Once in awhile, when I stumble upon an article like this one, I have to ask, “Where have you been all my life and why is this information withheld from the American public?” In an analysis written by David Hogberg entitled, “Don’t Fall Prey to Propaganda: Life Expectancy and Infant Mortality are Unreliable Measures for Comparing the U.S. Health Care System to Others“, the poor U.S. infant mortality rate is explained and critically examined to shed light on a very perplexing state of our healthcare system.

In the quake of quasi-scientist mother’s running their mouths off about things they do not know about, falsely representing themselves as experts on health, nutrition and medicine all over the net and then using it against the mainstream to roll their eyes of disgust as they criticize the lifestyles of the average American parent. Granted, the average American could probably use some positive lifestyle analysis, however, to use the net as a platform to spout off political and moral rhetoric, especially when it comes to breastfeeding vs. formula feeding or the quality of our healthcare system, with the motive to convince the mainstream into the hate, fear and self-loathing column, is a gross misrepresentation of their abilities and knowledge. It’s not all their fault however–Buyer Beware!

Often times, the infant mortality rate in the U.S. is thrown into the faces of those who choose a more conventional and mainstream-parenting path, not unlike the majority of parent’s offline. Through information blitzing, whereby the internet is bogged down with people who have a lot of time on their hands and a hatred for moms that use the power of technology, medicine, convenience, practicality and good old fashion common sense to guide their parenting decisions, instead of solely relying on their own bodies and paranoid distrust of government and business to drive their motives and parenting decisions.

So, next time a parent pulls the, “You know, the U.S. has the highest infant mortality rate [and it's because of you and your unenlightened behavior]“, point out to them that a little knowledge can be a dangerous thing.

Infant Mortality

At first glance, infant mortality appears to be a good measure of a health care system.  First, it assumes interaction with a health care system since most babies born in the industrialized world are born in a hospital or other health care facility.  It also satisfies the second criterion of assuming that health care professionals can affect the outcome, since doctors and nurses have a direct impact on the survival chances of a newborn.  If infant mortality were accepted as an adequate measure based on those two criteria alone, then the U.S. health care system is one of the least effective in the industrialized world.  This can be seen by constructing a table using the data on infant mortality utilized in the report from the Physicians for a National Health Program.  Table 2 shows that on infant mortality, the U.S. ranks below all nations save New Zealand.

But infant mortality tells us a lot less about a health care system than one might think.  The main problem is inconsistent measurement across nations.  The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then “breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles… is considered live-born regardless of gestational age.”16   While the U.S. follows that definition, many other nations do not.  Demographer Nicholas Eberstadt notes that in Switzerland “an infant must be at least 30 centimeters long at birth to be counted as living.”17   This excludes many of the most vulnerable infants from Switzerland’s infant mortality measure.

Switzerland is far from the only nation to have peculiarities in its measure.  Italy has at least three different definitions for infant deaths in different regions of the nation.18  The United Nations Statistics Division notes many other differences.19  Japan counts only births to Japanese nationals living in Japan, not abroad.  Finland, France and Norway, by contrast, do count births to nationals living outside of the country.  Belgium includes births to its armed forces living outside Belgium but not births to foreign armed forces living in Belgium.  Finally, Canada counts births to Canadians living in the U.S., but not Americans living in Canada.  In short, many nations count births that are in no way an indication of the efficacy of their own health care systems.

The United Nations Statistics Division explains another factor hampering consistent measurement across nations:

…some infant deaths are tabulated by date of registration and not by date of occurrence… Whenever the lag between the date of occurrence and date of registration is prolonged and therefore, a large proportion of the infant-death registrations are delayed, infant-death statistics for any given year may be seriously affected.20

The nations of Australia, Ireland and New Zealand fall into this category.

Registration problems hamper accurate collection of data on infant mortality in another way.  Looking at data from 1984-1985, Eberstadt argued that, “Underregistration of infant deaths may also be indicated by the proportion of infant deaths reported for the first twenty-four hours after birth.”21  Eberstadt found that in the U.S. and Canada more than a third of all infant death occurred during the first day, but in Sweden and France they accounted for less than one-fifth.  Table 3 shows that the pattern still holds today.

Inconsistent measurement explains only part of the difference between the U.S. and the rest of the world.  Were measurements to be standardized, according to Eberstadt, “America might move from the bottom third toward the middle, but it would be unlikely to advance into the top half.”22  Another factor affecting infant mortality Eberstadt identifies is parental behavior.23  Pregnant women in other countries are more likely to either be married or living with a partner.  Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own.  In the U.S., pregnant women are far more likely to be living alone.  Although the nature of the relationship is still unclear (it is possible that mothers living on their own are less likely to want to be pregnant), it likely leads to a higher rate of infant mortality in the U.S.

In summary, infant mortality is measured far too inconsistently to make cross-national comparisons useful.  Thus, just like life expectancy, infant mortality is not a reliable measure of the relative merits of health care systems.

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