HW Explains the U.S. Newborn Mortality Rate

15 May 2006 /

Just in time for Mother’s Day, Save the Children has published its seventh annual State of the World’s Mothers report on newborn mortality.

As usual, the U.S. takes a beating:

Although the newborn mortality rate in the United States has fallen in recent decades, it is still higher than most other industrialized nations — 2.5 times that of Finland, Iceland and Norway, and about three times higher than the newborn mortality rate of Japan.

  • Latvia has the highest newborn mortality rate in the industrialized world (6 per 1,000 live births).
  • The United States is tied for second-to-last place with Hungary, Malta, Poland and Slovakia (in all five countries,there are 5 newborn deaths per 1,000 live births).

The media report on this in straightforward “Ha Ha! We suck!’ fashion:

U.S. has second worst newborn death rate in modern world, report says

The theme then gets picked up and spread by “I take everything at face value as long as it fits my preconceived view of the world” dimbulbs:

Because of some unholy confluence of conservatism, free-marketism, and general head-up-ass-ism, this country has never made health care for all a national priority. Things like this are the result, and it infuriates me.

WARNING! Be on the lookout for infuriated imbeciles!

I’m endlessly disappointed by the absence of media curiosity about the reason or reasons for a phenomenon that seems totally counterintuitive.

Try looking at these numbers a little more closely:

First of all, newborn mortality requires a live birth. Stillbirths and miscarriages don’t count against your mortality rate. So before we go any further, we need to define what constitutes a live birth.

Here’s the World Health Organization (WHO) definition:

Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life – e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles – whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.

It’s a bit dry and impersonal, isn’t it?

A lot of countries — the United States included — use the WHO definition, but on the other hand, many countries don’t. And that creates a problem when you compare mortality numbers from country to country.

Some countries, for example, don’t count very low birth-weight babies as live births if the child dies shortly thereafter, which they almost always do. Those babies are written off as stillbirths.

If your goal is to maintain the lowest possible newborn mortality rate, that is definitely the way to go, because in the industrialized world, newborn mortality is largely a result of babies born too early and/or too small. If you don’t count them as live births, you really improve your newborn mortality rate.

In the good old U.S. of A., however, we don’t do it that way. Our doctors will try to save very low birth-weight newborns who would certainly have died a few decades ago. Sometimes they succeed, but when they fail, it’s scored — per the WHO definition — as a live birth followed by a death, and it counts against our newborn mortality rate.

Dramatic intervention on behalf of near-hopeless cases is bad for the mortality rate, but if you or a loved one were to give birth to a very low birth-weight baby, which approach would you prefer?

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