A nursing student in our cohort posted this article to our class Facebook page this week and I found it very interested and wanted to share with you all. The article begins by discussing the Healthy People 2020 goal to decrease the number of infant deaths to 6/1000 and tells how currently the US is at 6.1/1000. However, as we have discussed in class, the U.S. infant death rate is still relatively high compared to other developed countries such as Austria whose has a rate of 3.8, Finland who has a rate of 2.3, and Monaco who has a rate of 1.8 (the lowest in the world.) However, the article brings up an important concept that we have only briefly touched upon in class… how these data/stats are collected. The article states that there is often a discrepancy in the definition of a live birth and claims that the US rate may actually be lower (around 4.2). U.S. statistics include babies born before 24 weeks (even though chance of survival is very low for babies born before 23wks) while other countries may classify extremely low birth weight babies as a stillbirth/miscarriage; thus, if the ELBW babies die they are not included in the infant death rate.
While this in itself is interesting to think about, and can spark conversation about policies that perhaps need to be in place to insure more accurate data collection and parameters defining how we calculate infant death rate, the article goes even further to discuss an issue I find even more intriguing.
The article claims that the majority of infant deaths in the U.S. actually do not occur in the neonatal period (first 28 days) while the babies are still in the hospital, but over time after they are home. Furthermore, they examined how this is particularly true with babies born to women of lower socioeconomic status. While we have discussed how socioeconomic status contributes to birth outcomes across the globe, I found it interesting that the article claims that in comparing outcomes between the U.S., Austria, and Finland that children born to poor minority women in the U.S. “were more likely to die within the first year than children born to similar mothers in other countries.” So, I am wondering what you all think may play in to this. What makes infants (and women) of lower socioeconomic status in the U.S. more vulnerable than women of lower socioeconomic status in other developed nations?
Here is the link to the article:
Romm, C. (2014, October 1). Why American Babies Die. Retrieved November 18, 2014, from http://www.theatlantic.com/health/archive/2014/10/why-american-babies-die/381008/
I love that you shared this Molly because I was shocked by the figures as well. My initial thought about the first fact (US having lower mortality rate for neonates) was that perhaps our standards of care in the hospital are better than other countries. I don’t have hard evidence to back this up, but my idea was if babies are born in both countries that are equally sick, born premature, etc then it must have to do with the life saving interventions and supportive care they receive during that neonate period. Perhaps, with more investigation, I would find that Austria and Finland just have sicker neonates though, and so our care is not superior.
The second fact about more children dying in the US in the postnatal period is interesting as well, especially that they occur more frequently in lower SES families. Perhaps this could relate to the very sick neonates, supported by excellent hospital care and interventions, but then released to families that don’t have the means (financially or time capacity) to provide the high level of care or healthy lifestyle. As we have discussed in class, families of lower SES have lower education levels, more exposure to violence (and obstetric violence), drug abuse, alcohol abuse, poor nutrition, lower financial income, and less resources available. All of these are more risk factors to providing or achieving a good health status. Then you add in the fact that perhaps the babies were not born as healthy as others and have been supported by around the clock medical care. Unfortunately, such a transition can be fatal.
I would be interested to know more details of the data of this article. Thanks for sharing Molly!