May 10, 2006

Health Care > Save the Children Report on Infant Mortality, Mother's Index

A new report from Save the Children finds the U.S. infant mortality ranks among the worst for industrialized nations.

Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.

I'm always a little suspicious of reports on infant mortality. (LATER: And I was right to be. See update at the end of this post.) There have been too many reports where the figure was based on total mortality per mother, or where reporting differences (such as how premature babies are recorded) obscured the real figures. I'm also incredibly skeptical of reports of infant mortality being lower in Cuba than in the U.S. I don't trust official government health figures coming from a military dictatorship where reporters and librarians are routinely jailed, especially after seeing these pictures.

Based on CNN's summary, I don't see any obvious flaws in the infant mortality part of the report. The "mother's index," on the other hand, is flawed. The first two criteria are "Lifetime risk of maternal mortality" and "Percent of women using modern contraception." Both of those criteria are to the disadvantage of the U.S., which has higher birth rates than every other countries in the top 10. Clearly, the more children a woman has the higher her risk of dying from childbirth, and the less likely women in the report will report being on contraceptives. So actually practicing motherhood is reducing the U.S. rank on the mother's index.

Mother's Index

United States10
United Kingdom10

Birth Rates

CountryBirth Rank*Birth Rate/1000
United States15714.14
United Kingdom18910.78

Source: Nationmaster
* out of 225 countries

The consequence of Europeans not having children is that their elaborate social welfare system and free healthcare are liable to collapse in a generation or two as a consequence of their birth rate being below replacement level. They obviously know where babies come from, but it's less clear they know where adults come from.

Having said all that, it's possible that there are improvements the U.S. could make to improve its infant mortality rate and overall natal health rate. Free prenatal care is one of the few forms of universal healthcare I unambiguously favor. A humane society should help its most vulnerable members, and there's no one more vulnerable than an unborn child. Pro-natalist social policies also encourage more babies, which is a legitimate goal for any advanced society with a hand-to-mouth social welfare and retirement program.

LATER: In comments Daedaulus notes that QandO calls shenanigans on the infant mortality statistics, because they're collected according to different standards in different countries, with the U.S. following the strictest standard set by the World Health Organization.

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.

WHO defines the standard as follows:

According to the World Health Organization (WHO) definition, all babies showing any signs of life, such as muscle activity, a gasp for breath or a heartbeat, should be included as a live birth. The U.S. strictly follows this definition.


Switzerland, for instance, doesn't count the deaths of babies shorter than 30 cm, because they are not counted as live births, according to Nicholas Eberstadt, Ph.D., Henry Wendt Scholar in Political Economy at the American Enterprise Institute and formerly a Visiting Fellow at the Harvard University Center for Population and Developmental Studies. So, comparing the 1998 infant mortality rates for Switzerland and the U.S., 4.8 and 7.2 per 1,000 births, respectively, is comparing apples and oranges.

Posted by lesjones | TrackBack


Part of the problem with these numbers is that we (in the US) routinely attempt to save prematute infants that would simply be counted as miscarrages in other nations. We always try, even if we know in advance that many of them die. It makes our numbers look terrible, even though we are generally doing a very good job.

A fair, apples-to-apples comparison would yield very different results.

Posted by: Mike at May 10, 2006

I suggest you read about the GIGO of infant mortality here:

Posted by: Daedalus Mugged at May 10, 2006

Another thing never mentioned regarding Cuba"s "low infant mortality rate" is that if I recall correctly, 6 out of ten preganancies on the island are aborted. Ive posted on this before with references.

Posted by: Val Prieto at May 10, 2006

Oh come on. France has some of the most generous health and social programs around, and they are just behind Australia with 12.15.

Posted by: Alex at May 10, 2006

I think another metric that we should track is the average gestational age of surviving, pre-term infants--basically, all infants that live for, say, twelve months and were born before week 37 or 38. This, together with infant mortality, would illustrate the tremendous job that the US does with children born at 24 weeks. It also creates a goal post that can be used to drive further research.

Posted by: McCoy at May 10, 2006

Alex: I recall a Steyn column (that I can't find right now) that said that something like a third or half the children born in France are born not to native French, but to Muslim immigrants. The question then is whether France can integrate those Muslim children into society so as to contribute to the country's social welfare programs. The signs so far have not been encouraging.

Posted by: Les Jones at May 10, 2006

And to quote one of my favorite Mark Steyn pieces:

"The design flaw of the secular social-democratic state is that it requires a religious-society birthrate to sustain it. Post-Christian hyperrationalism is, in the objective sense, a lot less rational than Catholicism or Mormonism. Indeed, in its reliance on immigration to ensure its future, the European Union has adopted a 21st-century variation on the strategy of the Shakers, who were forbidden from reproducing and thus could increase their numbers only by conversion."

Posted by: Les Jones at May 10, 2006

There are many differences between countries that make this comparison relatively useless, however one thing that did stand out in the figures was the disparity on income and race.. That stands alone..

Posted by: Chris Wage at May 10, 2006

Well put!

Here is a great article on how Europe has effectively given up on the future, for reasons similar to what you mentioned.

Posted by: Twok at May 10, 2006

Congratulations on the Instalanche!

Posted by: The Sanity Inspector at May 10, 2006

I think it's important to note that the USA spends significantly more of its GDP on healthcare than European countries do. The US spends 13-15% of its GDP on healthcare, and European countries on average 10-11%.

Here in the UK, we spend 8-9% of our GDP to free everyone from worrying about whether they can afford their healthcare plan payments if, for example, they want to start their own business. Or whether they can leave their jobs, if they develop diabetes and transfer to a new health scheme would mean that was no longer covered (it would become a 'pre-existing condition').


Posted by: Tom Richards at May 10, 2006

Here in the UK, we spend 8-9% of our GDP to free everyone from worrying about whether they can afford their healthcare plan payments if, for example, they want to start their own business.

Reflected, I trust, in the statistics of how many people quit their jobs to start their own business.

Or whether they can leave their jobs, if they develop diabetes and transfer to a new health scheme would mean that was no longer covered (it would become a 'pre-existing condition').

My wee wifey, a diabetic, has no trouble job-hopping. Her pre-existing condition has been covered for over six months and thus is automatically picked up.

Posted by: triticale at May 10, 2006

Triticale, I have no idea if this is actually reflected in how many people start their own businesses: I put this in as an example of how nationalised healthcare costs the UK economy less and gives us advantages. We also don't exclude the poor: 38 million Americans went uninsured in 2000.

I'm very glad you and your wife are in such a happy situation; many Americans are not.


Posted by: Tom Richards at May 11, 2006

In all healthcare matters, the only country that can be compared fairly with the U.S. is Canada. Canadians and Americans have similar diets, workplaces and hours of work, family lifestyles, transportation, etc. Canada has a social system of healthcare while the U.S. has a system funded through private insurers. Comparisons of the health of Americans vs Canadians can show where a social system has an advantage or disadvantage compared with a 'private' system. The U.S. traditionally scores about 50% higher (worse) in infant mortality rates than Canada. This could be due to the lack in the U.S. of prenatal care for lower income women. Virtually all women in Canada can get prenatal care 'free' regardless of their income levels. Having said this, natal care in the U.S. is probably the best in the world for those who can afford it under their insurance plans. But, Canada does provide high standards of health care for everyone.

Posted by: Traveler at December 13, 2006
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