I think the rate in Japan and the European countries might be lower partially because their populations are more homogenous than theirs. I don't know whether their universal health coverage makes a difference or not. The idea I believe Oral had about preterm babies is an interesting one, but I have no knowledge of the way preterm babies are handled in the other countries that we are comparing America to. I also read on the web that the fact that a lot of our mothers are quite old, comparatively, may make a difference. Of course, European and Japanese mothers are getting older as well.
Infant mortality the way they are defining it is deaths for infants up to one year old. So there are implications not just for maternal health care, but for pediatric health care. The primary reason for the disparity according to this article seems to be that the figures are skewed dramatically by higher infant mortality rates in the populations of our underprivileged minorities.
I am posting what I found because you raised the question, but am not particularly interested in arguing about it, and am making no particular political statement in posting it:
sustainer.org
The State of the World As Seen by Its Babies
Politicians and economists look eagerly for the latest GDP reports to see how their nations are doing. I look for the latest IMR reports.
IMR stands for infant mortality rate. It's the number of babies out of every thousand born who die before they reach their first birthday. To give you an idea of the range of this index, Finland had the world's lowest IMR -- 3.5 -- in 1998. In Finland 996.5 out of 1000 infants born successfully reached age one. The highest infant mortality rate -- 195 -- was in Sierra Leone in West Africa. About one baby in five there did not survive its first year.
Babies die because their mothers get poor health care, poor nutrition, little education. They die because of unclean air and water. They die because they have been exposed to disease or toxic pollutants, before or after they are born. Which is to say, the IMR is a sensitive measure of the degree to which a nation has mastered the basics of life and health and the degree to which these basics are available to the society's most vulnerable members.
IMR data are full of surprises, among them the relatively high number for the United States, given our wealth. Our babies are twice as likely to die as Finnish babies; our IMR of 7.0 is higher than Canada's (6.3), Israel's (6.7), Taiwan's (6.7) or Portugal's (6.9). It is far higher than the infant mortality rates of Japan (3.8), Germany (4.9), France (5.1), Italy (5.8), Spain (4.7), the Netherlands (5.7), or Sweden (3.9).
If it looks like the difference between an IMR of 7.0 and 3.5 is unimportant, multiply it by the annual 4 million births in the U.S. and you see that if our rate were as low as Finland's, we would save the lives of 14,000 babies each year, 38 each day, 1.6 each hour.
People of different ideologies can look at those numbers and come up with different explanations for why some countries score so much better than we do. The explanation that most leaps out to me is that we don't include all our citizens fully as citizens. Infant mortality for our white population is 6.0; for our black population it is 14.2. For whites in Massachusetts it is 4.7, for blacks in Washington D.C. it is 19.2. We know perfectly well how to take care of pregnant and nursing mothers and their babies. We're just not extending that care to everyone.
The Hunger Project once set an IMR value of 50 as an arbitrary but reasonable target for all the world's nations. Below 50 a country can be said to have at least basic social and economic coherence. Above 50, a country that allows more than five percent of its babies to die can hardly be called developed.
All Europe meets that standard, even Croatia (IMR 8.0), Russia (17), Albania (20) and Romania (22.6 -- the highest IMR in Europe.
Asia has made astonishing progress in infant survival, especially such countries as Malaysia (IMR 10), South Korea (11) Sri Lanka (16.5), Thailand (25), Iran (35), and China (31 -- an amazingly low rate for a poor country that produces over 20 million babies a year). The Asian countries that don't make the target of 50 are few enough to list: Yemen (77), Afghanistan (150), Bangladesh (82), Bhutan (71), India (72), Nepal (79), Pakistan (91), Cambodia (116), Laos (97), Myanmar (83),and Iraq (127).
Latin America has been even more successful in bringing infant mortality below 50. All Central America has achieved that goal except Guatemala, which is right on the edge of doing so (51). All the Caribbean except Haiti (74). All South America except Bolivia (75) and Guyana (63). Cuba's IMR (7.2) is comparable to that of the United States, in spite of its trade embargo and other economic hardships.
When I first started paying attention to infant mortality rates, no country in Africa scored below 50 except some of the island nations of the Indian Ocean. (Mauritius 21, Reunion 9, Seychelles 7.) Slowly, however, some African nations are getting close to or past the goal. Algeria 44, Tunisia 35, South Africa 52, Zimbabwe 53, Botswana 60., Kenya 62. However there are the far too many African countries that still lose more than one in ten of their newborns -- Niger 123, Mali 123, Ethiopia 128, Malawi 140, Mozambique 134, Somalia 122, Angola 124. These are also countries where statistics on such everyday events as the deaths of babies are unreliable. The actual numbers could be even higher than the official ones listed here.
Sierra Leone, with its IMR of 195, averages 6.5 births per woman. Afghanistan averages 6.1, Haiti 4.8, Kenya 4.5. The U.S. averages 2.0, Cuba 1.4, Germany 1.3, Thailand 2.0, China 1.8, Finland 1.7.
(Donella H. Meadows is director of the Sustainability Institute and an adjunct professor of environmental studies at Dartmouth College.) |
