Infant morality rates and national healthcare

[Phillip Hone]

According to CIA world factbook, nations such as Canada or France have lower infant mortality rates than the United States. I've used this before when arguing with people who try and paint the Canadian medical system as nightmarishly ineffective. However, I've ran into someone who is now arguing that the United States actually has a lower infant mortality rate than other countries, and that our rate only looks high because we count infant deaths differently than other countries. They cited this article for evidence: http://health.usnews.com/usnews/health/ ... 2healy.htm

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.

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.

What would be a good response to this? Any help would be great, thanks.

[Patrick Ogaard]

One thing would be to note that the information about Germany's definition of live births is not accurate. Any baby born with a heartbeat, that breathes independently, or that has a pulsating umbilical cord counts as a live birth regardless of length, weight or viability, and regardless of how long those signs persist. The 500 grams reference comes from the fact that any baby born without those signs of life but that weighs at least 500 grams is counted as a stillborn child or a child that died in childbirth.

Babies born with no signs of life and weighing less than 500 grams are counted as stillborn.

Reference (albeit in German):
http://www.veid.de/166.0.html

§ 29 PSTGAVO (Ausführungsverordnung zum Personenstandsgesetz)

(1) Eine Lebendgeburt, für die die allgemeinen Bestimmungen über
die Anzeige und die Eintragung von Geburten gelten, liegt vor,
wenn bei einem Kinde nach der Scheidung vom Mutterleib entweder
das Herz geschlagen oder die Nabelschnur pulsiert oder die
natürliche Lungenatmung eingesetzt hat.

(2) Hat sich keines der in Absatz 1 genannten Merkmale des
Lebens gezeigt, beträgt das Gewicht der Leibesfrucht jedoch
mindestens 500 Gramm, so gilt sie im Sinne des § 24 des Gesetzes
als ein totgeborenes oder in der Geburt verstorbenes Kind.

(3) Hat sich keines der in Absatz 1 genannten Merkmale des
Lebens gezeigt und beträgt das Gewicht der Leibesfrucht weniger
als 500 Gramm, so ist die Frucht eine Fehlgeburt. Sie wird in
den Personenstandsbüchern nicht beurkundet.

[Lusankya]

If you look at the combined statistics for stillborn + newborn mortality rate, you'll find that the US comes out behind most other development countries. If you include the mortality rate within the first year, it looks even worse for the US. If the US system were better than those in other coutries, then the US should have a lower rates of stillbirth + infant mortality.

Here is my source