Thursday, November 05, 2009

Is the US' infant mortality really that bad?

Short answer: No, actually we have probably the best perinatal health care in the world.

This story in the New York Times is just about the most misleading item I've read in a long time. The Skeptical OB has an excellent detailed review, but I'll list the salient points.

When comparing infant mortality in the US vs Europe:

1. The US has a higher population of women of African descent which is an independent risk factor for pre-term birth.

2. Other countries often do not count extremely premature infants in their mortality statisitics.

3. The numbers do not correct for multiple births (twins, triplets, etc.) due to assisted reproductive technologies, which are used more widely in the US.

These are fatal flaws when comparing the US infant mortality to other developed nations. One odd comment by the statistician conducting the survey, Dr. Marian MacDormand, who said that "the strong role prematurity played came as a surprise to her." Huh? Prematurity has been recognized as by far the number one cause of infant mortality for, oh I don't know, the last 10,000 years.

Another oddity is the willingness of the medical director of the March of Dimes, Dr. Alan Fleischman, to throw the "US health system" under the bus, calling these findings an "indictment" of the poor way in which we care for women and children. I'm the first to say that the US health care system needs an overhaul, but not because of any incompetence of our perinatal services.

In fact, the issues of limited access that have adverse effects on overall US health care are almost nonexistent in regards to prenatal care and perinatal services. State-run, federally-funded Medicaid sets the income requirement very leniently for pregnant women thus allowing all pregnant women access to timely care.

If one were to correct for the larger numbers of multiple gestations and premature births in the US and the higher percentage of women of African descent, in fact the highest in the developed world, the US may still have higher infant mortality, but I doubt it and it certainly isn't shown in this study.

One modifiable risk factor is the liberal use of artificial reproductive technologies in the United States, and perhaps governing bodies should emphasize the importance of reducing multiple gestations.

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