Shortly before Mother’s Day, Save the Children released its annual report on the state of motherhood and infant mortality worldwide. As usual, the US does worse than almost every other industrialized nation when it comes to infant mortality (pdf file – see page 38).
The philosopher John Rawls suggested, as a thought experiment, imagining a “veil of ignorance.” The idea is, we sit around planning how to organize society from behind the veil; and none of us planners know what position in society we will hold, what race, what gender, how wealthy our parents will be, etc.. If the people planning society knew they might be born any race, any class, what society would they plan?
I don’t think they’d plan one in which infant mortality by race looked like this (source – pdf file):
As you can see, if you’re a newborn American infant, it kinda sucks to be an American Indian, Hawaiian, Puerto Rican, and the suckitude is simply enormous if you’re Black.
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Unfortunately, the racial aspect of infant mortality in the US is usually ignored in the mainstream media. Instead, the focus is on how bad the US does, compared to other countries. The QuandO blog, like many right-wingers, responds that it’s not that the US does any worse at caring for newborns. Instead, it’s that other countries give up on low-weight and otherwise unhealthy newborns more easily, counting them as “stillborns.” In contrast, doctors in the US work hard to save those infants – but since not all of them live, the result of the superior care here in the US is that our infant mortality rate appears higher.
In an op-ed piece, critics of the Save The Children statistics suggest that we should forestall trying to correct the US’s poor results:
If we want to lower our infant mortality rate so it compares better with that of other countries, maybe we should align our rules with theirs to better determine the actual extent of the alleged “problem.”
(Does calling the problem “alleged” and putting the word “problem” in scare quotes create a sort of double negative problem?)
My first question is, how does this critique account for the enormous racial gap in infant mortality within the USA? (It seems unlikely that in the US, doctors try harder to save babies of color while categorizing similar white babies as stillborn.)
My second question is, how much truth is there to QuandO’s critique? Some truth, but not enough to justify calling the US’s infant mortality rate, compared to other wealthy countries, an “alleged problem.” The OECD Factbook explains:
Some of the international variation in infant and neonatal mortality rates may be due to variations among countries in registering practices of premature infants (whether they are reported as live births or fetal deaths). In several countries, such as in the United States, Canada and the Nordic countries, very premature babies with relatively low odds of survival are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.
Yet Canada and the Nordic countries all have better infant mortality rates than the US. So the difference in reporting practices doesn’t account for all of the US’s dismal performance in this area.
If it’s true that the U.S. does as well as other wealthy countries in infant mortality, and we appear to do worse only because we classify cases as infant deaths that in other countries would be classified stillborn, then that should show up in higher stillbirth rates for those countries than for the U.S.. This is something we can check; a World Health Organization report issued earlier this year (pdf link) gathered statistics for stillbirths. So lets look at the WHO stillbirth numbers next to the infant and newborn mortality statistics from the Save The Children report:
The graph includes the five countries Save The Children credited with the lowest newborn mortality rates, plus Canada and the USA. Including stillbirths does make the US look better, and is consistent with the claim that other countries may be count some infant deaths (by US standards) as stillbirths.
However, most of these countries are doing as well or better than the US in all categories, including stillbirths. That’s incompatible with the claim that the US’s infant mortality problem is a statistical illusion caused by different standards for categorizing stillbirths.
To make this clearer, look at a graph combining infant mortality and stillbirth rates. (Newborn mortality is not included because the newborn and infant mortality categories overlap).
Even when stillbirth deaths are included, the US is still doing significantly worse than countries credited with low infant morality rates. It is therefore impossible that the US’s poor standing is caused entirely by the exclusion of stillborn children from infant mortality statistics (although this exclusion may be a contributing factor). The US’s terrible track record, compared to other wealthy countries, is not an “alleged problem”; it is an atrocity, and one that shouldn’t be swept under the rug.
If you’d like to avoid the comment moderation on “Alas,” you can also leave comments at the same post at Creative Destruction.