Infant mortality is still a big issue in the United States. And sadly, the problem may be even worse than previously recognized. A new study suggests infant mortality for full-term babies is worse in the U.S. than in many European countries, and things like health care access and sudden unexpected infant death (SUID), including sleep-related fatalities, may be to blame.
The study, reported in PLoS Medicine, found that while infant mortality rates for full-term babies differ across states in the U.S., all states' rates are worse than many European countries. Prior research had discovered that babies are more likely to die in the U.S. than in other developed nation, but this study is new evidence that is the case even for infants born at the very end of pregnancy, when they should have great odds of survival.
Throughout the country, infant mortality rates for full-term babies were 50 percent to 200 percent higher than in Austria, Denmark, Finland, Norway, Sweden, and Switzerland, according to the study. So we aren't talking a minor difference here — a 200-percent higher infant mortality rate should be absolutely shocking to any advocates for mothers and babies and for people fighting for adequate health care access and policy in general.
So why are infant mortality rates for full-term babies so high in the U.S.? Study co-author Neha Bairoliya, of the Harvard Center for Population and Development Studies in Cambridge, Massachusetts, told Reuters that the two main reasons for the higher mortality rates in the U.S. were “congenital malformations, which patients cannot really do much about other than ensuring adequate screening during pregnancy, and high risk of sudden unexpected deaths in infancy, which should largely be preventable through appropriate sleeping arrangements."
Both of those things can potentially be impacted by health care access and proper education for parents. If a mother-to-be doesn't have adequate health care through her pregnancy, that would certainly make screening for health conditions in her baby more difficult, for instance.
However, birth defects — or congenital malformations — only accounted for 31 percent of U.S. infant deaths in the study. The biggest cause was actually SUID, which includes sleep-related fatalities. That accounted for 43 percent of infant mortality cases in the study. That can come down to parents not being well-informed of safe sleeping habits for their baby. Bairoliya told Reuters:
While we do not have data on actual sleeping arrangements from our study, other data sources suggest that a substantial number of babies continue to sleep on their tummy. We also found a shockingly large number of babies dying from suffocation, which suggests that parents either use covers that are not safe, or let children sleep in their own beds.
The American Academy of Pediatrics recommends that babies are safest sleeping on their backs, "on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet." Parents and guardians should also avoid using soft bedding like "crib bumpers, blankets, pillows and soft toys," and the crib should be bare, the association recommended.
In the U.S., there are some major differences in infant mortality rates between states, but every state did worse than many European countries in this particular study. The researchers did acknowledge that mortality differences between states in the U.S. "were partially explained by state-level differences in maternal education, race, and maternal health," according to the research article in PLoS Medicine. But the study's data limitations made the researchers unable to further determine "the extent to which these state differentials are due to differential antenatal care standards as well as differential access to health services."
So it sounds like further study is needed into the differences in infant mortality rates for full-term babies between states, because the data for this study wasn't specifically meant to analyze that. But we do know that screening before birth for congenital malformations may impact the numbers, and in some ways, that comes down to health care access. And SUID rates may be impacted by health care as well — a 2017 WalletHub study found that Alaska, Arkansas, Alabama, and Louisiana ranked among states with the worst health care access, and What To Expect noted that those states have increasing SUID rates.
Researchers studied more than 10 million U.S. infants born between 2010 and 2012 at full-term — between 37 and 42 weeks gestation — to find this data. Out of every 5,000 full-term births, 11 babies died before they reached age 1, researchers reported in PLoS Medicine. And the researchers do seem to think it's worthwhile to try to follow what the "best-performing" states with the lowest rates for each cause of death are doing to try to reduce infant mortality rates, estimating that the numbers could be reduced by 4,000 deaths if all states achieved the levels of those "best" states.
A baby born in the U.S. is almost three times as likely to die during their first year of life as one born in Finland or Japan, The Washington Post reported in 2014. And if better health care access and education for parents could help change that, that's something we should all be willing to get behind.
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