This weekend several mainstream media outlets picked up a story (if they’d only pick up blog feeds) highlighting the rise in infant deaths in what they referred to as the “Southeast.” The article treated this discovery as though they had found an earthshaking scoop. It wasn’t.
The despicable infant death totals for the Old Confederacy have been occurring for some time. Pick up an old almanac or locate a source that lists infant mortality rates by state or region over time and you will find Southern states have long had shockingly high percentages of infant mortality just as they also rank at the bottom of other social indicators like education. I wrote about this in Strange Death:
Southern states typically rank near or at the bottom of surveys on education and health care, whether in measures such as student performance or infant mortality. The South�s poor performance has persisted for over a century, hanging like a millstone around the neck of America. This tilted playing field makes the climb for people of color particularly steep.
Perhaps this is the proper place to explain exactly what infant mortality measures and why many public health experts regard it as one of �if not the leading measure of a city’s, state’s, or nation’s health care system. UNICEF defines the term as follows:
[The] probability of dying between birth and exactly one year of age expressed per 1,000 live births.
Admittedly some of these deaths are due to causes that could not have been anticipated or prevented. Infant mortality is never zero, nor will it ever be. The Centers for Disease Control (CDC) notes that in the United States:
The leading causes of infant death include congenital abnormalities, pre-term/low birth weight, Sudden Infant Death Syndrome (SIDS), problems related to complications of pregnancy, and respiratory distress syndrome.
While some of the causes of infant mortality cannot be prevented, many can because they stem from inadequate care. In other words either before or after the baby is born, it does not receive the treatment it needs or the treatment is substandard.
Infant mortality also can come from the mother not receiving adequate care so that at birth, the infant may have significant health problems. This prenatal care may include everything from nutrition to education. Among a few Neanderthals there remains a tendency to blame the mother for an infant being born with health problems.
Certainly there are cases where a mother�s prenatal behavior harms their babies–so-called crack babies and fetal alcohol syndrome being two examples–but inadequate prenatal care is more often a systemic failure. Just as health care quality measures include whether doctors counsel diabetics and heart attack survivors about diet, exercise and smoking, health care quality also includes whether the system counsels mothers-to-be about nutrition and other measures and whether it conducted periodic checkups of the fetus’ health. The same is true for post-delivery care.
That is why infant mortality stands as such a crucial measure of the quality of a health care system. If we do not adequately provide for those at the dawn of life, we have a system in serious trouble. If we allow babies to die because of inadequate care we bankrupt the future of our country.
Typically nations that show high infant mortality rates in World Health Organization (WHO) statistics tend to be poor nations who cannot afford adequate health care systems. They have low percentages of trained doctors, nurses, and public health workers. They have fewer hospitals and birth centers and those they do have may lack adequate resources and be unsanitary. If we review WHO infant mortality statistics we find at the bottom nations such as Afghanistan, Angola, and Somalia with rates as high as 165 deaths per thousand.
On the other end of the scale we have Iceland and Singapore ranking number one with a rate of two per thousand followed by Finland, Japan, Monaco, Norway and Sweden with three per thousand. There is one glaring anomaly in WHO’s infant mortality statistics–the United States. Although this country spends more on health care than any other nation in the world, there are thirty nations ahead of us in the 2006 WHO statistics on infant mortality. Our number of six per thousand is double that of the leading countries and equal with nations such as Croatia, Cuba, and Estonia. In other words, our sworn enemy, the Cuba of Fidel Castro, has the same infant mortality rate as we do.
If we move over one column in the WHO statistics, the news becomes even grimmer. It shows the under-five mortality rate, which for the Unites States is eight per 1,000. This is worse than Croatia and Cuba (both with seven) and equal to that of Estonia and Hungary. In other words, a child under five has just as good a chance to survive to the age of six in Hungary as she or he has in this country.
These are appalling statistics. Yet I would venture that few reading this essay know of our dismal rankings. There may be no other statistics one could find that point to how this nation fails to live up to its own ideals. Infant and child mortality represent moral as well as medical measurements.
The medical literature has enough references to the causes of our miserable ranking and even more suggestions for how to cure it, to keep someone reading for a long time. But in the end all these words come down to one factor: some people in this country receive inadequate pre-and post-natal care.
WHO notes:
rural children, children of uneducated mothers and children in the poorest households continue to have higher mortality risks than better-off children–as they did ten years previously–even though overall mortality levels have declined.
In other words, the health of rich children around the world is improving, but the health of children of the poor and uneducated remains grim. In the United States these data also take on racial overtones. Reflecting on infant mortality in this country, the CDC states:
This ranking is due in large part to disparities which continue to exist among various racial and ethnic groups in this country, particularly African Americans.
The CDC goes on to say:
Infant mortality among African Americans in 2000 occurred at a rate of 14.1 deaths per 1,000 live births.
If African Americans were a country on the WHO chart their rate would put them below Bosnia, Malaysia and Sri Lanka and equal with the Ukraine.
A lesser-known–at least before the article–and publicized cause of our low ranking is how the shocking rates of the Old Confederacy pull down the nation’s overall rank. In its article on the rise of infant deaths in the South, The New York Times pointed out:
Whether the rises continue or not, federal officials say, rates have stagnated in the Deep South at levels well above the national average.
Where infant mortality in Dixie becomes more despicable is when you look at the rates for the poor and people of color. The Times states:
In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1.
Again a review of the WHO data shows this is on a par with Jamaica, Romania, and–get this–Vietnam. To put it bluntly, poor people of color in the South have infant mortality rates equal to Third World Countries.
Now we uncover another of America�s dirty little secrets: this represents a conscious decision. What do I mean by this? Infant mortality rates in Third World Countries are high because those countries do not have the resources to provide adequate health care. American has the resources, but chooses not to distribute them equally.
Those babies that are dying in this country are not dying for the same reasons they are dying in Vietnam. Although the actual physical causes of death may be the same, they are dying in this country because of a POLICY DECISION. Our system has consciously chosen to not provide the same resources to African Americans that it does to whites. The National Health Care Disparities Report for 2005 states:
The single largest access problem faced by all groups, except Asians, was lack of health insurance.
The United States did not always have such a poor infant mortality ranking. Under the leadership of Liberal America and its philosophy of the level playing field, this country pioneered a variety of measures designed to reduce infant mortality such as the visiting nurse service. Eleanor Roosevelt made health care for the poor a personal priority. In November 1945, Harry Truman asked Congress to enact a national insurance program:
To assure the right to adequate medical care and protection from the economic fears of sickness.
However, the Counterrevolution’s zeal to roll back the New Deal and eliminate “big government” has reversed these attempts to level the playing field, as our infant mortality rate shows. The result is that under George W. Bush infant mortality has increased. In Strange Death I noted it rose from 6.8 in 2001 to 7.0 in 2002. I then quoted the CDC�s dismay:
This was the first significant rise in the infant mortality rate since 1958.
By cutting back on government services, the GOP has cut back on the very interventions that would lower infant mortality. To repeat, in this country, which has the highest spending in the world on health care, a high infant mortality rate results from policy decisions!
The irony of the infant mortality article appearing less than a week after the Supreme Court’s abortion decision, should provoke some interesting discussions given that the worst infant mortality rates should occur in the strongholds of Christian fundamentalists and anti-abortion crusaders. The anti-abortion zealots like to refer to abortion as murder, saying those who support abortion have blood on their hands. The same might be said for those who fail to provide for the newborn. If abortion is murder what is inadequate support for those who are born? There is blood on the hands of the Counterrevolution and like Lady Macbeth no amount of washing can remove it.
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