Explaining the Country’s Infant Mortality Rate – Part 1
Description
The measurement of infant mortality says a lot about a country, especially its quality and accessibility of good public health. Even in some of the wealthiest countries in the world, though – such as the United States – infant mortality rates remain high. Infant mortality is defined as the death of a newborn baby before his or her first birthday, and there are three major causes for it in this country: birth defects, sudden infant death and prematurity.
Listen in to part one of two as Dr. Arthur James, Associate Professor of Obstetrics and Gynecology, The OSU College of Medicine, and co-director of the Ohio Better Birth Outcomes project at Nationwide Children’s Hospital and also co-director of the Ohio Department of Health’s Collaborative to Prevent Infant Mortality, talks about the main contributing factors of infant mortality in the United States. He’ll also bring to light some ways in which the state of Ohio and Nation Children’s are working to bring the infant mortality rate down. In part two of this podcast, he’ll continue to talk about initiatives aimed at reducing this rate, as well as the role of life experience as a contributing factor, specifically racism.
Transcript
[Music]
Rick McClead: Why does one of the most developed nations in the world have one of the highest infant mortality rates? What is being done about it? Why is this problem important to you?
The problem of infant mortality in the United States, next on Children’s on Quality.
Welcome to Children’s on Quality. This is your host, Dr. Rick McClead, Medical Director for Quality Improvement Services at Nationwide Children’s Hospital.
With me to discuss the problem of infant mortality in the United States is Dr. Arthur James, Associate Professor of Obstetrics and Gynecology, the Ohio State University College of Medicine, and Co-Director of the Ohio Better Birth Outcomes Project at Nationwide Children’s Hospital and also Co-Director of the Ohio Department of Health’s Collaborative to Prevent Infant Mortality.
Dr. James, welcome to Children’s on Quality.
Arthur James: Thank you, Dr. McClead. I’m happy to be here.
Rick McClead: All right, I want to begin with two quotes that appeared in the October 3rd, 2011 op-ed pages of “USA Today”.
Quote, “Twenty years ago, the United States was doing better than countries such as Cuba, Poland and Estonia in keeping newborn babies alive. Not anymore. As other nations improved this key indicator of women’s and infants’ health, the U.S. lagged, dropping to 41st worldwide in newborn death rates behind these three countries and 37 more,” unquote.
Contrast that with the opposing editorial by Dr. Scott Atlas, a Senior Fellow at the Hoover Institution and a professor at the Stanford University Medical Center. Quote, “Infant mortality rates are extremely misleading, contaminated by factors unrelated to health care quality and plagued by inconsistencies and gross inaccuracies, all of which specifically disadvantage the United States,” unquote.
Now I suspect that both of these statements are true. What should the public understand about the problem with infant mortality in the United States?
Arthur James: Well, first off, let’s define ‘infant mortality’. Infant mortality by definition is the death of a newborn baby before his or her first birthday. And we generally compare different countries or different groups by looking at what’s referred to as the infant mortality rate, which is the number of infant deaths per 1,000 live births.
So when we look at this, I actually think there’s some accuracies in both of those statements. Though infant mortality rate measures the number of babies who die in the first year of life per 1,000 babies born, the infant mortality rate is also one of the most sensitive measurements we have for the quality of life for any group.
So that when you look in the United States, first off, compared to other countries, while generally speaking our overall infant mortality rate does not compare as favorably as we would like, a lot of that is because of the contribution that some groups make to bring the United States infant mortality rate down, like African-Americans in the United States who have a significantly higher infant mortality rate than do the majority group in this country.
If you disaggregate the data and look just at the white infant mortality rate in the United States and compare that to other countries, then while the United States still isn’t at the top, we compare much, much, much more favorably. And so part of the issue for us in terms of trying to understand our infant mortality rate is to take into consideration that there’s some groups who don’t compare well.
I want to concentrate a little bit, though, on the second quote that you’ve mentioned that indicates that infant mortality rates are extremely misleading, contaminated by factors unrelated to health care quality.
Some of those factors that we normally don’t look at as being important to us in terms of health care issues are factors that influence the quality of life. And since infant mortality rates capture many of those other factors, things like poverty, under-education, unemployment, which are not generally considered quality measures in terms of health care, are things that have a significant impact on infant mortality.
Rick McClead: Well, putting the whole issue of what the real rate is and how we compare with the rest of the world, what are those factors that clearly are contributing to infant mortality in this country?
Arthur James: Well, let’s first start with the medical issues. Generally, when we measure infant mortality from a clinical perspective, we measure it by looking at clinical issues that significantly contribute to why babies die in the first year of life.
And I like to put infant mortality in the following perspective for people: If we look at all of childhood death, so all the death that occurred to children from birth through 18 years of age, those deaths that occur in the first year of life, what we refer to as infant mortality, account for two-thirds of all childhood death.
So putting it in appropriate perspective, then, in that first year of life, two-thirds of all children die from zero to 18 years of age. So that first year of life is pretty crucial for us. And within the first year of life, the period of time that’s most crucial is actually the first month of life, where about two-thirds of infant mortality occurs.
And the primary reason for that is the contribution of prematurity and of congenital anomalies. After the first month of life, post-neonatal, or that after the first month of life cause of death, the most common cause is sudden unexpected infant deaths. So from a clinical perspective or a medical perspective, those three things stand out: prematurity, congenital anomaly, sudden unexpected infant death.
Rick McClead: Before we go to the non-medical issues, what are we doing about those three things? Just summarize that.
Arthur James: Well, where prematurity is concerned and where congenital anomalies are concerned, there’s of course been a lot of work by the March of Dimes nationally to try to lead and spearhead some of our efforts.
Currently, where prematurity is concerned, the issues that the March of Dimes feels that we ought to address include decreasing the incidence with which scheduled but non-medically-indicated births occur before 39 weeks gestation.
They also suggest that we should work hard with our endocrine and fertility doctors to cut down the number of multiple gestation births that occur as a consequence of assisted reproductive technology.
They also advocate that we provide 17-hydroxyprogesterone to any woman who has experienced a previous pre-term birth because she is at risk for a repeat pre-term birth, and the data suggest to us that 17-hydroxyprogesterone helps to decrease the incidence with which those births occur.
And the other piece that the March of Dimes advocates pretty strongly is that we attempt to decrease the incidence with which women smoke during pregnancy, because in doing so, we believe we can cut down the incidence of miscarriages as well as pre-term birth.
So that from a clinical perspective, that’s what we’re doing in terms of the prematurity issue.
Where congenital anomalies are concerned, we continue to advocate pretty strongly that all women be on folic acid, preconceptually but especially during the early phases of pregnancy.
In the state of Ohio, we are also pushing real hard to try to decrease the incidence with which women are exposed to illicit drugs but also prescription drugs that can have teratogenic or harmful effects to the baby to help decrease risk of those pregnancies to babies.
And where the sudden unexpected infant deaths are concerned, we are strong advocates of the American Academy of Pediatrics’ October of 2011 revised recommendation for creating safe sleep environments for babies that emphasize the ABCs of back to sleep, that babies should sleep alone, that they should be put on their backs for every sleep, and that they should sleep in a crib or bassinet or a safety-approved sleeping surface.
I want to emphasize here that