America, We Have a Death Problem: Infant Death and Low Birth Weight
In a previous post, I talked about how Americans are less healthy and live shorter lives than almost all other high income countries. In this follow-up, I want to tell you about one aspect of the U.S. health disparity that really puzzles me: infant death and low birth rates. As in the previous post, the facts are drawn from U.S. Health in International Perspective: Shorter Lives, Poorer Health, a recent National Academies Press report. Overall, the U.S. has the highest infant death rate of 17 “peer” countries like Australia, Canada, and France. If you look at birth outcomes (infant death, stillbirth and low birth weight) and combine them to get a “composite” score – the U.S. ranks lowest again. Although infant death in the U.S. did decrease 20% between 1990 and 2010, other countries managed to decrease theirs by 50%. Clearly, we are behind the curve.
I suppose this was so shocking to me because I, like most Americans, see this country as a place with cutting edge medical knowledge and extremely well trained doctors. When I was pregnant I went through 9 months of medical pampering and overly enthusiastic micromanagement of my body, and it’s hard to imagine how we could be going so wrong.
Although I’m sure that health care plays an important role in this problem (note that the other countries all have universal health care), turns out it isn’t all that, however much we love to blame the system. The report puts it well, “Even if U.S. health care plays a role, health is determined by far more than health care,” this is very true. But, you can't blame it all on any of the other usual suspects either, like racial and ethnic differences or poverty and lack of education. Although there are certain groups that show a higher incidence of poor birth outcomes, such as African American women, the report shows that infant death for Caucasians in the U.S. is higher than for those in other countries. Also, women with 16 or more years of education still have worse birth outcomes than their peers in other high income countries.
In short, it’s a complex problem. However, some clues may be found in the details: the biggest differences in birth outcomes between the U.S. and peer countries were in low birth weights (an indicator of unhealthy womb and post-birth conditions) and newborn/infant deaths. Also telling is that the rate of preterm births in the U.S. equals that of Sub-Saharan Africa! Is our trademark, unhealthy American lifestyle/environment at least partially to blame? Could be. Womb conditions are influenced by lifestyle factors such as maternal smoking and diet, family factors such as marital status and stress, and societal and environmental factors – things like chemical exposures and the aforementioned access to health care.
Many of the American health deficiencies brought to light by the report could affect maternal and fetal health during the course of a pregnancy. For example, U.S. teens have higher rates of pregnancy than other high-income countries. Children of teen mothers are more likely to be born prematurely, have lower birth weight and have a higher risk of infant death. This is just one example, and I encourage you to download the free report on the National Academies web site. While you ponder the potential causes of this issue and the implications for our future generations, I will work on my next post: The Health Disadvantage of American Women.
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