Mamas on Bedrest: How Embarrassing-The US Infant Mortality Rate

September 12th, 2012

September is National Infant Mortality Awareness Month and there are numerous events, campaigns and activities taking place all designed to raise awareness about infant mortality. The United States has an embarrassingly high infant mortality rate in contrast to many other countries. But what is even more disturbing is the fact that according to an article published in The Lancet, May 2010, the country isn’t keeping up with global gains in reducing child mortality, despite significant health care spending.

Citing an article published on DOTmed.com summarizing The Lancet publication,

According to the World Bank, the U.S. has the highest infant mortality rate among 33 countries that the International Monetary Fund defines as having “advanced economies.”

At the time of the DOTmed summary, The U.S. ranked 42nd in the world in child mortality.

“What is surprising is that the U.S. continues to fall even farther behind, while other developed countries such as Australia and New Zealand have shown much better improvements in child mortality. If we look at progress over time, we see the U.S. was ranked 29th in the world in 1990 and has dropped to 42nd now (2010). What that tells us is that we’re not making as much progress as other high income countries.”

~Julie Rajaratnam, assistant professor with IHME and one of the study’s authors.

While our infant mortality rate is dismal and not readily improving in comparison to many other nations, researchers have found that there are some identifiable reasons for our high infant mortality rate. The leading causes of infant death in America are congenital defects, preterm birth and low birth weight and sudden infant death syndrome. They believe that if the US  addresses those issues, the infant mortality rate will surely improve.

Birth Before Due Date

The US has an unusually high preterm birth rate in comparison to many other countries. According to a 2009 report by the National Center for Health Statistics, compared to Europe, America has a higher percentage of preterm births, likely the main cause of its higher IMR. (Preterm is defined as birth before 37 completed weeks of gestation.) Not only do we see many babies born before the recommended 37 weeks gestation, there are also thousands of babies born before 39 weeks gestation, the acceptable length of “term birth”. The March of Dimes has repeatedly advocated for education and policy changes within hospital and birthing centers encouraging physicians and families to do their best to allow babies 39 weeks without any sort of intervention (induction or cesarean section) unless absolutely necessary (i.e. mama or baby at risk).

Dr. Scott Berns, a pediatrician and a senior vice president with the March of Dimes Foundation reiterates that there is important development that occurs between 37 and 39 weeks gestation. Because we have gotten so accustomed to seeing “good” outcomes at 37 weeks, we’ve been lulled into a false sense of security. Dr. Berns notes that if we were to look at the overall numbers, we’d see the dip in positive outcomes in babies born before 39 weeks gestation.

The US also has a higher percentage of older mamas and mamas who have used assisted reproductive technologies. Mamas who become pregnant using ART are at increased risk of having a multiple pregnancy which carries with it an increased risk of preterm birth.

Socioeconomic Disparities

Many experts also draw links between America’s vast socioeconomic disparities and infant death. According to Dr. Gregory, half of U.S. births are to mamas on Medicaid. While both preterm birth and SIDS can happen to any family, these conditions are more prevalent among poorer families. Additionally, a 2008 NCHS report found that the infant mortality rate for black women was 2.4 times the rate for white women in 2005 (and this disparity exists today!!).

According to IHME’s Rajaratnam, looking at the U.S. child mortality rates by counties would likely identify areas that are performing just as well as Europe, and others on par with the world’s poorest countries.

“We are starting to do some of that local level research now and those results will help us get closer to putting our finger on what needs to change in order to save more lives.”

Both Dr. Gregory and Dr Rajaratnam admit that socioeconomic factors and access to care can’t account for the entire higher infant mortality amongst lower income ethnic minorities. However, they play a major role and must be addressed if infant mortality rates are to be lowered nationwide.

More Research

Both Drs. Gregory and Rajaratnam agree that there needs to be more research into the possible causes of infant mortality and both advocate that the National Institutes of Health, the National Institute of Child Health and Human Development and other research and policy organizations allocate funds and research efforts into infant mortality.

It must also be noted that advances in treatments, such as the use of progesterone injections for preterm birth, Magnesium Sulfate’s impact on protection of preterm infant brains, improvements in neonatal intensive care and improving access to perinatal health care will all improve infant outcomes.

References

DOTmed.com

Neonatal, postneonatal, childhood, and under 5 mortality for 187 countries, 1970-2010; a systematic analysis of progress towards Millennium Development Goal 4. Julie Knoll Rajaratnam PhD et al. The Lancet, Volume 375, Issue 9730, Pages 1988 – 2008, 5 June 2010.  doi:10.1016/S0140-6736(10)60703-9

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