What are politicians doing about the shameful infant mortality rate?

The infant mortality statistics are out again. This always depresses me because: 1) The rates are atrociously high, and, 2) There is so much legislation passed to restrict abortion in the name of “life,” but politicians and judges seems awfully silent on infant mortality.

In the United States 6.4 infants out of every 1,000 born will not reach their first birthday. This is more than 24,000 infant deaths a year. The United States is also the leader in the industrialized world for infants dying on the day they are born. Over 35% of neonatal and infant deaths are the result of a premature delivery. As an OB/GYN I’ve delivered many tiny babies destined to die and my son, Aidan, is part of that data set … a child sharing a date of birth and date of death due to prematurity. I know this tragedy and sadness only too well.

It’s not that lowering the infant mortality rate isn’t possible, politicians who are pro-life can be assured that dramatically reducing the infant mortality rate is possible. In Iceland the infant mortality is 1.6 per 1,000 births.

It’s not that we’re not spending enough on health care. In the U.S. we spend $8,508 per person each year for health care (compare that with $5,699 for Norway and $4,522 for Canada) or close to 18% of our gross domestic product. We spend more than any other industrialized country on health care and yet more babies die here on the day they are born than any other industrialized country.

So why isn’t any of this of interest to pro-life politicians? Shouldn’t they be outraged that more than 75% of these deaths are preventable? And not only are they preventable, but given the money we spend on health care this just shouldn’t be happening. It’s mind-boggling. Really.

Study after study shows that high quality accessible maternity care dramatically lowers the rate of premature delivery (it doesn’t have to be expensive, in fact, the right care isn’t very expensive at all). It is possible to get the prematurity rate into the 6% range (it is approximately 12% now). We have laws mandating transvaginal ultrasounds and admitting privileges, so why not laws to mandate the right kind of maternity care?

Teen pregnancy is a factor, a complex mix of biology and the social circumstances that lead a teen to get pregnant. Why wouldn’t pro-life organizations an politicians be promoting long-acting reversible contraception so teens can delay child-bearing to a time when they are more likely to have a healthy outcome for both mom and baby? Instead of mandatory “women’s right to know” bullshit about breast cancer and abortion (there is no link, but the Federal courts say that doesn’t matter, in some states doctors just have to lie and say there is), why not mandatory information about long-acting reversible contraception for junior high students?

Maternal obesity is also a factor. And smoking. And obviously addressing these causes would also make for healthier women who are less likely to die from cardiac disease, diabetes, or lung cancer. Why don’t the politicians shut down big tobacco and ban trans fats?

We also have a disturbingly high rate of multiple deliveries through the misuse of assisted reproductive technologies. In Europe where the number of embryos that can be implanted is strictly regulated the incidence of multiples is dramatically lower than the United States, although the pregnancy rate is the same. Europeans just more likely to take home one baby at term. Professional societies have balked at regulating ART. If we are going to regulate abortion clinics in the name of life, why not infertility clinics? I mean the professional societies are too afraid to tackle it, so, why not?

But no, the shameful American infant mortality rate will likely be in the headlines for a day or two and then pass out of sight and the people who are in a position to actually make change? Well, they’re probably too busy crafting more abortion legislation to notice.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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  • Ron Smith

    Hi, Jennifer.

    Why are you so en pointe with pro-life? Is it that you want to make the mortality rate a pro-choice issue. I could presume that you are stating that if perhaps many of these babies weren’t born in the first place as a way to lop down the percentage, but I’ll think better of you and not assume that.

    Having practiced Pediatrics for thirty years and done level three neonatal intensive care for the first six and a half of those and been involved with the first pre-release exosurf use I have some grounds for my opinions.

    It is a little disenginuous to compare one infant newborn mortality rates as though you are comparing apples to apples. The causes that lead directly to increased and decreased mortality rates are multifactorial. Even the dollars comparisons are not appropriate.

    From one society to another the abortion rate now certainly plays a significant factor. In Iceland, in around 2000, for example, a quick Google search revealed that the teenage pregnancy rate and the abortion rates were rising dramatically compared to other Nordic countries.

    The health care dollars spent will certainly be different where medical values and standards of care are different. If you are resuscitating many more 21 to 23 weekers in one country where another country only aggressively intervenes with the same intensity for premies beyond 24 to 25 weeks, then the infant mortality rates are by definition going to be discordant.

    My point is that you cannot accurately compare infant mortality rates and health care dollars from one country to another, or even necessarily between geographic regions within a country without a thorough and exhaustive analysis. I don’t see how your points meet exhaustion here?

    So then it leads me to back to my first question? But then I have to remember that I’ve decided to think better.

    With respect and warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • ninguem


      This is an older report, about 20 years now. Of course, we were hearing the same story 20 years ago, about how USA infant mortality was so much higher than the rest of the world..

      The concern was, the reporting wasn’t standardized then, causing bias in the comparisons back then. Have things changed since then? I don’t know.

    • Pat Brown

      Thank you for saving me the time of posting a similar analysis of the comparison of apples to coconuts!! Does ANY other country try to save micro-preemies, only to “lose them” 98% of the time to death or severe and lingering damage?

    • Judith Johnson

      Thanks Ron, astute comments.

    • jere14

      Jennifer is simply pointing out the hypocrisy in taking a pro life stance but ignoring the issue of infant mortality. Why the sudden lack of concern for life when a baby is born?

  • John C. Key MD

    It takes really convoluted reasoning to lay infant mortality at the feet of pro-lifers. The points given here don’t seem to wash at all. I’ve also been told that what constitutes an infant death is not uniform throughout the world–we in the US report a lot of deaths that don’t get reported elsewhere. That may be true but I don’t have a reference to support it. Puts me in the same category as some of the “facts” given here.

  • NormRx

    And just what are the politicians supposed to do? Oh I know, mo money, mo money. It sure would be nice to see someone write an article and place the blame squarely where it belongs, on the individual. What are the politicians supposed to do if a 14 year old girl or boy decides to engage in sex? How about if the female decides to use drugs, alcohol, smoke or do any number of other activities that could be detrimental to the fetus? Maybe it is time as a society we ostracize people that engage in anti-social behavior, instead of glorifying that behavior.

    • SBornfeld

      What would you suggest?

  • Judith Johnson

    First of all there is a flaw in your logic. You cannot logically tie pro lifers and infant mortality together. One has nothing to do with the other. I just spent last year pursuing additional certification in midwifery (I am a family NP)…the answer, as Europe has so strongly shown us, is MIDWIFERY care. When a caring, master’s degree trained advanced practice nurse is inserted into the prenatal care and women’s health process, the infant mortality rates go down. When the low-intervention, mother intensive and proven practices of midwifery are involved, there is less prenatal problems and more term deliveries and those deliveries are safer. If you really look at those countries with the excellent low infant mortality you will see that they have lots of highly educated nurse midwives (NOT LAY MIDWIVES) seeing the expectant and delivering population… and they have low, low Ceasarean section rates too.

  • terragamo

    Why aren’t people just honest when they write these? Just say that you think pro-life is wrong, rather than try to hide your political feelings behind poor data.

  • SBornfeld

    Yes, the comparisons are not perfect. But some of the highest poverty rates in the developed world, plus the most expensive health care in the world yields predictable results.
    I’m all for responsible behavior by citizens. But if care is out of the reach of the most vulnerable, you can blame the victim–or you can work for improvement–or we’ll be having the same conversation in another 20 years (if we’re still breathing).

  • Jane OfVirginia

    I don’t know that I think politicians should tinker with mothers and babies before they rein in their habits of spending far more money than our nation can hope to earn.
    I think that the atrocious infant mortality rate in the US can be traced to the abyssmal and failing US educational system. Many young women, particularly the poor have a very poor grasp of how their own bodies work, and no conception whatsoever of the fragility of a newborn baby. They don’t understand that dehydration can kill an infant within hours, or that improper dilution of infant formula can kill and maim as a result of water intoxication. There is an unhealthy reliance on old wives tales where raising babies is concerned. I am tired of such women telling me they cut their babies gums to prevent teething fusiness ! Breast feeding is still not occurring as much as it should, unless contraindicated by medication or illness.
    We need higher standards for health classes for American teens and these classes need to include issues of caring for a normal newborn, toddler and child.

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