Live Births-Healthcare

[Whatssnew]

The whole "live birth" thing used to bash the American Healthcare system seemed a little skewed, and seems to be a fairly debateable subject.

I found that while America does have a higher infant mortality rate it isn't because its has a bad healthcare system:

Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies — considered “unsalvageable” outside of the U.S. and therefore never alive — is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

Norway boasts one of the lowest infant mortality rates in the world. But when the main determinant of mortality — weight at birth — is factored in, Norway has no better survival rates than the United States.

Pajamas Media » The Doctor Is In: Infant Mortality Comparisons a Statistical Miscarriage

The article also notes other differences in the way infant mortality is calculated by different countries that skew their infant mortality rate. Many countries, for example, won’t count a child as a live birth if he dies within 24 hours of being born. Since 40% of all infant mortality occurs within the first 24 hours after birth, this fact makes the infant mortality rate of those countries appear a lot better than it actually is.

Supposedly one reason there are more premature births here is our high number of women who undergo fertility treatments and IVF.

International comparisons are often unreliable because of different standards for statistical gathering.

Opinion/post

Can a Higher Infant Mortality Rate Be A Good Thing? « Vox Nova

[big_lefty]

The whole "live birth" thing used to bash the American Healthcare system seemed a little skewed, and seems to be a fairly debateable subject.

I found that while America does have a higher infant mortality rate it isn't because its has a bad healthcare system:



Pajamas Media » The Doctor Is In: Infant Mortality Comparisons a Statistical Miscarriage



Opinion/post

Can a Higher Infant Mortality Rate Be A Good Thing? « Vox Nova

The only claim here that is cited is about low birth weight babies in Canada supposedly not being registered as live births.
That's not what the Bureau of Child and Reproductive Health report says.
The blogger (your sources seem to be mostly blogs and emails, how telling) did not report key facts and quoted only one line of the report, which was out of context. The report actually found increased rates of registration over prior years in 1993, but she made it seem like non-registration is an issue.

The report;

"OBJECTIVE: To ascertain whether the increase in the crude infant mortality rate in Canada in 1993 was due to a recent increase in the registration of newborns weighing less than 500 g as live births. DESIGN: Ecological study, with Poisson regression analysis. SETTING: Canada. SUBJECTS: All live births and infant deaths in Canada between 1987 and 1993, as reported by Statistics Canada. Data from Newfoundland were excluded because they were incomplete for 4 years. OUTCOME MEASURES: Proportion of live births by low-birth-weight category; and annual crude and adjusted infant mortality rates. RESULTS: Over the study period the proportion of newborns weighing less than 500 g registered as live births increased significantly (chi 2 for trend = 71.26, p < 0.01). This trend was an isolated phenomenon rather than a general increase in all low-birth-weight categories (chi 2 for trend in the proportion of newborns weighing 500 to 2400 g registered as live births = 1.14, p = 0.28). The crude infant mortality rate per 1000 live births decreased from 6.4 in 1991 to 6.1 in 1992 and then increased to 6.3 in 1993. Poisson regression analysis revealed that the apparent increase in the infant mortality rate was caused by the increased registration of infants weighing less than 500 g as live births. The adjusted infant mortality estimate for 1993 was lower than that for 1992. CONCLUSIONS: The increased infant mortality rate in Canada in 1993 appears to be due to increased registration of infants weighing less than 500 g as live births. Comparisons of infant mortality rates by place and time should be adjusted for the proportion of such live births, especially if the comparisons involve recent years."

Recent trends in Canadian infant mortality rates: effect of changes in registration of live newborns weighing less than 500 g.

Her claim that registration increased only "briefly" is false. The report just studied one brief period.

More (starred emphasis mine);

"In several countries, such as in Canada, the United States, Japan and the Nordic countries, ****very premature babies with relatively low odds of survival are registered as live births*****, which increase mortality rates compared with other countries that do not register them as live births."

The Well-Being of Canada's Young Children - Government of Canada Report 2008

Note that this information is sourced at the bottom of the page, unlike your blog crap.
Since she made the same claim about Japan and the Nordic countries, she is revealed once again as totally wrong.

More;

"The recent increase in LBW rates may be partly explained by the increasing proportion of multiple births and an increase in reporting very small and premature babies, who later die, as live births rather than stillbirths."

The Atlas of Canada - Low Birthweight

Regarding her claim about age of first pregnancy, it only affects mortality rate if the mother is less than 16. She admits herself that the average US age for first pregnancy in the year she is making the claim for was 25.

"After adjusting for birth weight, the race-specific relative risks for babies born to mothers less than 16 years of age were still elevated from 11 to 40 percent, compared with babies born to mothers 25-29 years of age."

Young maternal age and infant mortality: the role of low birth weight.

The silliest claim she made was this howler; "In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates.
Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States."

It should be obvious to anyone that the number of these extreme low birth weight babies who are born alive is far too low to ever affect mortality rates. If Switzerland fails to register the few of these babies which are breathing when they come out as live births (if indeed there even are any), that's going to do nothing to the overall mortality rate.

Given these errors, do I really need to debunk the rest of her drivel?
Think before answering, because I can probably do it.

Be that as it may, there are certainly factors which play into infant mortality which are not directly or exclusively related to health care, such as a higher fertility rate, and others which are, such as lack of access to care for pregnant women with low income.
However, a higher fertility rate can be caused, in part, to a lack of access to contraception counseling and prescriptions for contraception, which are services the heath care system provides, so once again, we're back to health care.

[Apeman81]

From Wikipedia:

The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[5]

The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control researchers,[6] some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[7] which are used throughout the European Union.[8] However, in 2009, the US CDC issued a report which stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries and which outlines the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[6][9][10] However, the report also concludes that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[10]

Another well-documented example also illustrates this problem. Historically, until the 1990s Russia and the Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least seven days.[11] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[12] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[13]

Just so you know your comapring apples to oranges