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  1. Opinion

The plight of a poor baby in U.S.

The United States has a higher infant mortality rate than any of the other 27 wealthy countries, according to a new report from the Centers for Disease Control. A baby born in the U.S. is nearly three times as likely to die during her first year of life as one born in Finland or Japan. That same American baby is about twice as likely to die in her first year as a Spanish or Korean one.

Despite healthcare spending levels that are significantly higher than any other country in the world, a baby born in the U.S. is less likely to see his first birthday than one born in Hungary, Poland or Slovakia. Or in Belarus. Or in Cuba, for that matter.

We're the wealthiest nation in the world. How did we end up like this?

New research, in a draft paper from Alice Chen of the University of South California, Emily Oster of the University of Chicago, and Heidi Williams of MIT, offers up some clues. They note that the infant mortality gap between the U.S. and other wealthy nations has been persistent — and is poorly understood.

One factor, according to the paper: "Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries. Since survival before 22 weeks or under 500 grams is very rare, categorizing these births as live births will inflate reported infant mortality rates (which are reported as a share of live births)."

Oster and her colleagues found that this reporting difference accounts for up to 40 percent of the U.S. infant mortality disadvantage relative to Austria and Finland. This is somewhat heartening.

But what about that other 60 percent?

"Most striking," they write, "the U.S. has similar neonatal mortality but a substantial disadvantage in postneonatal mortality" compared to Austria and Finland. In other words, mortality rates among infants in their first days and weeks of life are similar across all three countries. But as infants get older, a mortality gap opens between the U.S. and the other countries, and widens considerably.

Digging deeper into these numbers, Oster and her colleagues found that the higher U.S. mortality rates are due "entirely, or almost entirely, to high mortality among less advantaged groups." To put it bluntly, babies born to poor moms in the U.S. are significantly more likely to die in their first year than babies born to wealthier moms.

One way to understand these numbers is by noting that most American babies, regardless of socio-economic status, are born in hospitals. And while in the hospital, American infants receive exceedingly good care.

But the differences arise after infants are sent home. Poor American families have considerably less access to quality healthcare as their wealthier counterparts.

One measure of the Affordable Care Act's success, then, will be whether it leads to improvements in the infant mortality rate. Oster and her colleagues note that ACA contains provisions to expand post-natal home nurse visits, which are fairly common in Europe.

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