Where the youngest die more

The U.S. lags seriously behind in preterm births and infant mortality.

A recent CDC report finds that the U.S. lags seriously behind almost all European countries on two key indicators of women and children’s health: preterm births and infant mortality.

Preterm births and infant mortality are related, sequentially. That is, we have very high rates of pre-term births (defined here as those born between 22 and 36 weeks of gestation)…

… and, partly as a result of that, we have high rates of infant mortality (defined here as deaths in the first year of life, per 1,000 live births):

The CDC report concludes: “The main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States.” Excluding those born extremely early – at less than 22 weeks – for example, Sweden has an infant mortality rate of 3.0, compared with 5.8 in the U.S. Using standardization, the report determined that with the Swede’s gestational age distribution the U.S. rate would be 3.9 – which means the differences in the gestational age pattern accounts for 68% of the difference between the two countries.

So reducing the rate of preterm births is two-thirds of the battle for the U.S. infant morality rate problem.

So what causes preterm births? I’m not a medical expert, but this is from reading a few general reviews and specific studies. Large studies show that preterm births are associated with older age and smoking, as well as maternal infections or other underlying health conditions. Black women and those with lower socioeconomic status and higher stress are at greater risk of preterm births.¹ And women with more prenatal visits have lower risks.²

I take all that to confirm that preventive care for women in general and prenatal care for mothers is essential. Check back here for an update in 2019. If these rankings haven’t improved in 10 years, health care reform didn’t work.

Notes:
¹ Overall, 13% of U.S. mothers smoke during pregnancy, with White women having the highest rates. The U.S. rates are similar to Sweden’s, but lower than some others, such as Denmark’s, and the United Kingdom.
² Multiple births related to assisted reproductive technology and older mothers also account for some of the U.S. pattern of preterm births.