Child mortality rates by the numbers

Another one of the things that anti-vaccine and alternative medicine (which is not medicine, by the way) use to justify their corrupted way of thinking is the fact that the United States is not at the bottom of the list when it comes to infant mortality rates. If you look at the headlines, the US has the highest infant mortality rate in the industrialized world. Maybe. To the anti-vaccine activists, it’s because the US has a robust vaccination program. To the alt med crowd, it’s because we rely so heavily on medicine to, you know, get cured from disease. I’m almost willing to bet that it’s because we drive too many cars to the environmental activists and because we have too many Mexicans to the anti-immigration bigots. That’s how bias works. You see something and attribute it to the thing you hate.

But why did I write “maybe” up there?

I wrote “maybe” because you need to know how infant mortality is assessed in the United States compared to the rest of the world. In the United States, most children are born in healthcare facilities that are properly staffed. The laws are comprehensive when it comes to reporting deaths, especially infantile deaths. There is a lot of money — comparable to the entire budgets of smaller countries — to tallying up all these data. Health departments have large and well-trained staff members to look at death certificates coming in and classify the numbers correctly. Other countries don’t.

Other countries don’t have all of their children being born in hospitals or clinics. Page 57 of this report by Save The Children puts the US at the top of the list among industrialized nations. But look at the other countries, and look at what is being compared. It’s not “infant mortality” per se, it’s first day deaths. Infant mortality is death at any time before one year of age. Neonatal death is death before 28 days of birth. Compare the US to, say, Latvia (on the list of industrialized nations), and the US is doing better with 4.3 deaths per 1,000 neonates compared to 5.1 deaths per 1,000 neonates in Latvia, according to the world bank. Does the United States need to do more? Absolutely, but we cannot compare ourselves to countries with different surveillance systems.

But forget all this. Forget how numbers are collected and counted. Let’s look at the plausibility that vaccines, or medicine in general, keep infant mortality high in the United States. There are less deaths from vaccine-preventable diseases in the United States than ever. There are also less deaths from complicated births because those births are happening at hospitals and other healthcare facilities with trained staff. Furthermore, the countries with a really bad — and I do mean bad — infant mortality rate lack hospitals and robust vaccine services like those we have here. You try and control pestilence with homeopathy.

Go ahead, try it.

As you read these headlines about how horrible the infant mortality rate in the US, keep in mind that there is surveillance bias at work there. We do surveillance for these things better than other countries. And keep in mind that we also have a robust, albeit cumbersome, healthcare system in the US. Keep all these things in mind when looking at data, and think critically about what you’re being told.

Now, how many times did I write “robust”?

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9 thoughts on “Child mortality rates by the numbers

  1. That article that you linked to is as wrong as any article I’ve read recently about perinatal mortality. The BMJ published an excellent article last year about the great disparity in the criteria used by different countries to determine newborn and infant mortality…and the clear disregard of the WHO reporting guidelines, for reporting countries:

    http://www.bmj.com/content/344/bmj.e746

    Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study
    BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e746 (Published 17 February 2012)
    Cite this as: BMJ 2012;344:e746

    “International differences in birth registration

    The World Health Organization’s International Statistical Classification of Diseases and Related Health Problems has long defined a live birth as any product of conception that shows signs of life at birth, with no consideration for birthweight or gestational age criteria.13 Although this definition remains unchallenged, countries have widely varying regulations for registration of birth that range from definition based to pragmatic. For instance, birth registration is required for all live births that satisfy the WHO’s definition of live birth in Canada, England and Wales, and the United States,…”

    And,

    “Conclusions

    In summary, we observed large international differences in the reported proportion of live births under 500 g and under 1000 g birth weight and in neonatal deaths in these birthweight categories. International comparisons based on crude fetal, neonatal, and infant mortality rates yielded results that differed from comparisons that excluded extremely low birthweight and early gestation births, especially those at the borderline of viability. Variations in the registration of births at the borderline of viability and related problems compromise the validity of international rankings of industrialised countries by perinatal and infant mortality.”

    Is it any wonder then, why crank bloggers and their groupies use these bogus statistics to claim that: *the American health care system is broken* and that *the number of vaccines, the spacing of vaccines, *the ingredients in vaccines* *etc., etc.* are driving up perinatal mortality rates? //sarcasm

    • Thanks for that. I was wondering where it was. I had only heard about it but not read it. It makes perfect sense. I talked to a friend who works in vital statistics. He said that they pretty much can document each and every death in his state at this point and that other states are following suit in making death reporting universally electronic. If a baby unfortunately dies at birth in the Yukon, do you think Canada counts them?

        • I want to like her. I really do. She’s just very rough in her approach. She alienates a lot of her audience. Then again, so do I. 😉

            • Oh, I totally agree. It’s just that rubbing people the wrong way immediately puts anything else you say into a kind of context that makes it difficult to agree with. We’re human. Take for example the comments about using “Autistic people” instead of “people with autism” the other day. The guy that came to comment about that started off attacking me and seriously missed an opportunity to educate me on the matter. I had to go out and look for information about his point of view instead of getting it straight from him in the comment. I think that’s the problem with Dr. Tuteur. I believe her anger, and many times a righteous anger, gets the best of her.

              • The guy that came to your blog the other day “to correct you” was incorrect…”people with autism” and “autistic persons” are acceptable phrases within and without the autism community. I remember posting a comment on a popular media outlet, where I mentioned my son’s physical, intellectual and medical impairments and stated he was profoundly mentally retarded. An advocate for autistic people proceeded to “correct me” and I informed her that mental retardation (mild, moderate, severe and profound) are properly used in clinical areas, in published research papers, ICD coding and the DSM IV. Note: the commentary on the Wikipedia entry…”euphemism treadmill”.

                http://en.wikipedia.org/wiki/Mental_retardation

                The other young woman on her own blog is quite strident about what is “permitted” on her blog and uses words and phrases that would even make you and I blush (not really)…:-)

                I hate language policemen and pedants who cruise the internet and post off-topic remarks. I despise the lack of empathy and compassion for the young man who was abused by a caretaker.

                Dr. Tuteur’s latest blog posting about a new report on perinatal deaths from the “Save The Children” campaign is a gem:

                http://www.skepticalob.com/2013/05/oops-save-the-children-illustrates-us-neonatal-death-by-using-a-cpm-attended-homebirt.html#disqus_thread

          • I rarely read Dr Tuteur after she was very wrong (some years ago) about nurse-midwives and she refused to apologize even after I proved, with literature from peer-reviews, that she WAS wrong. Maybe it’s petty of me, but I don’t admire someone who can’t apologize. (and yes, there were times I was wrong in our back and forths, and I did apologize and learn from her until the last issue).

    • I’ve been out of maternal-fetal medicine for about 14 years now, so things *may* have changed. But in the states I worked in (Michigan, Virginia, New Jersey) a non-viable live birth was not always registered as a live birth. There were a lot of criteria bases on the appearance, weight, respiratory effort, etc. And it did vary between facilities, too (my big hospital employers considered them live births, the small hospitals often treated them as “late miscarriages”).

      But, knowing that, I take the infant death rate with a little degree of skepticism. However, due to our lack of consistent maternal health care, I would agree that the US probably has a higher rate of neonatal and premature infant death, just due to that.

      Unfortunately for the antivaccinationists, all the babies *I* saw die had not received any… (even those premies who survived and went home didn’t get their first vaccine until discharge.)

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