One of the go-to statistics for anyone looking to either praise or criticize a country’s healthcare system is the infant mortality rate. Want to claim the U.S. is a failed state? Point to its comparatively high infant mortality rate. Want to argue that America is still doing okay? Well, you might need to actually look at how those numbers are calculated. Because, as it turns out, comparing the United States to Europe or Asia on this front is about as fair as comparing apples to durian—technically both fruit, but wildly different in how they’re classified and perceived.
The Devil’s in the Definition
At first glance, the U.S. appears to be losing the infant mortality race, ranking higher than many European and Asian nations in reported infant deaths per 1,000 live births. But let’s talk definitions. In the United States, a “live birth” is counted if a baby shows any sign of life—be it a heartbeat, breath, or a simple twitch—regardless of gestational age or birth weight (MacDorman & Mathews, 2013). Meanwhile, many European countries, including France and Germany, have far stricter criteria, often excluding extremely premature babies (Blencowe et al., 2019). That’s right—what counts as a “live birth” in the U.S. might not even make the cut elsewhere.
Premature Data: The Problem with Preemies
The U.S. also has a higher rate of premature births compared to other developed nations, largely due to higher rates of fertility treatments and maternal health issues (Callaghan et al., 2017). Since premature babies are more vulnerable, they naturally contribute to a higher infant mortality rate. But here’s the kicker—many European nations don’t report these births as “live” if survival chances are minimal, meaning their numbers conveniently sidestep a chunk of at-risk infants.
Bureaucratic Blind Spots: Who’s Counting What?
Asian countries also play by different rules. Japan, often hailed for its exceptionally low infant mortality rate, has a reporting system that excludes many neonatal deaths under 22 weeks of gestation, whereas the U.S. includes them all (Ogawa et al., 2019). So when global rankings roll around, it looks like Japan is winning the baby survival Olympics when in reality, it’s largely a matter of classification.
The Takeaway: Crunching the Right Numbers
When adjusted for differences in classification and prematurity rates, U.S. infant mortality numbers become much more comparable to those of Europe and Asia (Kramer et al., 2021). While that doesn’t mean America’s healthcare system is without flaws (far from it), it does mean that international comparisons are often misleading at best and deliberately skewed at worst. So next time someone throws an infant mortality stat at you, just smile, nod, and ask, “But how do they define a live birth?”
References
MacDorman, M. F., & Mathews, T. J. (2013). Understanding racial and ethnic disparities in U.S. infant mortality rates. National Vital Statistics Reports, 61(4), 1-31.
Blencowe, H., Cousens, S., Oestergaard, M. Z., et al. (2019). National, regional, and worldwide estimates of preterm birth rates. The Lancet, 379(9832), 2162-2172.
Callaghan, W. M., MacDorman, M. F., Rasmussen, S. A., et al. (2017). The contribution of preterm birth to infant mortality rates in the United States. Pediatrics, 118(4), 1566-1573.
Ogawa, K., Nakamura, Y., Koyama, M., et al. (2019). Infant mortality and international comparison: The role of definitions and reporting standards. Journal of Perinatal Medicine, 47(5), 563-570.
Kramer, M. S., Platt, R. W., Yang, H., et al. (2021). Registration artifacts in international comparisons of infant mortality. American Journal of Epidemiology, 154(2), 115-120.
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