Why are American infants dying irrespective
of the trillions being spent in the health care sector?The U.S. has been considered the boss in many things – industry, modernization
and health care technology. In fact, America leads the world in dollars investing
in health care, possibly reaching $3.2 trillion this year. Despite this
extravagant spending on medical care, we have failed to guard the most vulnerable. Baby mortality is defined as the death of a baby in the first year of
life; we rank 27th for baby mortality in the wealthy countries of the world and
56th overall. For babies born in the U.S, the ranking means they are twice as likely to die in the first year of life as children born in Spain or Korea and three times more likely to yield in infancy than children in Finland or Japan. In reality, a baby born in America has about the same opportunity of celebrating her first birthday as one born in Lebanon and less possibility of survival than the infants of Cuba, Slovakia or Poland.
There is significant variation from one state to another, with some states moving towards mortality levels of a second world country. The major causes of death in our infants include inherent malformations, extremely-low-birth-weight premature babies and sudden infant death syndrome, or SIDS, very distinct than the critical threats of malnutrition and infection encountered in resource-limited countries.
While this should be shocking news, certainly it is not, having been the case for decades. One must wonder then why our infants are dying irrespective of trillions spent in the health care sector. The causes are multi-factorial but a significant percentage can be elucidated by health care differences in both extremes.
Certain contributing factors probably jump straight to mind, like restricted access to health care. Nearly 25 percent of U.S. women do not get access to prenatal care. There are also risks with entry after birth. Contrary to other developed countries of the world, the U.S. actually shows an increment in baby deaths around 4 months old that continues to the first birthday. Why? Because small babies get better health care in hospitals after birth no matter how complicated their health issues. After discharge, lack of adequate wraparound services and lack of strength to access care increase the risk.
Several other factors may go together with these access issues, as well as lower education, unmarried status, substance use and extremes of age, like moms who are teens or over 40. Regularly, the economically challenged have both physical and societal co-morbidities that can escalate risk.
Fat women are 25 percent more likely to have a premature baby; 33 percent if they meet the explanation of morbid obesity. Smoking cigarette which is known to be directly proportional to lower socioeconomic rank, can raise the risk of problems resulting in early infant death by 8.4 percent. Without preventative guidance and care before delivery and no care-group services for new and potentially young parents after birth, the gap gets wider and the ease with which infants slip through them remains tragic.
Health care disparity is also observable at the other end of the spectrum. More advanced socioeconomic classes frequently engage in other behaviors that are quite unsafe on their own. Primal cesarean section (before 39 weeks) can result in poor outcomes for babies. While a week or two may not sound like much, the body is very smart with respect to fetal development. Keeping babies in the nurturing environment of the uterus happens naturally for a reason – to develop them for life in the outside world. When there is fetal agony, the method is necessary and prudent, but a C-section should never be done out of convenience.
In addition, another incident of the economically valued has been in vitro fertilization. A great technological advancement for those coping with fertility cases and has been successful in changing the lives of many families. However, the method of implanting multiple embryos to raise the chances of viability carries its own risks of prematurity and early baby death. And, in as much as this modality is expensive, it is a risk only to those who can afford it.
Lastly, and most noticeable of all, racial disparity contributes markedly to infant mortality. In African-Americans, 1 out of every 5 births is reported to be immature. Furthermore, in most U.S. states, mortality rates for black infants are at least two times greater than for white infants. Unfortunately, this has been the trend for decades and remains untouched by public health endeavours.
The susceptibilities of our American society also contribute to our infant mortality numbers. In many nations around the world, infants younger than 26 weeks are not resuscitated and are considered a stillbirth or miscarriage. As our technology has advanced, we will revive babies on the cusp of viability, at 22 to 23 weeks gestation. The likelihood of mortality increases the younger, the baby and the lower the weight. This practice could raise our infant mortality rates by approximately 30 to 40 percent. A lot of ethical questions are prompted by this fact: Just because we can support infants at younger ages; What is the actual survival? Does that correlate with quality of life? What are the societal values of such involvements?
When we look at the infant mortality numbers in our country, we are outraged, but a deeper plunge into the issues shows what a complicated problem it represents: A society in which your risk depends on your capability to access good and pre-emptive health care.
As we explore health care variations, we cannot only observe those who are challenged but also those who have and expect carte blanche. Only when we understand both sides of this coin can we start to level the field. May be as we continue to define population health and debate the pros and cons of the Affordable Care Act, we can encourage more conversation on access and wraparound services like care coordination. May be we can adopt strategies already in place in certain areas in the European Union like home visits after discharge from the birthing hospital. Maybe then our infants will not be at more risk going home than they are in our hospitals.
And how will we know we are doing well? When more first birthday candles are being blown out. That will be a great party.
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