A number of countries report lower infant mortality than the U.S., but it has nothing to do with the source of payment for medical care.
In Japan, which has the best statistics (3.3 die per 1,000 live births), the national system does not cover normal childbirth—or prenatal, postnatal, and postpartum care (Your Health Matters by Gregory Dattilo and David Racer, Alethos Press, 2006).
In the U.S., mortality is only 3.0 per 1,000 for full-term babies weighing at least 5.5 lbs (ibid.). Premature, low-birth-weight babies, who have a much higher risk of early death, have a better chance of survival in the U.S. than anywhere else, because of the excellent medical care they receive here.
The incidence of prematurity and low birth weight is relatively high in the U.S.; one reason is ethnic composition. Black American mothers give birth before 37 weeks twice as often as whites, and 3.8 times as often before 28 weeks (Future of Children, Spring 1995).
Predictors of premature birth include socioeconomic factors such as age under 20, single marital status, being on welfare, and not having graduated high school (Lieberman E, et al. N Engl J Med 1987;317:743-748) ; chronic health problems such as diabetes, hypertension, or clotting disorders; certain infections during pregnancy; use of cigarettes, alcohol, or illicit drugs (CDC); and prior abortions (Rooney B, Calhoun BC, J Am Phys Surg 2003;8:46-49). Increasing Medicaid coverage for pregnant women had no effect on birth outcomes (Ray WA, et al. JAMA 1998;279:314-316).
Many nations do not count very small babies as live births. Hence, they don’t count as deaths either. In France and Belgium, for example, babies born before 26 weeks are automatically considered stillborn, states Bernardine Healy.
In the U.S., all our babies count, even if they make our statistics look worse. The tiny ones we now save could be the first casualties of “reform.”
“[A question] that assumes even greater significance as we contemplate the finances of health care reform [is] how much capital are we willing to invest to save the lives of the most extremely preterm infants?” (Future of Children, op. cit.)