US lagging behind in prevention of newborn deaths

By Shannon Jones

3 September 2011

A report published earlier this week shows that while mortality rates for infants in the first month of life have declined globally over the past 20 years, progress has slowed, particularly in countries suffering from the highest rates. Significantly, the study documents the fact that the United States, the world’s wealthiest industrial nation, has fallen to 41st place worldwide in neonatal deaths per 1,000 live births, placing it next to last among developed countries.

Newborns in the US are more than three times as likely to die as those in Japan. The US is tied near the bottom of industrial nations with Serbia and Croatia. Only Latvia, with six deaths per live births, ranks lower.

The United States, which spends the greatest percentage of its GDP on health care of any country in world, has a neonatal mortality rate of 4.3 per 1,000 live births placing it even with Qatar (4.3) and below Poland (4.0), Cuba (2.9), South Korea (2.2.) and Cyprus (1.6).

The report was sponsored by the World Health Organization (WHO), the London School of Hygiene and Topical Medicine and Save the Children and was published in PLoS Magazine. Focusing on deaths of infants under four weeks of age researchers built a database of neonatal deaths and child deaths in 193 countries covering the period 1990-2009. The study shows that in 2009 an estimated 3.3 million babies died in the first month of life compared with 4.6 million in 1990. Among the 15 countries with the highest infant mortality, 12 are from Africa. Afghanistan has the highest neonatal mortality, with one of 19 babies dying in the first four weeks of life. Ninety-nine percent of newborn deaths occur in the developing world.

The newly released report is one is the most comprehensive studies of neonatal mortality ever produced. It shows that the overall neonatal mortality rate fell 28 percent in the period covered by the study, from 33.2 deaths per 1,000 live births to 23.9. While the neonatal mortality rate was halved in some regions, it only fell by 17.6 percent in Africa. Globally, more than 8 million children die each year before reaching their fifth birthday. Forty-one percent of these deaths occur in the first four weeks of life.

Five countries account for one-half of all the newborn deaths globally: India (27.8 percent), Nigeria (7.2 percent), Pakistan (6.9 percent), China (6.4 percent) and Democratic Republic of Congo (4.6 percent).

More than 19,000 newborns in the US still die each year. Over the past 20 years US neonatal deaths have declined at a rate 26 percent below the global average, with America’s position in relation to the rest of the world declining steadily. The study found that 50 countries, including China, had cut their neonatal mortality rates by more than 50 percent over the past 20 years.

In 1960 the US ranked 12th in the world in terms of infant deaths in the first year of life. By 1990 it had fallen to 23rd place and in a study published in 2008 it ranked 34th. It has since fallen another seven places, according to the WHO study.

In an interview with the World Socialist Web Site Jeff Lancashire, public affairs officer for the National Center for Health Statistics, said, “The US rate has been declining. But the rate of decline is not as significant as in other countries. We’re holding ground, not gaining ground. There is great disparity in the US population. The overall rate is going to reflect those doing the best as well as those doing the worst.” Lancashire pointed out that African American infants, for instance, are more than twice as likely to die in the first four weeks of life than the national average.

He continued, “Pre-term births have been going up over the past several years. Low birth weight babies have gone up. Those are risk indicators for infant mortality. Prenatal care is very important in terms of a healthy pregnancy, healthy birth, a healthy birth weight.”

Each year more than a half million babies, 1 in every 8, are born prematurely in the US, more than double the rate in Europe and North Africa. “Prenatal care is not all created equal. There are areas of the United States where access to prenatal and preventive care is a real problem”, said Dr. Joy Lawn of Save the Children, one of the author’s of the study, in an interview with CNN. “It puts the mother at a disadvantage and contributes to premature births and death rate.”

The latest figures of neonatal mortality are an indictment of the profit system and reveal in particular the decay of American capitalism. The growth of poverty, unemployment, the gutting of social programs and the increasing numbers of Americans who lack health insurance is taking a terrible toll on the youngest and most vulnerable sections of society. At the same time there has been an obscene accumulation of wealth in the hands of the richest citizens, who have unlimited access to the most modern medical technology.

Despite spending more on health care per capita than any country, the US is unable to provide basic prenatal care to large segments of its population due to the corporate stranglehold over medicine. Further, much of what is counted as health care spending is simply siphoned off as profits by the insurance companies and pharmaceutical manufacturers.

According to the WHO the three primary causes of infant death are premature birth, asphyxia and severe infections, problems that can be eliminated with proper care. The report concludes, “The majority of neonatal deaths could be prevented with existing interventions including some that can be delivered at community level with potential to reduce neonatal deaths by one-third, such as improved hygiene at birth, breastfeeding and simple approaches to keeping babies warm.”

Despite this, the relative number of neonatal deaths to overall childhood deaths is increasing and now account for 41 percent of all deaths of children under the age of 5. Progress has been particularly slow in reducing infant mortality in the regions with the greatest risk. Africa, which is being crushed by debt payments to the world banks, has seen the least progress of any region, with a reduction of just one percent a year.