For the longest time I have been under the impression that the United States’ infant mortality rate is on a downward slide, already much worse than most all other developed countries. The NYT recently reported it as being number 29 on the list.
Most of the top countries attribute their success in few babies dying to the high use of midwives and home birth with good access to OB’s. But my whole belief in this just got turned on it’s head. I recently found a reference to the Organization for Economic Cooperation and Development (OECD) who discourages comparison of world-wide infant mortality rates because they are all registered differently.
Some countries count any baby born over 1 pound, others count babies over 12 inches long, others register babies born after 26 weeks of pregnancy, and in the US we count any baby born alive after 22 weeks, I believe. That would mean we would have more babies dying just because of the way we count live births.
Half of infant deaths are due to preterm birth, and a report by U.S. News and World Report in 2006 showed that once you adjust for birth weight our babies the US infant mortality rate is comparable to Norway’s, which we all know is one of the lowest. The high preterm birth rate is probably due in part to higher use of fertility drugs in this country than in other countries.
As of this writing, a healthcare bill is being pushed through Congress which would presumably take effect in 2013. The purpose of H.R.3200 – America’s Affordable Health Choices Act of 2009 is essentially to broaden healthcare coverage to those who are not currently insured. It sounds good at first, but the huge debate cross country over this issue has been for good reason. OpenCongress summarizes that this bill includes: “a new government-run insurance plan (a.k.a. a public option) to compete with the private companies, a requirement that all Americans have health insurance, a prohibition on denying coverage because of pre-existing conditions and, to pay for it all, a surtax on households with an income above $350,000″.
The consequences of allowing the government to have such large scale control over our healthcare would be devastating to our economy, and some countries with national healthcare plans such as this are even backtracking to an open-market system. Yet some well-known natural birth advocates and maternity care providers are pushing hard for a system like this to be put in place in the United States. They argue that countries like Norway, Netherlands, Denmark, and Sweden have some of the best outcomes world-wide in maternity care because of the benefits of a national healthcare system; primarily, close working relationships between doctors and alternative healthcare providers, and an established role for home birth and midwives. So the question is, do the presumed benefits of a national healthcare plan outweigh the large-scale consequences?
The answer lies in taking a much closer look at the methods of comparing the United States to countries with national healthcare plans. Using infant and maternal mortality rates, countries are compared to each other to determine who is offering the best healthcare. As I just showed, comparing global infant mortality rates is a highly inaccurate way of comparing healthcare systems, and when you take a closer look at the numbers, the United States is doing far better than many care to admit.
Of course, the countries commonly referred to when discussing who offers the best maternity care are those which have national healthcare plans, but they do have certain features about their maternity care which probably would have a beneficial effect on our own, namely, the high value they place on well-trained home birth midwives, and access to home birth for every healthy woman. And while I look forward to the day when home birth is valued by more Americans, we can be assured that passing this healthcare bill or any comparable bill, will not improve our access to or quality of healthcare, it will not create better access to home birth for our women, and it will absolutely not improve the maternity care our women are receiving.
So, after spending all this time talking about the United States’ infant mortality rate being worse than most other developed countries, I now have to backstep. Something hadn’t felt quite right about it, and I realize now that using a biased organization like the World Health Organiztion for such an important resource is really not a good idea. I will not defend our current infant mortality rate, which should of course be improved, but we can no longer use the reasoning that countries with higher home birth rates have lower rates of death, and we absolutely cannot argue that countries with national healthcare plans offer the best maternity care, because it is just not true.
Instead, we should refer to accurate studies which show the safety of home birth in comparison to hospital birth, and make efforts to improve our current maternity care system based on a free market. More on this in my book, Inspired Birth.
Ah!!! at last I found what I was looking for. Somtimes it takes so much effort to find even tiny useful piece of information.
Nice post. Thanks
By: Anonymous on November 11, 2009
at 7:03 am