Imagine my surprise when reading this article about French health care, I read this quote:
Infant mortality rates are often cited as a reason socialized medicine and single-payer systems are better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.
Official World Health Organization statistics show the U.S. lagging behind France in infant mortality rates — 6.7 per 1,000 live births vs. 3.8 for France. Halderman notes that in the U.S., any infant born that shows any sign of life for any length of time is considered a live birth. In France — in fact, in most of the European Union — any baby born before 26 weeks’ gestation is not considered alive and therefore doesn’t “count” in reported infant mortality rates.
This definitely makes a difference in infant mortality and neonatal mortality, n’est-ce pas? Most states have definitions of live and stillbirth which are similar to definitions used by the United Nations, namely, that if there is any sign of life (the umbilical cord still pulsing, the child taking even one breath, etc.), then the baby is considered to have been born alive. But if these extremely premature babies are just swept under the rug in most European statistics, then that is, at the least, disturbing. Sort of like counting up adult deaths but saying, “heart attacks don’t count, though.”
Since I recently learned how to do screen-shots, I’ll post the results of the CDC infant mortality rates (this is infant deaths from a live birth, as most broadly defined, up until one year of age), by gestational age for all mothers and babies — as broad as I can make it — from 2003-2005:
As you can see, it includes births from before 20 weeks of pregnancy (which no baby yet has survived, as far as I know), and combines all deaths from all gestational ages [from 17-47 weeks] into a single figure of 6.83/1000 deaths. Below is the same query, but limited to births from 28 weeks and above, including pregnancies of unknown gestation (which may also be below 28 weeks):
This drops it to 3.76, a tad lower than the above-stated French infant mortality rate — although it’s not a perfect comparison, because it starts at 28 weeks, rather than at 26 weeks. [And if you exclude “unknown” gestational age, the rate drops a bit lower, to 3.64.] I wonder what the French (and other European nations’) infant mortality rate would be, if it were to include births as premature as what we count. So, it’s similar, if not identical.
This does change things in my mind. While as an absolute, we need to prevent premature births as much as possible (and I will note that the above figures do not include stillbirths; and many babies born so fragile and premature do not survive the birth process), so we can still do more and make our figures better; as a comparative measure, it’s simply inaccurate to say that the U.S. has worse infant mortality than European countries, if we include these high-mortality gestations in our figures, and they don’t. It’s apples and oranges.
Frankly, I’m a little irritated that I’ve not heard this before. I can understand impoverished countries not counting babies prior to 27 weeks, because they don’t have the technology of saving babies born so prematurely, while we do. But for France — which ought to have as much access to technology as we do — not to count babies that they could save in infant mortality rates is a little upsetting. Especially when it falsely makes us look worse by comparison.
Filed under: studies & stuff Tagged: | baby, birth, childbirth, france, french, health care, healthcare, infant mortality, infant mortality rates, pregnancy, pregnant, socialized health care, socialized medicine