Infant mortality has long been considered one of the most important indicators of the health of a nation and the quality of its medical system. In 1960, the United States ranked 12th lowest in the world, but by 2004, the latest year for which comparisons were issued by the Centers for Disease Control and Prevention, that ranking had dropped to 29th lowest.
This international gap has widened even though the United States devotes a far greater share of its national wealth to health care than other countries. In 2006, Americans spent $6,714 per capita on health — more than twice the average of other industrialized countries.
Some blame cultural issues like obesity and drug use. Others say that the nation’s decentralized health care system is failing, and some researchers point to troubling trends in preterm births and Caesarean deliveries.
Many agree, however, that the data are a major national concern. More than 28,000 infants under the age of 1 die each year in the United States.
“Infant mortality and our comparison with the rest of the world continue to be an embarrassment to the United States,” said Grace-Marie Turner, president of the Galen Institute, a conservative research organization. “How can we get better outcomes?”
The data, collected by the Centers for Disease Control and Prevention, indicate that the nation’s infant mortality rate has been static for years despite enormous advances in the care given to preterm infants. Two-thirds of the infant deaths are in preterm babies.
In 2006, 6.71 infants died in the United States for every 1,000 live births, a rate little different from the 6.89 rate reported in 2000 or the 6.86 rate of 2005. Twenty-two countries had infant mortality rates in 2004 below 5.0 infant deaths per 1,000 live births, with many Scandinavian and East Asian countries posting rates below 3.5. While there are some differences in the way countries collect these data, those differences cannot explain the relatively low international ranking of the United States, according to researchers at the disease control agency.
Preterm birth is a significant risk factor for infant death. From 2000 to 2005, the percentage of preterm births in the United States jumped 9 percent, to 12.7 percent of all births. The most rapid increase has been among late preterm births, or babies born at 34 to 36 weeks of gestation. Some 92 percent of these increased premature births are by Caesarean section, according to a recent study.
Dr. Alan Fleischman, medical director of the March of Dimes Foundation, said that a growing number of these late preterm births might be induced for reasons of convenience. “Women have always been concerned about the last few weeks of pregnancy as being onerous,” Dr. Fleischman said, “but what we hadn’t realized before is that the risks to the babies of early induction are quite substantial.”
Dr. Mary D’Alton, chairwoman of the department of obstetrics and gynecology at Columbia University, said doctors should not induce labor before 39 weeks of gestation unless there was an urgent medical or obstetrical need. For unknown reasons, the number of preterm births is far higher among African-American women even when those women have access to good medical care, Dr. D’Alton said.
There is some evidence, she said, that steroids given to mothers at risk of giving birth early may help. A trial to test this theory is about to start.
Some economists argue that the disappointing infant mortality figure is one of many health indicators demonstrating that the health care system in the United States, despite its enormous cost, is failing.
Although the United States has relatively good numbers for cancer screening and survival, the nation compares poorly with other countries in many other statistical categories, including life expectancy and preventable deaths from diseases like diabetes, circulatory problems and respiratory issues like asthma.
Ms. Turner blamed socioeconomic factors like obesity, high drug use, violence with guns and car accidents — factors that she said could not be addressed by health reform. Karen Davis, president of the Commonwealth Fund, a nonprofit research organization, agreed that socioeconomic factors played a role but said that the nation’s heavy reliance on the private delivery of care was also to blame.
“We’re spending twice what other countries do,” Ms. Davis said, “and we’re falling further and further behind them in important measures like infant mortality.”