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Infant Mortality and Premature Birth
Myth: The U.S. infant mortality rate is higher than that of other countries
Fact: The U.S.’ infant mortality rate is not higher; the rates of Canada and many European countries are artificially low, due to more restrictive definitions of live birth. There also are variations in the willingness of nations to save very low birth weight and gestation babies.
The ethnic heterogeneity of the U.S. works against it because different ethnic and cultural groups may have widely different risk factors and genetic predispositions.
Definitions of a live birth, and therefore which babies are counted in the infant mortality statistics very considerably. The U.S. uses the full WHO definition, while Germany omits one of the four criteria. The U.K. defines a still birth “a child which has issued forth from its mother after the twenty-fourth week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life.”1
This leaves what constitutes a sign of life open and places those born before 24 weeks in a gray area. Canada uses the complete WHO definition but struggles with tens of thousands of missing birth records and increasing numbers of mothers sent to the U.S. for care.2 France requires “a medical certificate [that] attests that the child was born ‘alive and viable’” for baby who died soon after birth to be counted, which may be difficult to obtain.
Myth: The U.S. premature birth rate is higher than that of other countries.
Fact: In the Netherlands, babies below 25 weeks gestation are no longer resuscitated, but rather given only palliative treatment. Those at 25 to 26 weeks are generally resuscitated and kept alive, but the decision depends on the facts of each case.3 The result is underreporting the number babies that may be live-born but who are not offered aggressive treatment.
Switzerland only uses two of the four WHO criteria, respiration and heart beat, and does not aggressively treat very premature babies. In some cantons, the baby must be 30 cm long to be registered as a live birth. Switzerland also requires registration of still births only from 6 months gestation and has no rule regarding registration of live births. Studies have found significant underreporting of premature births in Switzerland, which can alter the overall mortality rate by more than a percentage point.4
- 1 Births and Deaths Registration Act 1953, paragraph 41, modified by Still Birth Definition Act 1992.
- 2 Lisa Priest, “Canada’s U.S. baby boom,” The Globe and Mail, 5 May 2008; Caroline Abraham, “Red tape denies baby Sonja her brief life; To the dismay of parents, thousands of births go undocumented in Ontario,” The Globe and Mail, 22 July 2006.
- 3 From the newsletter of the Dutch Paediatric Association, quoted in “The Dutch Policy,” BBC News, 22 September 2004, http://news.bbc.co.uk/go/pr/fr/-/2/hi/programmes/panorama/3677278.stm.
- 4 Martina Müller, Gero Drack, Christian Schindler, and Hans Ulrich Bucher, “Live and Stillborn very low birthweight infants in Switzerland: comparison between hospital based birth registers and the national birth register,” Swiss Medical Weekly, vol. 135, (2005).
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