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Debunk – ‘US infant mortality rates aren’t so bad’

They’re at it again.
The latest assault on logic and reasoned debate comes from a physician in California (no longer practicing) who claims:
“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." This is a very sneaky way to push a political position.
The doctor, Linda Halderman, has apparently not done any independent research. Instead, she has merely rehashed a 2005 article authored by a ‘scientists’ employed by that noted bastion of scientific objectivity, the Discovery Institute (for those unfamiliar with these folks, their primary mission is to promote creationism/”intelligent design”, perhaps that’s why their science is so faulty)
For comparison purposes, infant mortality statistics should be calculated using the same definitions for all countries, with very few exceptions (specifically a couple former USSR satellites, the Czech Republic and Poland). It is possible that other countries ‘report’ their data differently, but for comparison purposes, a standard definition is used. Fortunately, infant mortality rates are reported using WHO standards, which do NOT include any reference to the length of the infant, duration of the pregnancy, but do define a ‘live birth’ as a baby born with any signs of life for any length of time. For a detailed explanation of WHO data definitions, click here, for a really long discussion of the issue, click here.
Perhaps the good doctor was so busy providing policy advice to the California (she claims she is no longer practicing medicine due to low Medicaid reimbursement) that she didn’t have time to do her research thoroughly. Either that or she’s attempting to intentionally mislead her readers.
Halderman takes a couple rhetorical shots at our friends to the North, shots which are easily refuted. She claims “When Canada briefly registered an increased number of low weight babies previously omitted from statistical reporting, the infant mortality rose from 6.1 per 1,000 to 6.4 per thousand in just one year. [Canada has been reporting births of babies <500 grams at least since 2001]." Canadians report their birth rates two ways; babies between 500 and 2500 grams, and babies <2500 grams. And the percentage difference between the two is negligible - 0.1% (5.8% including babies <500, 5.9% for all births) for 2001, 2002, and 2003.
Regardless of the measure you use, Canadian infant mortality figures look way better than the US’. And for comparison purposes, the WHO uses the same definition for Canadian and American births.
Halderman also says “Pregnancies in very young first-time mothers carry a high risk of delivering low birth weight infants. In 2002, the average age of first-time mothers in Canada was 27.7 years. During the same year, the same statistic for U.S. mothers was 25.1 — an all-time high.” The statement just sort of sits there, but I’m assuming she’s using this to somehow say that if you correct for the age of the mother, then we aren’t so bad.
Uh, not so fast. In fact, older Canadian women are at higher risk (9.3% higher, to be precise) of delivering low birth weight babies than their younger compatriots.
And Canadian women as a whole are at much lower risk than American women.
Before someone makes the ludicrous claim that Canadian women at high risk go to US hospitals, thereby increasing the US’ infant mortality rate and lowering Canada’s, know that Statistics Canada counts Canadian women giving birth in the US in their stats.
Halderman makes another incorrect statement – “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.”
Wrong again, doc – for comparison purposes a standard definition is used.
This nonsense has been picked up by others in the right wing media machine (attempting to refute the liberal bias of the main stream media, no doubt). As of today, there were 1700 hits on a search for halderman infant mortality; a brief scan indicated a substantial portion were from bloggers rejoicing at the Halderman’s insights and using same to make them feel better about high US infant mortality rates.
What does this mean for you?
It is indeed distressing when a physician spews this nonsense. This is a textbook example of an ‘expert’ using an inaccurate conclusion based on faulty research to support a political position.
So much for the Hippocratic Oath, Dr. Halderman.

5 thoughts on “Debunk – ‘US infant mortality rates aren’t so bad’”

  1. Interesting article, however, the most important question which no one seems interested in gathering information on; why the US has such high mortality rates in infants. What are the top causes and how are deliveries handled differently in Canada and other countries that can improve our outcomes?

  2. Joe — According to data published by the UnitedHealth Foundation each year, infant mortality varies considerably within the United States, where, presumably, there are no definitional issues as to what constitutes a live birth. From what I can gather, the factor most correlated to (relatively) high infant mortality in certain states vs. others within this country is low socioeconomic status generally and poverty more specifically. Access to adequate prenatal care is much less of a factor. Given both the greater cultural diversity of U.S. society and greater income inequality as well vs. Canada, Western Europe, Japan and Australia, I think using infant mortality (and life expectancy) statistics as indicators of healthcare system quality are both misleading and uninformative.

  3. Just because countries are supposed to report based on a standard definition does not mean they actually do.
    From the WHO site:
    “The reliability of the neonatal mortality estimates depends on accuracy and completeness of reporting and recording of births and deaths. Underreporting and misclassification are common, especially for deaths occurring early on in life.”
    Underreporting is common according to the WHO. This is an important point as individual countries may not accurately report their data.
    It’s unfortunate that you took this important issue and turned it into a personal attack.

  4. Barry – thanks for the thoughtful comment. I’m not sure if infant mortality and life expectancy is related to a country’s health system, or more accurately to what degree it is (it does seem logical to expect there is some degree of correlation).
    My post is a response to Halderman’s attempt to slam ‘socialized medicine’, using infant mortality as her club.
    Halderman is directly condemning the health care delivery systems of other countries, as she states “The parents of these children [US parents of very low birth weight babies] may view socialized medicine somewhat differently than its proponents.”
    bob – thanks for the comment. I think you are conflating accuracy with consistency.
    I would differentiate between accuracy of reporting and what WHO uses to compile its reports. WHO uses the same criteria across all countries, and while some countries likely have more errors and are less reliable than others, that is not germane to my point. I would also argue that it is more likely that third world countries such as the Sudan and Ethiopia are more likely to have ‘underreporting and misclassification’ issues than industrialized countries such as the ones cited by Halderman in her original piece.
    You misunderstand my issue with the doc. Halderman bases her ‘analysis’ on individual countries’ statistics and does not use the WHO standard to make her agenda-driven point. She is correct that individual countries do report their own data their own way; where is she dead wrong is her conclusion that US infant mortality rates are higher due to that discrepancy – a point central to my post.
    that point is that Halderman et al have been using this misinformation to advance an agenda. Do I have a personal problem with that? Absolutely, as should you. They are mis-using data to scare people away from universal care (read the rest of her site for more), a common tactic of people of her ilk. Either she did that purposefully or she just redid someone else’s post (which is what appears to have happened). Regardless, her interpretation of the data is incorrect, and does not support her claim that “Babies don’t do better in countries with socialized medicine.”

  5. I am so glad that I found this website! I read a comment posted to a news article about infant mortality (stating how shameful the rate is in the US), using this crap information. It’s amazing how valiantly and dishonestly some folks fight against ‘offering free healthcare’ to all—services considered to be a basic human right in some countries—in a country whose people—frequently and arrogantly—refer to as the best country in the world. God bless the AMA, spin doctors and corruption! But then again Canada had to go through hell to change their health system. Unfortunately we are short of ‘Tommy Douglases’ within our politicians.
    Thanks for this site.

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Joe Paduda is the principal of Health Strategy Associates



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