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On Infant-Mortality Rates

Don’t miss this very useful and sober article by Econlog’s Arnold Kling. In it, Arnold spells out several straightforward ways for improving the ways that international health-care statistics are gathered – ways that, if followed, would make cross-country comparisons of health care more reliable.

One particular fact emphasized again and again by those who instinctively believe that centralized, socialized, bureaucratized health-care provision is better than health-care provision by the market is the relatively high rate of infant mortality in the United States. Arnold says much that is sensible on this point, for example:

I also believe that it is beyond reasonable doubt that the United States does not enjoy a significantly lower measured infant mortality rate than other countries. However, it is likely that the numbers are sensitive to the treatment of pre-term infants. In the United States, it is not uncommon for a baby to be delivered three or four months before the due date, where otherwise there would be a miscarriage. It is not uncommon for these low birth-weight babies to die.

In addition to Arnold’s hypotheses, I add here four of my own hypotheses for why raw U.S infant-mortality numbers are higher than raw infant-mortality numbers in many other industrialized nations:

1) American women’s high earning potential in the job market. This high earning potential means that taking time off of work – both for short durations and, especially, for long durations – is costlier for American women than for women elsewhere (where wages might be lower, or job availability less). Therefore, a higher proportion of American women (than women elsewhere) shift at least part of their child-bearing years into their mid-30s and later, increasing the chances of problems with fetal health.

2) A greater proportion of American women (than women elsewhere) have access to infertility treatments – and such treatments arguably increase the frequency of fetal health problems.

3) America continues to attract many immigrants, legal and illegal. To the extent that immigrant women are poor – especially to the extent that they come from countries in which their access to quality health care was quite limited – they are more likely than American-born women of the same ages to suffer health-care problems while pregnant.

4) Other countries have different standards for distinguishing live births from miscarriages. It’s conceivable to me that MDs in some countries count as ‘miscarriages’ infant deaths that occur within, say, an hour of birth while in U.S. hospitals such deaths are counted as deaths of live-born infants.

I don’t know if any of these hypotheses is correct, but each strikes me as plausible and relevant. Sound empirical research is necessary to determine their validity and significance. If any of these hypotheses is correct, however, the raw numbers showing relatively high U.S. rates of infant mortality do not necessarily indicate that health care in the U.S. is worse than elsewhere. (In fact, if my hypothesis about infertility treatments is correct, then, ironically, superior U.S. health care – making infertility treatments more attractive and accessible – might be responsible for at least part of the high raw numbers on infant mortality in the U.S.)