US surpasses other industrialized countries in infant death rate

By Naomi Spencer
9 May 2013

A new report on motherhood paints a devastating portrait of social conditions for poor women and their babies around the world. In both developing and industrialized countries, the first month of birth is the most dangerous of an infant’s life.

“State of the World’s Mothers,” a report from the humanitarian organization Save the Children, released May 7, finds more than three million babies die within the first month of their birth. A staggering one million infants die on the day they are born.

The US has by far the highest first-day death rate in the industrialized world. The report states, “An estimated 11,300 newborn babies die each year in the United States on the day they are born. This is 50 percent more first-day deaths than all other industrialized countries combined.” The 33 other industrialized countries for which data was collected recorded a combined total of 7,500 first-day deaths each year.

The report, done in conjunction with the London School of Hygiene & Tropical Medicine, is the first global analysis of newborn day-of-death data. Its findings are an indictment of social inequality created by the capitalist system worldwide. Because the report analyzes 2011 statistics, it is likely that the ensuing year and a half have seen a worsening of these indices.

Within wealthy countries, a widening section of the working class are subject to poor living standards and extreme disparities in health care. Millions of Americans as a result fare little better—and in some aspects worse—than their counterparts in some of the poorest countries in the world.

Some US counties, clustered in the deep south, Indian reservations, and in Appalachia, as well as distressed urban centers such as Detroit and Cleveland, have mortality rates equivalent to those in “developing” countries, where 98 percent of all first-day deaths occur.

India recorded the largest number of first-day deaths: more than 300,000 per year. Nearly 90,000 Nigerian babies die the day they are born. Somalia registered the highest first-day death rate at 18 per 1,000 live births.

Save the Children estimated that an investment in four simple medical products costing between 13 cents and $6 each could save one million newborns every year. These products, including resuscitation devices and antiseptics, have been on the market for decades and would cost next to nothing to provide worldwide. That such investments have not been made is an exposure of the indifference of governments and global organizations such as the United Nations and World Bank to the suffering of billions around the world.

The high US infant death rate compared to other developed countries is a focus of the report. “The large US population size explains some of this disparity,” the report states, “but it does not explain all of it. The US represents 31 percent of the population in these 34 industrialized countries and 38 percent of the annual live births, but it has 60 percent of all first-day deaths.” The European Union, which has 1 million more births than the US each year (5.3 million versus 4.3 million), registered half as many first-day deaths as the US.

While the report does not analyze disparities among socio-economic groups within wealthy countries, it notes that “newborn and infant mortality are often higher among the poor and racial/ethnic minorities, and populations with high newborn mortality rates also tend to have high first-day death rates. Poor and minority groups also suffer higher burdens of prematurity and low birthweight, which likely lead to first-day deaths in the

US and elsewhere.”

One in eight babies in the US are born preterm, or less than 37 weeks gestational age. This is second only to Cyprus for preterm birthrate in the industrialized world, and 131st out of the 176 countries surveyed. Complications of preterm birth are the direct cause of one-third of all newborn deaths in the US.

A major factor behind the high rate of preterm birth in the US is poverty. Tens of millions of Americans live in destitution, including millions of young mothers and their children. Some 16 million children in the US live in “extreme poverty,” in households whose annual income is less than half the official poverty line. Since the onset of the 2008 recession, many social outreach, nutrition, and public health programs serving these women and their babies have been gutted.

This state of affairs has made it more difficult for young poor women to access prenatal, family planning, and general health care. The US has the highest adolescent birthrate in the industrialized world. Teenage mothers are overwhelmingly poor, less educated, and receive less prenatal care than older mothers. They are also more likely to suffer malnutrition and lack transportation and access to information about maternal health. As a result, their children are much more likely to be low-birthweight and premature.

Preterm births present special problems, such as undeveloped lungs and an immature immune system. These conditions require constant and intensive care at quality hospitals. Across the US, hospitals have been cutting such care and raising costs over the past decade. In Philadelphia, for example, which the federal Centers for Disease Control and Prevention ranks as 196th out of 200 urban counties for infant mortality, 15 maternity wards have been closed down. Only six remain open.

The growing ranks of the uninsured and Medicaid recipients have also put the strain on hospitals that receive state reimbursement for services to the poor. As states slash reimbursement rates, hospitals have tightened admissions and scrapped charity care programs. According to reproductive health organization the Guttmacher Institute, one in five US women of childbearing age are uninsured. Another 15 percent are enrolled in Medicaid.

The Save the Children analysis does not account for the huge increase in the number of Caesarean sections performed in the US: one in three births are done on a pre-scheduled basis, including many well before full-term. The C-section is a lifesaving operation when it is undertaken to deliver breech births or in cases where the mother has a serious medical condition. However, many US hospitals have used the operation to schedule births, particularly those of Medicaid recipients, in order to maximize profit.

A University of Minnesota analysis of 593 hospitals nationwide, published in March 2013, found that C-sections accounted for nearly 70 percent of all deliveries at some hospitals. The states with the highest rates, according to the CDC, are in the deep south.

While only one percent of the world’s newborn deaths occur in industrialized countries, the report states, “The percentage of child deaths that occur during the newborn period is rising in wealthy countries, as it is in poor countries.”

The US is not alone in rising infant mortality rates among the developed countries. Canada and Switzerland rank second and third in first-day mortality rates in the industrialized countries. Switzerland has the highest share of infant mortality cases whose deaths are within the first day: 71 percent. The Save the Children report notes that this is the highest percentage of first-day deaths of any country in the world.

The report also features Save the Children’s annual “Mothers’ Index,” a global ranking of conditions for new mothers and their children.

Overall, the “worst place in the world to give birth” is the Democratic Republic of the Congo, where 1 in 30 women die delivering their babies. The other countries in the bottom ten of the list are also in Africa: Somalia, Sierra Leone, Mali, Niger, Gambia, Nigeria, Chad, and Ivory Coast. Mothers in rural areas confront lack of health care providers in their communities, the report said.

The US ranks number 46—the worst among developed countries—in maternal health, and 41st in child well-being. Overall, the US ranks as the 30th “best place to be a mother,” just above Japan and South Korea, but below all of Western Europe, Slovenia, Poland, Belarus, and numerous other countries.

An American woman faces a 1 in 2,400 risk of death during childbirth. Only five other industrialized countries—Albania, Latvia, Moldova, the Russian Federation, and Ukraine—fare worse on maternal death rates. “A woman in the US is more than 10 times as likely as a woman in Estonia, Greece or Singapore to eventually die from a pregnancy related cause,” the report states.

American children under the age of 5 are far more likely to die than their counterparts in other industrialized countries. The US under-5 mortality rate is 7.5 per 1,000, a rate on par with Bosnia, Herzegovina, Qatar, and Slovakia.