom.

U.S. public health officials are rightly concerned about infant mortality, particularly its link to lack of breastfeeding. But many argue, like Atlas, that infant mortality rank alone should not be a measure of the quality of health care given the differences in terminology, reporting, and populations. The best strategies for reducing infant mortality are those guided by representative data, reliably collected, and objectively interpreted. The best strategies are those that reduce the incidence of prematurity, asphyxia, and severe infection—conditions that contribute to 75 percent of infant deaths.

The best strategies for reducing infant mortality ensure that all women:

• receive quality prenatal care starting in the first trimester
• give birth in clean conditions with a skilled birth attendant
• hold their babies skin-to-skin after birth
• breastfeed for at least one year (exclusively for six months)

Only then will we see significant reductions in the 3.3 million infant deaths that occur each year. Deaths that regardless of the rankings can’t be distorted.