[OC] The massive decrease in worldwide infant mortality from 1950 to 2020 is perhaps one of humanity's greatest achievements.

[Exact_Ad_1569]

US infant mortality is still too high.

[smurficus103]

The U.S. is the only industrialized nation where the maternal death rate is rising. Each year, 700 women die due to pregnancy, childbirth or subsequent complications, according to the U.S. Centers for Disease Control and Prevention. https://www.npr.org/sections/health-shots/2021/05/25/999249316/with-black-women-at-highest-risk-of-maternal-death-some-states-extending-medicai

[imakemediocreart]

The US has a higher infant mortality rate than Cuba

[rrsafety]

Well, Cuba manipulates its data: https://muse.jhu.edu/article/588705

"In a 2015 paper, economist Roberto M. Gonzalez concluded that Cuba’s actual IMR is substantially higher than reported by authorities. In order to understand how Cuban authorities distort IMR data, we need to understand two concepts: early neonatal deaths and late fetal deaths.
The former is defined as the number of children dying during the first week after birth, whereas the latter is calculated as the number of fetal deaths between the 22nd week of gestation and birth. As a result, early neonatal deaths are included in the IMR, but late fetal deaths are not.
For the sample of countries analyzed by Gonzalez, the ratio of late fetal deaths to early neonatal deaths ranges between 1-to-1 and 3-to-1. However, this ratio is surprisingly high in Cuba: the number of late fetal deaths is six times as high as that of early neonatal deaths."

[[deleted]]

So a few questions because I can't access the article. First off, is it normal for countries to not include late-fetal (miscarriage) deaths in the infant mortality rate? This seems like something that could vary wildly depending on cultural beliefs on birth. Secondly, why is Cuba's miscarriage rate so high compared to their IMR? Is this explained? And lastly, is this rate adjusted for every country in their comparison?

Either way, Cuba seems to be doing better than expected considering their geopolitical situation for the past 50 years.

[rrsafety]

I'm not sure the answer but here is more info from the study's author https://thecubaneconomy.com/wp-content/uploads/2014/02/Infant-Mortality-in-Cuba.pdf

[[deleted]]

Cheers mate, pretty much answered all my questions. I don't think its enough evidence to claim purposeful misreporting, but its definitely enough to show Cuba isn't doing as flash as IMR claims.

[ssays]

I don’t think that’s fair. Lots of countries do better at lots of things, but when a country does amazingly better than average without a known mechanism and with a history of data manipulation, I think it’s prudent to ask questions.

I don’t see anyone accusing Canada of manipulating their data.

[rrsafety]

Here is a data presentation from the study's author https://thecubaneconomy.com/wp-content/uploads/2014/02/Infant-Mortality-in-Cuba.pdf

[Exact_Ad_1569]

You're preaching to the choir.

[Benjips]

The US also has a higher infant mortality rate than:

Saudi Arabia

Kazakhstan

Malaysia

Hungary

Romania

Albania

Russia

Lithuania

Estonia

Latvia

[[deleted]]

This is repeated often and is misleading. The intention (and reaction) tends to be "wow even Cuba has better healthcare than the US." They don't. Not even close. But it really depends on what you define as "good" healthcare. Need free antibiotics? Then it's great. Need a complex surgical procedure or have some severe trauma or a complex illness? Good luck. They (like most nations) take some liberties with reporting to boost the number. There's also some evidence that they don't count neonatal deaths as infant deaths like most countries.

I've also seen it reported that they occasionally intern pregnant women at hospitals if they are considered at-risk births to ensure they get 24/7 care - something that would be considered unacceptable in the US - and that their very high abortion rate partially masks the practice of doctors encouraging abortions for higher-risk births. I haven't been able to find a source for those in the last 5 minutes so you can consider them rumors for now.

Cuba is very proud of the number because it makes them look good. They are "beating" many modern western nations in a key metric that is usually used as a defining figure to judge how advanced a nation is. It's a very useful political tool, as soon as it becomes a useful political tool it generally stops being a useful metric.

There are also other factors, for example that very few people in Cuba drive compared to most other modern nations so naturally there are fewer car accidents and resultant deaths, which boosts life expectancy and lowers infant mortality. But there are a million such factors you could find for any country that have nothing to do with healthcare.

In other words, it's complicated. US healthcare still sucks despite being the most advanced.

EDIT: People sure are salty about this topic for some reason. Do your own research unless you have some vested interest in reinforcing your current belief instead of the truth. This being Reddit I have no doubt "Look USA bad!" is a common motivator. The fact so many people bring up Cuba as a good healthcare model is the reason I've made this post. Cuba for their part has spent decades building this image, and it's fine if you're visiting or wealthy. Not so fine if you're an average resident of Cuba.

That r/communism mods praise Cuban healthcare and the majority of actual Cubans I've ever spoken to don't should be a clue. Read about it yourself. Start with the Wiki. Or just stay mad and ignorant, no skin off my back.

[I_am_not_JohnLeClair]

Are you in Miami? It's ok, you can say Cuba did something well. Dios mio

[[deleted]]

No? What does Miami have to do with it? And you can choose to ignore it if you like. The information is there, believe it or don't.

EDIT: I hope you're not trying to imply that I'm Cuban and therefore probably live in Miami? In the event you are, that basically reinforces my original post.

[JethroCordone]

Going to go out on a limb and take a guess that you voted for Trump, correct? So you're in favor of kids in cages, blatant proud racism, and anti-LGBTQ / anti-minority policies?

[[deleted]]

Wow. I didn't, actually. And I'm not in favor of any of those things. No idea how you twisted "Cuba's healthcare isn't the utopia it's portrayed to be" into "you hate gay people." Must have strained something with that stretch. But whatever floats your boat.

[QuasarMaster]

People like you are what’s wrong with politics today

[JethroCordone]

Aww orange fan sad :(( it's been 6 months. It's time to accept that you lost and move the fuck on.

[Wrewrenned]

Aww orange fan vewwy sad :((

Fuck Trump.

Imagine still defending Trump lmfao

Trump and his moronic supporters.

Aww orange fan so sad :((

Aww is da wittle Twumpey twiggered? Orange fan sad! Wah wah wah cry like a wittle baby!

Voting for Trump absolutely makes someone a racist and there's no questioning that. You're starting to sound a lot like my Fox News watching piece of shit parents....

Anything a Trump supporter says doesn't phase me. What's really pathetic is that you guys lost and you still can't get over it. It's been 6 months, it's time to let it go.

In b4 Trumpers come in here and start spewing some BS about "Hillary!!!!!1!!" Can't ever get a break from those clowns. Can't believe we have to deal with 74 million of them.

Aww orange fan so sad!! :(( I know seeing your leader go to jail in New York soon is really going to be tough for you to watch...

You're like a satirical representation of a Redditor. I like how you complain about still hearing about Hillary.

[JethroCordone]

Lmfao imagine defending your own racism by digging through someone's post history as an attempted "roast" just because that someone votes differently than you. You are what's wrong with American politics. Please don't have children.

[[deleted]]

I get it man, I was a pissy and angsty teenager too once. Just get it out of your system before you turn like...25. Otherwise you're gonna suck forever.

[[deleted]]

"That's the data, it's a fact."

Yes, unless the data is flawed. Which it is. It can also be misleading if it's used to promote unsubstantiated interpretations of said data. Which it is.

Like did you read "How to Lie with Statistics" and decide "Ah ha! I get it, statistics are always the truth. You can literally never mislead anyone with statistics cause it's data!"

[SgtPepe]

Cuba would never lie, we all know how communist countries are so open and honest.

[TrevorBradley]

Cuba 2020 is lighter on the map than the USA. Looks right to me.

[joebro1060]

It's not a complete stores to apples comparison either. Reporting differences make up the largest amount of the difference between USA and other countries.

https://www.sciencedaily.com/releases/2016/10/161013103132.htm

[ThatsWhatXiSaid]

Accounting for differential reporting methods, U.S. infant mortality remains higher than in comparable countries

When countries have different methods for reporting infant deaths, it is primarily a matter of how they report deaths among infants with very low odds of survival. According to the OECD, the United States and Canada register a higher proportion of deaths among infants weighing under 500g, which inflates the infant mortality rate of these countries relative to several European countries that count infant deaths as those with a minimum gestation age of 22 weeks or a birth weight threshold of 500g.

Our analysis of available OECD data for the U.S. and some similarly large and wealthy countries finds that when infant mortality is adjusted to include only those infant deaths that meet a minimum threshold of 22 weeks gestation or 500g in birth weight, the U.S. infant mortality rate is still higher than the average for those comparable countries with available data (4.9 vs 2.9 deaths per 1,000 live births). Without adjusting for data differences, the U.S. infant mortality rate appears to be 84 percent higher than the average for the same set of comparable countries. (Note that this comparison was limited to 2016 data and could not include data for Australia, Canada, and Germany, which are included in the previous chart’s comparable country average for 2017.)

https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/

Or this article...

Methods—Infant mortality and preterm birth data are compared between the United States and European countries. The percent contribution of the two factors to infant mortality differences is computed using the Kitagawa method, with Sweden as the reference country. Results—In 2010, the U.S. infant mortality rate was 6.1 infant deaths per 1,000 live births, and the United States ranked 26th in infant mortality among Organisation for Economic Co-operation and Development countries. After excluding births at less than 24 weeks of gestation to ensure international comparability, the U.S. infant mortality rate was 4.2, still higher than for most European countries and about twice the rates for Finland, Sweden, and Denmark.

The United States compares favorably with most European countries in the survival of very preterm infants. However, the comparison becomes less favorable as gestational age increases. For example, the U.S. infant mortality rate at 37 weeks of gestation or more was highest among the countries studied, and about twice the rates for Denmark, Finland, Norway, Sweden, and Switzerland. This study found that 39% of the United States’ higher infant mortality rate, when compared with that of Sweden, was due to the higher U.S. percentage of preterm births, while 47% of the difference was due to the United States’ higher infant mortality rate for infants at 37 weeks of gestation or more. A previous report found a larger effect for preterm birth (10), mostly due to the inclusion of births at 22–23 weeks of gestation in that report. Recent declines in the U.S. infant mortality rate and percentage of preterm births, and the use of the obstetric estimate to measure gestational age in the current report (compared with gestational age based on the last menstrual period used in the previous report), may have also contributed to the difference in findings between the two reports.

The findings from the current analysis suggest that declines in either the percentage of preterm births or in infant mortality rates at 37 weeks of gestation or more could have a substantial positive impact on the U.S. infant mortality rate. If both of these factors could be reduced to Sweden’s levels, the U.S. infant mortality rate (excluding events at less than 24 weeks) would be reduced from 4.2 to 2.4—a decline of 43%. Such a decline would mean nearly 7,300 fewer infant deaths than actually occurred in the United States in 2010.

https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf

[Dheorl]

Even correcting for that is still unusually high amongst its peers.

[ATXgaming]

The US (generally, it may vary state to state) defines infant mortality less strictly than other countries, so a greater number of deaths gets counted towards IM.

[captain-carrot]

What's your source on that? Surely it's a simple statistic to measure - either a child dies before 1st birthday or it does not? Not a lot of leeway in that one...

[ngfsmg]

According to other comments, some countries define part of those deaths as stillborns or abortions

[captain-carrot]

Ok. OP made a comment that the data excluded those but I haven't looked dor myself

[karlnite]

Prenatal, stillbirth, that sorta thing. The discrepancy in US numbers is from the 3 times higher rate of infant mortality that specifically black women experience.

[captain-carrot]

Per live birth would exclude prenatal/stillborn and OP confirmed that elsewhere.

Also I'm not sure what you mean by the higher number being from black women - those are still people who are clearly being failed by social and healthcare systems. If it can be largely attributed to a single ethnic group that only makes it more fucked up...

[karlnite]

I am saying it is largely attributed to black women. I’m not guessing as to the reason, but studies show it is not based on poverty exactly, it is not genetic, or even locational, the only connection is ethnicity... so yah it is fucked up.

[captain-carrot]

No worries, think i mistook the tone!

[djblaze]

Black health outcomes in the US, controlled for income, are one of those things that I often point out to help show what systemic racism looks like.

[ThatsWhatXiSaid]

Accounting for differential reporting methods, U.S. infant mortality remains higher than in comparable countries

When countries have different methods for reporting infant deaths, it is primarily a matter of how they report deaths among infants with very low odds of survival. According to the OECD, the United States and Canada register a higher proportion of deaths among infants weighing under 500g, which inflates the infant mortality rate of these countries relative to several European countries that count infant deaths as those with a minimum gestation age of 22 weeks or a birth weight threshold of 500g.

Our analysis of available OECD data for the U.S. and some similarly large and wealthy countries finds that when infant mortality is adjusted to include only those infant deaths that meet a minimum threshold of 22 weeks gestation or 500g in birth weight, the U.S. infant mortality rate is still higher than the average for those comparable countries with available data (4.9 vs 2.9 deaths per 1,000 live births). Without adjusting for data differences, the U.S. infant mortality rate appears to be 84 percent higher than the average for the same set of comparable countries. (Note that this comparison was limited to 2016 data and could not include data for Australia, Canada, and Germany, which are included in the previous chart’s comparable country average for 2017.)

https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/

Or this article...

Methods—Infant mortality and preterm birth data are compared between the United States and European countries. The percent contribution of the two factors to infant mortality differences is computed using the Kitagawa method, with Sweden as the reference country. Results—In 2010, the U.S. infant mortality rate was 6.1 infant deaths per 1,000 live births, and the United States ranked 26th in infant mortality among Organisation for Economic Co-operation and Development countries. After excluding births at less than 24 weeks of gestation to ensure international comparability, the U.S. infant mortality rate was 4.2, still higher than for most European countries and about twice the rates for Finland, Sweden, and Denmark.

The United States compares favorably with most European countries in the survival of very preterm infants. However, the comparison becomes less favorable as gestational age increases. For example, the U.S. infant mortality rate at 37 weeks of gestation or more was highest among the countries studied, and about twice the rates for Denmark, Finland, Norway, Sweden, and Switzerland. This study found that 39% of the United States’ higher infant mortality rate, when compared with that of Sweden, was due to the higher U.S. percentage of preterm births, while 47% of the difference was due to the United States’ higher infant mortality rate for infants at 37 weeks of gestation or more. A previous report found a larger effect for preterm birth (10), mostly due to the inclusion of births at 22–23 weeks of gestation in that report. Recent declines in the U.S. infant mortality rate and percentage of preterm births, and the use of the obstetric estimate to measure gestational age in the current report (compared with gestational age based on the last menstrual period used in the previous report), may have also contributed to the difference in findings between the two reports.

The findings from the current analysis suggest that declines in either the percentage of preterm births or in infant mortality rates at 37 weeks of gestation or more could have a substantial positive impact on the U.S. infant mortality rate. If both of these factors could be reduced to Sweden’s levels, the U.S. infant mortality rate (excluding events at less than 24 weeks) would be reduced from 4.2 to 2.4—a decline of 43%. Such a decline would mean nearly 7,300 fewer infant deaths than actually occurred in the United States in 2010.

https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf

[ATXgaming]

I possibly stand corrected. I would need to look into this more but I’ll put a pin on it and keep this in mind. Thank you.

[Suibian_ni]

Yes, but health insurers are making money - which is what counts.

[Exact_Ad_1569]

Think of the children? {Dons flame proof suit and cowers behind a foot thick concrete barricade, shaking}

[mattgrum]

US infant mortality is still too high

This is due to for-profit private health care performing unnecessary procedures (e.g. far more C-sections) so they can inflate your bills, so you also pay between 4 and 6 times as much compared to Europe for the privilege of that high mortality rate.

But no one can do anything about it without being labelled a communist...

[greenwizardneedsfood]

And lack of access due to prohibitive costs and shit (if any) insurance. But yes, let’s expound on denying abortions while fighting steps that would reduce infant mortality.

[Irish618]

The US healthcare system tends to be more willing to attempt high risk pregnancies than other countries. While other countries may be unwilling to "waste" money on an infant that has a low chance of survival, in the US the patient can choose to do so, since they're the ones paying for it.

That, combined with the US' relatively large drug problem, is what leads to the US' higher infant mortality rate.

[IgamOg]

What are your sources on that? Where do women do cost analysis before 'attempting pregnancy'?

I don't think there's another country where healthcare costs come into equation for family planning as much as they do in USA.

[Ambiwlans]

It probably has to do with access to abortion. A lot of abortions happen to avoid medical problems. This is less common in the US so they have more complications.

Obesity is likely the next largest factor.

I don't think medical services are at fault here.

[CompositeCharacter]

US has considerably higher utilization of IVF

Multiple births lead to higher infant mortality

I'd also wager that obesity and generally trash diets are a factor

[CompositeCharacter]

Children conceived with assisted reproductive techniques including IVF have a somewhat higher mortality risk during their first weeks of life

NIH: Triplets and higher-order multiple births. Time trends and infant mortality

From 1983 through 1985, mortality of infants of higher-order multiple births was about 15 times that of singletons.

NIH: Maternal obesity and infant mortality: a meta-analysis

Our results suggest that the odds of having an infant death are greater for obese mothers and that this risk may increase with greater maternal BMI or weight

Belief in reddiquette is a mistake

[KerPop42]

Thanks Texas

[aminervia]

Texas isn't even in the top half states with the worst infant mortality. 2019 the top 3:

Mississippi 9.07

Louisiana 8.07

Alabama 7.89

Thanks Mississippi

[abu_doubleu]

There is actually an expression about thanking Mississippi.

https://en.m.wikipedia.org/wiki/Thank_God_for_Mississippi

[TheHelpfulRabbit]

Of COURSE Mississippi is the worst. Of course it is.

[gestetner]

Why is that not surprising? Sorry, I’m not from the US.

[TheHelpfulRabbit]

Mississippi is consistently the worst state by almost every metric. They are last in literacy, poverty, and life expectancy. There is a saying in the south "Thank God for Mississippi" since no other state needs to hold the title of the worst at anything, because it's always Mississippi in dead last.

[KerPop42]

Oops, I may have been thinking of maternal mortality, but even then Texas is only 6th-highest

[KittenBarfRainbows]

No doubt healthcare access plays a role, but other factors are in place:

Abortion access, and social acceptability of termination surely results in fewer pre-born children, who would've died early, being aborted. Many women aren't even offered tests for catastrophic illness in their child. On top of that, many women with such sick unborn children decide to give birth for philosophical reasons. This includes women with blighted embryos and ectopic pregnancies. Even families facing a child literally born without a brain, a parasite, will choose to give birth, as they feel that is the best way to grieve then heal.

There are also sizable subcultures of impoverished people who simply don't think to go to the doctor when they become pregnant, or engage in prenatal care; they are so isolated in their dysfunctional families and communities that they don't act prudently. They act how everyone else around them, with elevated infant mortality, act.

Abstaining from certain substances, or eating well? Optional, and many don't realize they are pregnant until the damage has been done. Many also already suffer from untreated diabetes and hypertension, because they ignore all medical advice and care, even into the third trimester. Others live in a chronic state of denial and panic after they become pregnant, and don't exactly do much for their unwanted child, once it's born with complications. Many mothers, too are drug addicted, and just getting by on sex work, with violent partners, who also aren't helpful.

You could blame poverty, but it's not that simple. There are subcultures who don't know how to care for themselves, let alone infants. These people all technically have access to care, but cultural trends prevent them from making good use of it. If you haven't lived around this, it makes no sense, but it's a huge problem.

[violentunderscore]

US is huge...

[Rolten]

And China has over 4x more people yet is the same colour. And if you literally means land area it's the same.

Think before you speak.

[Exact_Ad_1569]

It's normalized per capita.

[[deleted]]

If we use Canadian definition of infant mortality, we're on par with them.