Report: U.S. Trails In Infant Mortality

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A report from the National Center for Health Statistics shows that the U.S. ranked 30th in the world in infant mortality rates, mainly because of a higher rate of pre-term births than most countries in Europe. Analysts say these studies don't take sufficiently into account the U.S. population mix.


From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.


And I'm Robert Siegel.

One of the most common indicators of a country's health is its infant mortality rate. The U.S. lags far behind other industrialized countries on this measure. And a new study puts the U.S. at 30th, behind Poland and just ahead of Slovakia.

As NPR's Brenda Wilson explains, that's because of a high rate of premature births.

BRENDA WILSON: The percentage of infants born preterm in the United States has risen 36 percent since 1984. Infants born at 37 weeks or before have a greater risk of death or disability than infants born full term. Marian MacDorman of the National Center for the Health Statistics examined how the United States stacks up against other industrialized countries.

Ms. MARIAN MACDORMAN (National Center for Health Statistics): In the United States, one of eight births is preterm, compared to one out of 18 in Ireland and Finland and one out of 16 in Sweden and France. So, that's a very large difference.

WILSON: And the higher preterm rate has led to a higher infant mortality rate. In 1960, the U.S. ranked 12th in the world in the rate of infant mortality, and now is down to 30th. The survival rate for infants born prematurely in the United States is actually better than many countries. We do a better job than all but Sweden, Denmark and Austria, in keeping really premature infants alive.

Ms. MACDORMAN: Once they're born too early, we do pretty a good job of saving them. What we're not doing a good job with is preventing them from being born too early in the first place.

WILSON: Even though doctors do a good job of saving them, there are so many preterm births, the infant mortality rate remains high. Dr. Courtney Lynch, a professor at Ohio State University, says too much can be made of international rankings like this. For one thing, she says, dating a pregnancy varies.

Dr. COURTNEY LYNCH (Ohio State University): What's unclear is how gestational age is determined in each of the countries in Europe and there are definitely variable practices as there are in this country as to how often a ultrasound is used to date pregnancies.

WILSON: It can be affected by a women's recall of her last menstrual period or her first visit to the doctor. In comparing preterm rates in the U.S. to European countries, Lynch thinks it's important to consider the population mix here. The preterm rate for African-Americans, for example, has led to an infant mortality rate that has more than doubled the rate for white Americans. And there's a gap even when adjustments are made for income, education, obesity, smoking and disease.

Dr. LYNCH: A black woman who is a physician and is well-educated actually has a higher risk of preterm delivery than the least well-educated white woman.

WILSON: Race alone, Lynch say, remains the distinguishing factor.

Dr. LYNCH: It makes some folks uncomfortable and, you know, it's sort of tough to drill down. Those of us who have been working in this field have really been trying to figure out what it is. But we think that it is something related to the physiologic effects of experiencing lifelong racism.

WILSON: When you look at other groups, for example, Hispanics, the infant mortality rate is higher than for whites, but not as high as blacks. Asian-Americans have an infant mortality rate lower than many European countries. Other things that lead to a high preterm rate in the U.S., Lynch says, are an increase in fertility treatments, which cause multiple births and a high rate of Cesarean sections.

There's also a phenomenon more common in this country of women asking to have labor induced, so they can end a pregnancy early. The consequence, however, is a greater risk of losing the child.

Brenda Wilson, NPR News.

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