Wednesday, November 4, 2009

Why does America have so many more premature births than Europe?

"Premature births are the chief reason the U.S. ranks 30th in the world in infant mortality, with a rate more than twice as high as infant mortality rates in Sweden, Japan, Finland, Norway and the Czech Republic."

The AP lists possible reasons suggested by "experts":

-Fertility treatments and other forms of assisted reproduction probably play a role because they often lead to twins, triplets or other multiple births. Those children tend to be delivered early.

-The U.S. health care system doesn't guarantees [sic] prenatal care to pregnant women, particularly the uninsured, said Dr. Alan R. Fleischman, medical director for the March of Dimes.

-Maternal obesity and smoking have been linked to premature births and may also be a factor.

-Health officials are also concerned that doctors increasingly are inducing labor or performing C-sections before the 37th week. However, Fleischman said most infant deaths do not occur in babies just shy of 37 weeks gestation, but rather in those much younger....
While "smoking" makes sense as one of the factors causing premature births in the US, it doesn't make sense as an explanation of why America has more premature births than Europe. Europeans smoke much more than Americans, and I'd assume there's a direct correlation between a country's overall smoking rate and the prevalence of pregnant women smoking. There must be factors aside from smoking that are so harmful to babies that they go even further than canceling out America's advantage in having relatively few smokers.

9 comments:

Ann Althouse said...

Isn't a big part of the disparity caused by whether a birth is reported in the first place? That is, don't Americans try to save babies that would be listed elsewhere as born dead? They are called live births, and then they die.

John Althouse Cohen said...

I don't know. How often does this happen?

Even if Americans do try to save more babies (which, again, I don't know if they do), I would prefer that we apply that impulse to save babies more broadly. It might not be as dramatic, but universal access to prenatal care is more important than the occasional act of heroism once a baby has already been born prematurely.

Ann Althouse said...

I'm just saying the numbers are distorted by the fact that we don't hide the marginally savable babies by pronouncing them dead from the start.

It's certainly better to try to do things to make the pregnancy healthy and get a healthy baby than to need to save an unhealthy one.

I am sure doctors know that.

John Althouse Cohen said...

I'm just saying the numbers are distorted by the fact that we don't hide the marginally savable babies by pronouncing them dead from the start.

Again, I don't know if this practice actually happens, and even if it does, it'd need to happen a lot for it to significantly affect the statistics.

I am sure doctors know that.

I wish we lived in a country where we could just say "Well, doctors know what they're doing" and expect people who need medical treatment to get medical treatment. The problem isn't whether doctors know things about medical care that are so basic that I can point it out in a blog comment. The question is whether people have access to doctors at all.

Ann Althouse said...

Here's some discussion.

John Althouse Cohen said...

Thanks for the link. I'm hesitant to put much stock in an ideologically committed blog (the banner reads, "Free Markets, Free People"). The article it links to also seems to be right-leaning.

But I agree that the link shows that different countries have different standards for how they report infant mortality, which throws off the comparisons.

They quote an economist saying: "'Taking into account such data-reporting differences, the rates of low- birth-weight babies born in America are about the same as other developed countries' in the Organization for Economic Cooperation and Development. Likewise, infant mortality rates, adjusted for the distribution of newborns by weight, are about the same." I hope that's true, but I'd want to know what "about the same" means. I also wish the countries themselves would fix the discrepancies so we wouldn't have to rely on random economists who claim to have corrected for those discrepancies.

Jason (the commenter) said...

Why does America have so many more births than Europe?

Perhaps the two questions are related.

John Althouse Cohen said...

By "more premature births," I meant proportionately more. For instance, the article says: "About 1 in 8 U.S. births are premature. Early births are much less common most of Europe; for example, only 1 in 18 babies are premature in Ireland and Finland."

Meade said...

There is also some thought that there are genetic predictors for premature birth.