Throughout the world, first-day mortality claims over a million babies per day, as reported this week by Save the Children. According to the organization’s “State of the World’s Mothers” report, newborn mortality now represents 43 percent of the global under-5 mortality. An estimated 36 percent of these newborn deaths occur on the day the child is born.
While Congo, Somalia, Mali, Sierra Leone, the Central African Republic and Niger top the list as the least-safe places to give birth, the United States — at 30th on the list of lowest first-day mortalities, just above Japan and South Korea — has a first-day mortality rate of three deaths per 1,000 live births, for a total of 11,300 first-day deaths in 2012. In the U.S., first-day mortalities constitute 61.4 percent of all first-month deaths and 35.1 percent of all under-5 deaths.
Among industrialized nations, these numbers give the United States, by far, the highest rate of first-day deaths. While the industrialized world amounts to only 1 percent of the world’s total first-day death tally, the United States’s total is 50 percent more than all of the remaining industrialized countries combined.
The 27 nations of the European Union have, per annum, one million more births — in total — compared with the United States (4.3 million in the U.S. to 5.3 million in the EU), but also have half of the first-day deaths as the U.S. (11,300 in the U.S. to 5,800 among the EU countries).
An avoidable epidemic
The U.S. numbers are due in part to a high premature birth rate in the United States. As argued by Save the Children, “The three leading causes of newborn death are prematurity, birth complications and severe infections. Among wealthier countries, higher U.S. rates of prematurity contribute to higher newborn mortality. Whether in the United States or the developing world, the poorest mothers are more likely to lose a newborn baby.”
The March of Dimes has calculated that in 2011, there was a 11.7 percent chance of an American child being born premature. Since 2006, the rate has been falling at a steady rate. “We’re making progress, but we still have more work to do,” Janis Biermann, the March of Dimes’ vice president for education and health promotion, told The Huffington Post. “We have some states that are doing well, and we have some states that still have some real challenges.”
According to the March of Dimes’ report card, Vermont, Oregon, New Hampshire and Maine all earned an “A,” indicating that their preterm birth rates were 9.6 percent or less. Louisiana, Mississippi and Alabama all earned an “F” — meaning that their preterm birth rates were 14.6 percent or higher. Babies born before the 37th week of pregnancy are considered premature (normal gestation constitutes 39 weeks). Premature births expose the infants to a higher risk of various short- and long-term health and developmental issues. At an annual national cost of $26 billion, preterm birth is the leading cause of infant mortality in the United States.
The United States ranks 131 out of 184 nations in preterm birth rates, according to the Partnership for Maternal, Newborn & Child Health, an alliance of more than 50 non-government organizations (NGOs), including the March of Dimes and the World Health Organization. Globally, more than 15 million infants are born prematurely each year.
On saving babies
The Centers for Disease Control and Prevention (CDC) has indicated that race and socioeconomic standing may be the single largest risk factor in determining if a child will be bore premature. Black women are 50 percent more likely to give birth prematurely. Likewise, Hispanic women are also more likely to have preterm births. This may be due to the fact that, as of 2011, 25.8 percent of all African-Americans were living below the federal poverty line. This is compared with a rate of 15.9 percent of the nation’s population that are impoverished, per the U.S. Census.
Depending on nationality, the poverty rate for Hispanics can range from 16.2 percent for Cubans to 26.3 percent for Dominicans.
Carolyn Miles is the CEO and president of Save the Children. She explained to Mint Press News that socioeconomic barriers may be the reason behind the United States’ extraordinary first-day death rates.
Poor mothers may not have access to health insurance or to quality health care facilities. Some mothers may choose to forego prenatal care — possibly in fear that the health care provider will not provide them with care, or possibly out of fear, particularly among illegal residents, that seeing a doctor may expose them to law enforcement or immigration authorities.
This is important because the mother’s health directly affects the child’s survivability. Carrying more than one child in vitro, uterine or cervical problems, chronic health conditions — such as high blood pressure, diabetes, clotting deficiencies and major diseases (such as cancer or AIDS) — and certain bacterial or viral infections or the use of drugs during pregnancy — have all been marked as major risk factors in preterm births. Early detection and treatment of these risk factors will mitigate the possibly of a preterm birth.
Even if a child survives a preterm birth, the child faces increased risks of respiratory problems, digestive issues, cerebral palsy, developmental delay, vision problems and hearing complications.
Miles argues that outreach and education is needed to resolve the nation’s high rate of first-day mortalities. The value of prenatal and early childhood care must be taught, the public must be made aware of the crisis at hand and public funding for prenatal programs must be prioritized.
While access to health insurance — which will be facilitated by the full implementation of the Affordable Care Act next January — may help to bring down the numbers of deaths, the most important change that can be made is convincing more mothers that they need prenatal care and screenings. The lack of information and guidance on how to be healthy during pregnancy — more than any other risk factor — is contributing to the high mortality numbers, according to Miles. In regard to pregnancy and childbirth, there can never be enough caution.