Thursday, December 19, 2013

One Day of Life: Death Rate Among America's Newborns Highest in the Industrialized World

Infant Mortality
by Nomad

More infants die on their birthdays in the US than any other industrialized nation in the world. But in a nation as wealthy as America, why should that happen? 

A comparison between Sweden -which has one of the lowest rates of one-day old deaths-and the state of Mississippi- which has the highest rate of infant mortality in the US- might provide some clues at reducing the death rate among American's youngest and most vulnerable victims.

“The United States has the highest first-day death rate in the industrialized world. An estimated 11,300 newborn babies die each year in the United States on the day they are born. This is 50 percent more first-day deaths than all other industrialized countries combined.”
More day-old babies die in the US than in 68 other countries, including Egypt, Turkey and Peru.
The study cited premature births as being one major cause. Globally, 35 percent of all newborns that die are pre-term. In the United States, this is also true.
“Many babies in the United States are born too early. The U.S. preterm birth rate (1 in 8 births) is one of the highest in the industrialized world (second only to Cyprus). In fact, 130 countries from all across the world have lower preterm birth rates than the United States,” the report reads.
The study suggests that politics and culture might play a role in the causes for the United States' poor record.

It's not all bad news but it's bad enough. According to the Center for Disease Control and Prevention the rate of deaths of first year infants has been in decline from 24,586 U.S. babies in 2010 to 23,910 in 2011. This has been achieved primarily through effective affordable health care. especially with access to health care to all women of childbearing age and and other specific prenatal initiatives.
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More children die at birth in India than anywhere else, followed by Nigeria, Pakistan and China,  the report finds. Finland and Sweden have the lowest rates of newborn deaths in the world.
Certainly poverty might explain the contrast between India and Sweden. But that doesn't explain the differences between Sweden and the United States.

A Swedish Model
So, it is worth asking: What are they doing right in Sweden? 
Firstly the education of women. Following the sequester fiasco, states have been forced to cut funding for education so that's probably a non-starter. Still, as Save the Children explains:
“The more time girls spend in school, the later they marry and begin childbearing. Educated girls also are more likely to grow up to be mothers who are healthy, well-nourished, economically empowered and resourceful when it comes to caring for themselves and their babies. “
If education in general is beneficial then sex education is a particularly helpful in keeping down the number of unwanted pregnancies. Sex education plays an important role in reducing infant morality.
When half of all U.S. pregnancies are unplanned, it is hard not to believe that sex education in American schools is failing. And that fact,  the report says, is another complicating factor.
Women whose pregnancies are accidental are much less likely to take good care of themselves and to get thorough prenatal care, from vaccines to vitamins, that can protect the baby and her.
In Sweden it is a very different story. Sex education has been compulsory in Swedish schools, from the earliest grades through high school since 1956. Sex is a fact of life, the Swedes reason, and its is best to deal with the subject in a mature way. Hysteria. so common in the US, seems to be absent.
The curriculum starts out clinically at around age 6, when children learn about anatomy, eggs, and sperm. From age 12 on, the topics lean more toward disease and contraception.
The main objection in the US to such a frank discussion of sex with young people is that it would inevitably promote teenage promiscuity. However, the percentage of girls having sex before age 15 is 12 percent in Sweden and 14 percent in the States. So the evidence for that assumption is simply not there.

In Sweden, individual responsibility is stressed over religious or moral prohibitions. Sex within loving relationships is emphasized. Gender equality too is promoted in class. None of these ideas, unlike what religious groups might say, seemed to have undermined Swedish society.

On the contrary, according to an article in USNews, educating young people about the potential risks, both of unwanted pregnancy and sexually-transmitted diseases, seems to have worked.
The rates of teen pregnancy and sexually transmitted disease in Sweden are among the world's lowest. Sweden's teenage birthrate is 7 per 1,000 births, compared with 49 in the United States. Among 15-to-19-year-olds, reported cases of gonorrhea in the United States are nearly 600 times as great on a per capita basis.
Americans like to think they lead the world but sometimes that's not always something to be proud of. The US leads the world in having the highest teenage birth rate of any industrialized country. 
This too contributes to the problem of infant mortality. The Save the Children report noted:
“Teenage mothers in the U.S. tend to be poorer, less educated, and receive less prenatal care than older mothers. Because of these challenges, babies born to teen mothers are more likely to be low-birth weight and be born prematurely and to die in their first month. They are also more likely to suffer chronic medical conditions, do poorly in school, and give birth during their teen years (continuing the cycle of teen pregnancy.
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Unlike American where abortion is constant source of discord, the subject in Sweden has largely been settled. Its legality is not disputed and not at all a political issue. According to one source:
Consensus in Sweden is in favour of preventing unwanted pregnancies by the use of birth control and the primary goal is not to lower the amount of abortions, but rather the goal is that all children that are born should be wanted. The number of abortions statistically follows the number of pregnancies.
The situation is very different in the US, where the Christian Right has fought to cut funding for realistic sex education (in favor of abstinence only programs) as well as limiting access to legal abortion.

Putting Women at the Center
Another reason for Sweden's success. is related the overall quality of maternity services in Sweden. Home visits by nurses or community health workers, quite common in Europe, provide expectant mothers with high-quality care before, during and after pregnancy.

According to a Guardian article, more than 99 percent of births happen in the hospital. Excellent maternity care is free of charge through a Swedish healthcare system which is mainly government-funded and decentralized.
Mothers in labour are looked after with every hi-tech advantage possible; the foetal monitoring system here is among the most advanced and sensitive in the world
It might have something to do with the value the society places on women generally. As one Swedish obstetrician told the Guardian reporter:
"What makes us successful is that we put women at the centre of what we're doing, We have everything technology can offer but, even more importantly, we treat mothers as individuals."
According the Save the Children report, there is a political side, namely where women are represented fairly, the survival rates for newborn is higher .
Women hold only 18 percent of seats in the United States Congress. Sixteen countries have more than double this percentage of seats occupied by women. In Finland and Sweden, for example, women hold 43 and 45 percent of parliamentary seats, respectively.”
If women must demand control over their own bodies they must also demand fair representation in their legislatures.

What the Comparison Suggests
When it comes to tackling the problem of newborn deaths, it would seem that the passage of Affordable Health Care - so ferociously resisted by conservatives- is a step in the right direction. For the first time, pregnant women who live below the poverty line will have access to health care.
And yet, there is still so much to be done and mostly on a state level, where state legislatures where Republican conservatives dominate.
In the 50 states combined, legislators introduced more than 1,100 reproductive health and rights-related provisions, a sharp increase from the 950 introduced in 2010. By year’s end, 135 of these provisions had been enacted in 36 states, an increase from the 89 enacted in 2010 and the 77 enacted in 2009.
There was only one reason for this sharp increase. To restrict a women's constitutional right to abortion. In fact, fully 68% of these new provisions—92 in 24 states—-aimed at limiting access to abortion services.
That's only half the story. Organizations like Planned Parenthood came under attack too.

Family planning services and providers were especially hard-pressed in 2011, facing significant cuts to funding levels, as well as attempts to disqualify some providers for funding because of their association with abortion.
There were attempts by politicians in states like Texas, Indiana and Kansas to de-fund Planned Parenthood have been largely successful. 

No matter what one thinks about abortion, Planned Planned Parenthood happens to be one of the nation’s leading providers of high-quality, affordable health care for women, men and young people at no or low cost. Added to that, it is the nation’s largest provider of sex education.
As its website explains:
In 2011, we provided nearly 11 million medical services for nearly three million people, and helped to prevent approximately 486,000 unintended pregnancies. Seventy-eight percent of our clients have incomes at or below 150 percent of the federal poverty level.
In addition, Planned Parenthood offers sex education, which as we saw, was essential in the Swedish model.
In 2011, affiliate staff and volunteer educators provided educational programs to more than one million people of all ages and in a variety of settings — from preschools to universities, from prisons and social service programs to religious institutions and civic organizations.
Programs focused on more than 28 different content areas, such as AIDS/HIV and contraception/family planning — including abstinence, family life education, parent-child communication, puberty education, safer sex, sexual orientation/homophobia, sexuality education, sexually transmitted infections, teenage pregnancy, and women’s health
And yet, despite all of those valuable social works, Planned Parenthood has become a target for conservative Republican politicians.
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Back in 2011, Indiana Governor Mitch Daniels boasted that his state would be the first state to deny medicare funds to Planned Parenthood. However, after two-years of controversy, U.S. District Judge Tanya Walton Pratt issued a permanent injunction against the law following the Supreme Court refusal to hear the state's appeal of an initial ruling.

So, the War on Women truly exists and its front line causalities are the defenseless new born babies.

The Mississippi Distinction
In 2010, the top five states with the highest infant mortality rates were:
  • Mississippi
  • Alabama
  • Tennessee
  • Ohio
  • Delaware
  • Indiana
  • Louisiana
  • Oklahoma
  • South Carolina
  • Arkansas
All but one of those states- Delaware- is solidly Republican. It would easy to write that off as a coincidence but it's worth a look at the state with the highest rate to see if we can learn anything.

Despite being the state with the highest infant mortality rate in 2010, Mississippi legislators decided to cut funding of its Title X Family Planning program which provides individuals with comprehensive family planning and related preventive health services, especially for low-income citizens. According to its site, these services include contraceptive services, supplies and information to all who want and need them.

And in the long term Title X was a cost saver. How? By providing citizens with contraception, counseling, and other services it helped to reduce the number of unwanted pregnancies. Unwanted pregnancies cost the state of Mississippi a great deal and a full 81 percent of births resulting from unintended pregnancies in the state are paid for by Medicaid.

Until the passage of Obamacare, the poor of the poorest state in the nation simply could not afford health care, including pregnant women.

According to the site:
  • Family planning services at Mississippi’s Title X-funded health centers helped prevent 16,600 unintended pregnancies in 2010, which would likely have resulted in 8,200 unintended births and 5,700 abortions
  • Without publicly funded family planning, the number of teen pregnancies in Mississippi would be 42% higher.
  • Adequate family planning through education, counselling and contraceptives through Title X has actually decreased the number of abortions in Mississippi would be 69% higher.
Nevertheless, funding for the program peaked at 317,491,000 in 2010 and has declined since then to a low of $297,400,000 in 2012. 

Legislators instead spent their time (wasted it, as it later turned out) drafting the so-called “Personhood Amendment” which would have re-define personhood back to the moment of conception. This would have criminalized both abortion - under all circumstances, even to save the life of the mother- as well as the so-called morning-after pill.

With all of the hoopla, one would think that abortion was a major problem in Mississippi. That however is not at all true. Mississippi has some of the tightest regulations on abortions in the nation and has only one clinic where the procedures are performed. 

So where was the support for this pointless anti-abortion crusade? The state's largest Christian denomination, the Mississippi Baptist Convention, reportedly backed the proposal through its lobbying arm.

Part of the problem is the failure to separate Church from State. And that makes it much more of a partisan issue. Why? Gallup found conservative Republicans much more likely than moderate/liberal Republicans to say religion is very important in their lives. That's fine. Nothing wrong with that.. as long as they don't decide to legislate their religious values on their citizens.

Sadly while the Religious Right is allowed to dictate public policy in Republican- held state capitols, we cannot expect any real change to this pathetic situation. More new born babies- not theoretical babies- will continue to die in order to satisfy the moral code of a politically-powerful minority. 

It is ironic, however, that the Religious Right touts itself as a defender of the unborn while supporting the very policies that guarantee that the early deaths of newborns.

In the end, Mississippi voters proved wiser than their representatives when they rejected the personhood amendment by 55 percent. In short, the futile efforts of Mississippi legislators to outlaw abortion were a waste of valuable time and money. And this same battle is being played in state legislatures across the country, from South Dakota to Kansas, from Texas to Virginia. 
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If, as Mahatma Ghandi once said, "A nation's greatness is measured by how it treats its weakest members," then America is failing to measure up. In the end, a nation as powerful and as wealthy as the United States should have been able to come together and find sensible solutions, as Sweden seems to have done.. 
And it should be able to offer its newly born, its most defenseless member of society, more than just a single day of life.
For an executive summary of the Save the Children report, click HERE.