Don Boudreaux posts some thoughts about why the U.S. might have higher infant mortality rates than some other developed countries. For example, Canada, Japan, the United Kingdom, France, Germany and Sweden all have lower infant mortality rates. (The reason why this is topical is because the economist/NY Times columnist Paul Krugman recently implied that our healthcare system sucks on account of our high infant mortality rate.)
Doing a little digging on the internet revealed a 1992 CBO report which sheds a lot more light on the issue. The reason why our infant mortality rate is high is because our rate of low birthweight births is high. After a low birthweight infant is born, it has “better chances of survival in the United States than elsewhere.” But the reason for why low birthweight births are more common in the U.S. than in other developed countries is a mystery.
One factor is multiple births. Compared to singleton births, low birthweight and infant mortality is many times more likely to occur in a multiple birth situation. Incidence of multiple births has been increasing significantly in the United States. Fertility treatments and older women having children are factors contributing to the increase. Some statistics can be found here.
Another factor is that black women seem to have a disproportionate amount of low birthweight births compared to whites. There’s no way of knowing if this is all environmental, or if perhaps there is some genetic difference between the races that make black women more susceptible to the problem. If the latter, then the greater percentage of blacks living in the United States contributes to our higher infant mortality compared to Western Europe and Asia.
Finally, drug and alcohol abuse by pregnant mothers contributes significantly to the problem of low birthweight births. I don’t think it’s fair to blame the healthcare system for this self-inflicted problem.
The infant mortality literature talks a lot about prenatal care. But I am not convinced that lack of prenatal care is so significant of a factor. I think it’s likely that the type of woman who is going to abuse drugs and alcohol while pregnant is also less likely to seek prenatal care. It’s the substance abuse and not the lack of prenatal care causing the problem.
In conclusion, it seems to me that the higher infant mortality rate in the U.S. compared to some other developed countries is not a direct result of inferior medical care in the U.S., but due to societal factors that are outside the scope of the medical profession. Paul Krugman, therefore, is wrong to bring this up in his op-ed pieces.