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Thursday, September 10, 2009

Infant-mortality myths

From the Orange County Register by two doctors:

Statistics, even at their best, don't tell a whole story. A variety of people employ medical statistics dubiously to push pet causes.

A perfect example: infant mortality statistics. The officially reported U.S. infant mortality rate has been indisputably high compared with similarly industrialized countries since at least the 1920s.

That fact has led to public health officials in the U.S. to conclude the rates are "caused" by poorly distributed health care resources and can be "solved" with a socialized, government-run health care system.

However, there's a basic problem with the numbers: Different countries count differently.

According to the World Health Organization (WHO) definition, all babies showing any signs of life - such as muscle activity, a gasp for breath or a heartbeat - should be counted as a live birth. The U.S. strictly follows this definition. But many other countries do not.

Switzerland doesn't count the death of very small babies, less than 30 centimeters (11.8 inches) in length, as a live birth, according to Nicholas Eberstadt, a former visiting fellow at Harvard's Center for Population and Developmental Studies. So comparing the 1998 infant mortality rates for Switzerland and the U.S. (4.8 and 7.2,respectively, per 1,000 live births) is comparing apples and oranges.

In other countries, such as Italy, definitions vary depending on where you are in the country.

Eberstadt notes "underreporting also seems apparent in the proportion of infant deaths different countries report for the first 24 hours after birth. In Australia, Canada and the United States, over one-third of all infant deaths are reported to take place in the first day."

In contrast, "Less than one-sixth of France's infant deaths are reported to occur in the first day of life. In Hong Kong, such deaths account for only one-twenty-fifth of all infant deaths."

As UNICEF has noted, "Under the Soviet-era definition ... infants who are born at less than 28 weeks, weighing less than 1,000 grams [35.3 ounces] or measuring less than 35 centimeters [13.8 inches] are not counted as live births if they die within seven days. This Soviet definition still predominates in many [formerly Soviet] countries. ... The communist system stressed the need to keep infant mortality low, and hospitals and medical staff faced penalties if they reported increases. As a result, they sometimes reported the deaths of babies in their care as miscarriages or stillbirths."

Read the whole thing.

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