Mortality - Infant

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United States ranks 41 in newborn mortality report
Free Film on Infant Mortality
US Among Worst in World for Infant Death
Infant mortality rate per 1,000 live births
Infant mortality rates by race/ethnicity

Free Film on Infant Mortality

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United States ranks 41 in newborn mortality report (8/30/11)

Although newborn death rates have decreased over the last 20 years, a new study shows that the U.S. newborn mortality rankings have dropped by 26 percent. The United States is now ranked for having the 41st lowest risk of newborn death, down from a ranking of 28th two decades ago, with a current newborn death rate of 4.3 per 1,000 live births.

Babies in the United States have a higher risk of dying during their first month of life than do babies born in 40 other countries, according to a new report.

Some of the countries that outrank the United States in terms of newborn death risk are South Korea, Cuba, Malaysia, Lithuania, Poland and Israel, according to the study.

Researchers at the World Health Organization estimated the number of newborn deaths and newborn mortality rates of more than 200 countries over the last 20 years.

The results show that, while newborn mortality rates have decreased globally over that period, progress to lower these rates has been slow, the researchers said.

In 2009, an estimated 3.3 million babies died during their first four weeks of life, compared with 4.6 million in 1990, the report found. About 41 percent of all deaths of children under 5 occur in the first month (the neonatal period). Progress to reduce newborn deaths has been particularly slow in countries in Africa, the researchers said.

Newborn deaths could be reduced by as much as a third with simple preventive measures. And measures taken within hospitals, including providing antibiotics and implementing resuscitation techniques, could reduce deaths by two-thirds, the researchers said.

"We know that solutions as simple as keeping newborns warm, clean and properly breast-fed can keep them alive," said study researcher Joy Lawn of the Save the Children Foundation, which worked with the WHO on the report. "It isn't that you have to build invasive care units to halve your neonatal mortality."

More health care workers, including midwives, are needed to teach and implement these lifesaving practices, she said.

Newborn deaths worldwide

Statistics on exactly how many babies are dying globally during their first month are lacking. Currently, the United Nations collects annual data on deaths of children under age 5 and children under 1 year old, but not specifically on neonatal deaths.

In the new study, Lawn and colleagues estimated national neonatal mortality rates from 1990 to 2009. For 38 countries, they made these estimates using information in databases that track births and deaths. But for 155 countries, they had to rely on information from household surveys, and create a statistical model to make their estimates.

The global neonatal mortality rate decreased 28 percent over the 20 years, from 33.2 deaths per 1,000 live births to 23.9 deaths per 1,000 births, the researchers found.

"It's good news, but it's not enough," Lawn said. Deaths of children between the ages of 3 and 5 and maternal deaths are going down 30 to 40 percent more quickly than neonatal deaths, Lawn said. The difference may be due in part to a lack of attention, funding and policy changes related to reducing neonatal deaths, Lawn said.

Preterm delivery, asphyxia (lack of oxygen) and severe infections are the three leading causes of newborn death. These are largely preventable with the right care, the researchers said.

By country

In the United States, the drop over the last 20 years was less than the average drop — 26 percent. And the United States dropped from No. 28 to No. 41 in the rankings of newborn death risk. It is now tied with Qatar, Croatia and United Arab Emirates.

One of the bigger challenges in the U.S. is complications from preterm birth, Lawn said. The U.S. rate of preterm birth is double that of countries in Europe and Northern Africa, she said. Babies who are born preterm need extra care that is often expensive. While there are few things that can reduce preterm birth, she noted that disadvantaged people in the United States may be less likely to receive proper care for preterm infants.

Still, the toll of neonatal deaths is much worse in other countries. In Afghanistan, one in 19 babies dies in the first month of life (53 per 1,000 births). Five countries account for more than half of the world's newborn deaths: India, Nigeria, Pakistan, China and Democratic Republic of Congo. India has the most newborn deaths, with 900,000 per year, the researchers said.

If progress is not made to reduce the number of newborn deaths, the portion of child deaths that occur in the neonatal period is likely to increase in the future, the researchers said.

"It is essential that national governments, international agencies, and civil society increase attention to systematically preventing and tracking neonatal deaths," the researchers wrote.

The study is published today (Aug. 30) in the journal PLoS Medicine.

Infant mortality rate per 1,000 live births

1 Singapore 2.31
2 Bermuda 2.46
3 Sweden 2.75
4 Japan 2.79
5 Hong Kong 2.92
6 Macau 3.22
7 Iceland 3.23
8 France 3.33
9 Anguilla 3.52
11 Norway 3.58
12 Malta 3.75
13 Andorra 3.76
14 Czech Republic 3.79
15 Germany 3.99
16 Switzerland 4.18
17 Spain 4.21
18 Israel 4.22
19 Slovenia 4.25
20 Liechtenstein 4.25
21 South Korea 4.26
22 Denmark 4.34
23 Austria 4.42
24 Belgiium 4.44
25 Guernsey 4.47
26 Luxembourg 4.56
27 Netherlands 4.73
28 Jersey 4.73
29 Australia 4.75
30 Portugal 4.78
31 Gibraltar 4.83
32 United Kingdom 4.85
33 New Zeland 4.92
34 Monaco 5.00
35 Wallis and Futuna 5.02
36 Canada 5.04
37 Ireland 5:05
38 Greece 5.16
39 San Marino 5.34
40 Taiwan 5:35
41 Isle of Man 5/37
42 Italy 5.51
43 European Union 5.72
44 Cuba 5.82
45 Guam 6.05
45 United States 6.26
47 Faroe Islands 6.32
48 Croatia 6.37
49 Belarus 6.43

Infant mortality rates by race/ethnicity: US 2003-2017 Average
Rate per 1,000 live births

Asian 4.7
Hispanic 5.6
White 5.7
US Average 6.3
Native American 8.5
Black 13.6

US Among Worst in World for Infant Death

The rate at which infants die in the United States has dropped substantially over the past half-century, but broad disparities remain among racial groups, and the country stacks up poorly next to other industrialized nations.

In 2004, the most recent year for which statistics are available, roughly seven babies died for every 1,000 live births before reaching their first birthday, the Centers for Disease Control and Prevention says. That was down from about 26 in 1960.

Babies born to black mothers died at two and a half times the rate of those born to white mothers, according to the CDC figures.

The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.

The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom - but still had a higher rate of infant mortality than any of those nations.

Doctors and analysts blame broad disparities in access to health care among racial and income groups in the United States.

Not surprisingly, the picture is far bleaker in poorer countries, particularly in Africa. A 2005 World Health Organization report found infant mortality rates as high as 144 per 1,000 births - more than 20 times the U.S. rate - in Liberia.

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