U.S. lags other rich nations in infant mortality (goes from 27th to 29th under Bush)

[usregimechange]

WASHINGTON (Reuters) - Infant mortality in the United States is still higher than in many other industrialized countries, with progress stalling this decade, the U.S. government said on Wednesday.

The United States ranked 29th lowest in the world in infant mortality in 2004, the latest year for which comparative global figures were available, the U.S. Centers for Disease Control and Prevention said in a report.

This extends a worsening trend for the United States in global infant mortality rankings. The 2004 ranking compares to 27th in 2000, 23rd in 1990 and 12th in 1960, the CDC's National Center for Health Statistics said.

"Infant mortality is one of the most important indicators of the health of a nation, as it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions and public health practices," the report said.

http://www.nlm.nih.gov/medlineplus/news/fullstory_70500.html

[hack89]

1. Calculating and comparing infant mortality rates is not a straight forward process

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; 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 some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country." <2> However, all of the countries named adopted the WHO definition in the late 1980s or early 1990s.<2>

Historically, until the 1990s Russia and other countries of the former Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.<3> Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.<4> In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.<5>

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.<6>

http://en.wikipedia.org/wiki/Infant_mortality