U.S Infant Mortality Compared to the Developed World: 2000-2008

Infant mortality rate (IMR) is one of the most important indicators of the general health and well being of a country because it points to many factors such as the health of mothers, access to medical care, quality of medical care, public health practices and socioeconomic conditions. It is also a key indicator of longevity in a nation. The higher the infant mortality rate the shorter the average life expectancy of the people in that country.

Infant mortality is defined as deaths per 1000 live births occurring from birth to the age of 1 year and includes all causes.

The U.S. infant mortality rate in 1900 was 100 deaths per 1000 live births or 10%. In 1960, the rate was 26.0 per 1000 or 2.6%. In 2000 the rate was 6.89 deaths per 1000 live births or 0.69%. This decrease is expected given the vast advances made in science, medicine and healthcare during the 20^th century.

However, between 2000 and 2005 (inclusive) the U.S. infant mortality rate did not decrease. It remained about the same during that 6 year period where many other countries in the developed world saw steady declines in infant mortality.

The U.S. infant mortality rates (deaths per thousand live births) between 2000 and 2008 are:

• 2000: 6.89
• 2001: 6.84
• 2002: 6.95
• 2003: 6.84
• 2004: 6.78
• 2005: 6.86
• 2006 is estimated to be 6.71
• 2007 is estimated to be 6.40
• 2008 is estimated to be 6.30

The 2008 world IMR average is estimated to be 42.06 per 1000 or 4.21%.

Singapore has the lowest rate at an estimated 2.30 per 1000.

As of October 23, 2008, the U.S. has the 41st lowest infant mortality rate in the world according to the CIA World Factbook. That means 40 other countries have an IMR that is lower than the United States. Thirty other developed countries have infant mortality rates of 5.0/1000 or lower.

The U.S. goal is to reduce our IMR to 4.5/1000, but it is unlikely this goal will be reached by 2010.

Why is the United States' infant mortality rate decreasing so much more slowly in the 21^st century than in past decades and in 40 other countries?

Not Everyone Counts the Same Way

Statistics compared to other countries can be deceiving. There is no world-wide uniformly accepted method for counting live births and deaths. The World Health Organization has guidelines, but not all countries follow them, nor are they required to follow them.

In the U.S., we consider a live birth to be any baby born who breathes on its own, has a heart beat or has any independent motor function no matter when during gestation it is born, no matter how small or underdeveloped it is or how short the duration of its life signs.

Other countries; especially in Asia, some countries in Europe, and Russia; may have set guidelines that a fetus must be born after a certain number of weeks of gestation and birth size must be a certain minimum number of centimeters or weight must be above a certain number of grams for a baby born to be considered a live birth, regardless of any life signs displayed at birth. These countries count infants that don't meet the guidelines as miscarriages, not live births. This lowers a country's IMR statistic considerably, especially if that country is heavily populated.

The more closely a country follows the World Health Organization guidelines like the U.S. does, the more its IMR tends to be higher than other developed countries that don't follow WHO guidelines as closely, such as Singapore, Hong Kong and Japan.

Reasons the U.S. rate stagnated compared to our own counting methods

Counting differences do not explain our failure to lower our own IMR compared to past years using the same counting methods we have used for decades.

Until 2000 the U.S. saw a steady decrease in IMR each year. As we got closer to the 21^st century the smaller the decreases became, but they were still statistically significant decreases.

From 2000 to 2005 the U.S. IMR didn't decrease. It stagnated at an average of 6.86 per 1000. If progress was made one year it was lost the next. Starting in 2006, the U.S. began to make significant strides in lowering the IMR again.

According to the CDC, increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the United States′ infant mortality rates from 2000 to 2005.

Why IMR Stagnated from 2000 to 2005

Why the IMR likely stagnated for a 6 year period is explained by disparities that continue to exist between different racial and ethnic populations within the U.S. African Americans have an IMR 2.4 times higher than non-Hispanic whites, and Native Americans and Alaska Natives have a rate 2.3 times higher than non-Hispanic whites. This disparity did not change significantly between 1998 and 2005. The non-Hispanic white population had an IMR of 5.76 per 1000 in 2005.

The IMR began to decrease again in 2006. Still, parity with whites and those of Asian descent has not been reached. If parity had been reached, the U.S. IMR would be approximately 5.28 per 1000, taking into account the overall decrease of 9% between 2005 and 2008 and the 2005 IMR for whites. The U.S. IMR is estimated to be 6.30 per 1000 in 2008, 19% higher than if parity were reached.

The 2008 U.S. IMR is still 40% higher than our goal of 4.5 per 1000.