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Baby blues: Why the country's infant mortality rate is so high and what can be done about it

by Olga Deshchenko, DOTmed News Reporter | May 24, 2011
From the May 2011 issue of HealthCare Business News magazine

In 2009, advocates working to reduce child mortality rates around the globe had cause to celebrate. The year marked the first time the number of children who died before the age of five dipped below nine million, according to UNICEF data.

Strategies aimed at improving the children’s chances to survive are working, but the United States can’t quite join in on the celebration.

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.”

In 2006, the U.S. infant mortality rate was 6.71 deaths per 1,000 children. According to research estimates, that’s about the same rate as last year. On a broader global scale, the nation lags behind countries like Cuba and Chile. The U.S. ranks 42nd in the world in child mortality, according to a study by the Institute of Health Metrics and Evaluation at the University of Washington, published in the medical journal The Lancet last May.

For those who study child mortality, the fact that the U.S. fares worse than other developed nations is no surprise. But what shocks even researchers is that the country isn’t keeping up with global gains in reducing child mortality, despite significant health care spending.

“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,” Julie Rajaratnam, assistant professor with IHME and one of the study’s authors, wrote in an email to DOTmed News. “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,” she said. “What that tells us is that we’re not making as much progress as other high income countries.”

And the study shows it’s not only the top industrialized economies leaving America in the dust. In 1990, Serbia and Malaysia had higher child mortality rates than the U.S., but by 2010, both countries managed to reduce their child mortality rates by 70 percent, while the U.S. only saw a 42 percent decline, in pace with Kazakhstan and Sierra Leone. Even Singapore, which has the world’s lowest child mortality rate of 2.5, slashed its rate by two-thirds between 1990 and 2010.

To make matters more complicated, it’s important to recognize that the rankings aren’t all black and white. International differences in data collection might unfairly impact America’s standing.

For instance, the definition of a “live birth” varies by country, points out Dr. Kimberly Gregory, vice chair of women’s health care quality and performance improvement at the OB/GYN department of Cedars-Sinai Medical Center, and professor at the David Geffen School of Medicine at the University of California, Los Angeles. Thus, we’re not always “comparing apples to apples,” says Gregory, who is also a member of the Society for Maternal-Fetal Medicine.

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