In the year 2013, the mortality rates in the US was ranked 51st globally irrespective of their massive GDP per capita. The Center for Disease Control reported that the US ranked at position 29 globally for infant mortality behind several developed states (Mathews & MacDorman, 2010). The US is thus worse than Greece, Cuba, Singapore, Hungary and Northern Ireland. The US IMR has been discussed and considered as the most critical factor as a determinant of the US disadvantages. WHO defined infant mortality rates as the number of death of infants below age one per 1,000 live births. According to WHO, live birth is when an infant shows signs of life. Maternal death is the number of women who die due to conditions related to pregnancy per 100,000 births (Chen, Oster & Williams, 2016). One of the most suitable one of the most suitable solution to address this problem is nurse visits which will help in managing the rising rates of maternal and infant mortalities. Several countries including Austria and Finland and several others in Europe have strategic policies in place that brings nurses to visit infants and mothers at their home. In this analysis; the paper will discuss birth weight, reporting, documentation, neonatal mortality and postneonatal mortality to understand why the US has higher infant and maternal mortality rates.
Definition and Reporting Differences
A standard issue with the comparison of the infant mortality is probably the reporting differences and definition for the infants around the threshold of viability. MacDorman & Mathews, (2010) notes that infant mortality is the number of deaths of the infants below age one; however, variations between states are illustrated by differences in the manner in which they count. The question raised is, is an infant with less than one pound and after 21 weeks gestation, born? Certain nations do not consider such child as born and instead, they are counted as stillbirths. In the US, despite having relatively lower survival chances, such child is termed as born and this accounts towards the high infant mortality rates. Such premature delivery is actually behind the higher infant mortality rates in the US (Mathews & MacDorman, 2010). Severely preterm birth entered as a live birth in specific regions might be considered as miscarriages or even stillbirth in other countries. Based on the fact that survival before 22 weeks is significantly rare, then it follows that grouping such a birth as live birth would ultimately result in inflated infant mortality rate that is entered as live births. In addition to this technologies have led to increased frequency of multiple births which has led to increased mortality rates. Research has shown that pre-term births might have numerous maternal causes like diabetes and high blood pressure are not entirely within what can be termed as an expectant mother control. Chen, Oster & Williams, (2016) asserts that significant issues of lack of universal access to quality prenatal care ought to be focused on the preterm birth and infant mortality discussions. Additionally, approximately 50% of US pregnancies are not planned where individual women may not know that they are expectant to access early prenatal care thus being a part of the reasons for the premature births in the US.
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Lack of Proper Documentation
Approximately 70 and 12000 women in the US often die from various complications that are closely linked to pregnancy yearly. Roughly 50,000 barely escape death, and 100,000 women fall seriously sick yearly during the period of pregnancy. The rates in the year 2013, a recent year when concerned institutes obtained detailed US information was triple that of Canada. It has further been projected that the US rates dipped within the last two years to 25 by 2015. MacDorman & Mathews, (2010) posits that the dangerous data collection situation on the maternal mortality used in the US is critically disturbing and this apparently contributes to higher rates compared to other countries, particularly in Europe. Maternal mortality rates are evidently challenging to count since the US lack detailed data on the death certificate to show whether the death was related to pregnancy.
Until the 1990s, the death certificates failed to indicate whether the women were expectant or had delivered recently. Such a situation went on until the year 2017 when the US introduced a checkbox to their death certificate. MacDorman & Mathews, (2010) claims that calculations of the numbers of near-death and severe illness associated with expectancy are currently founded on presumption. There is still no typical or authorized technique used to track the rates, and further, cases are rarely regularly documented. Therefore, information compilation on maternal mortality is a total mess. The rise in the rates evidently put the US above several poor states whose rates had significantly declined with the worldwide trends such as Romania, Vietnam, and Russia.
Certain Important Features Are Omitted
Research has shown that the ranking of the maternal and infant mortality rates fail to take into consideration that the US has the most heterogeneous and diverse population (Chen, Oster & Williams, 2016). Unlike is the case with Iceland which apparently tracks all the maternal and infant deaths irrespective of factors but has a population under 300,000 that is 94% homogenous. Both Japan and Finland also have been shown to have an ethnic and cultural diversity of the US’s 300 cm-plus citizens. MacDorman & Mathews, (2010) claims that the US has higher rates of teen pregnancies and uses drugs and is uneducated which ultimately contributes to higher mortality rates. There are significant racial disparities in the total numbers based on the Centers for Disease Control and Prevention (MacDorman, Mathews & Centers for Disease Control and Prevention (CDC), 2011). For instance, the maternal mortality rates currently are about 42.8 per 100,000 live births for the African American black, compared to about 12.5 for the white women and approximately 17.3 rates for the women of various races.
Conditions at Birth
MacDorman & Mathews, (2010) asserts that the US higher preterm birth rates significantly contribute to higher maternal and infant mortality rates. A comparison has been made between the US and Scandinavian countries, believed to have the least infant mortality rates throughout Europe and the focus has been on the gestational age rather than the birth weight. What is considered to count as birth varies from states. Mathews & MacDorman, (2010) asserts that in both Germany and Austria, the fetal weight ought to be about 500 grams before these states could count such infants as live births. In some other countries like Switzerland, the fetus ought to be about 30 centimeters long. In both France and Belgium, the births which are less than 26 weeks of pregnancy are often registered as lifeless. Birth weight and gestational age in the US has been shown to be worse compared to that of other countries like Finland (Kim et al., 2012).
Birth weight tends to account for approximately 75% of the gap between Finland and US. Based on this, it becomes evident that birth weight often matters for the US infant and maternal death disadvantage, however, it also posits that directing the focus to Scandinavian states might exaggerate the significance of such a clarification (Kim et al., 2012). It is important however to note that even with such calibration, a simple statistics tend to make it apparent that various conditions-at-birth rationalization is significantly deficient.
The Timing of the US IMR Disadvantage
The US IMR disadvantage is broadly discussed and is considered to be quantitatively important. The timing of the US IMR disadvantage is another disadvantage that makes the US have higher maternal death rate and high infant mortality compared to other comparable countries (Birth, n.y). Research has shown that the elevation seen in the postneonatal death is primarily caused delays of the death. Taking into consideration the average mortality rates, research has shown that the US disadvantage on postneonatal period is significantly massive. Postneonatal mortality evidently plays a critical role regarding driving the difference between the US and various countries in Europe. However, the determinants of such a disadvantage are not understood, and this hinders policy attempts aimed at reducing maternal and infant mortality in the US (Kim et al., 2012). One of the constraints has been focused on lack of a suitable that can be used to make the comparison.
A cross-country comparison of the average infant and maternal death rates provides a constraint perspective for various reasons. A clearly-recognized challenge is that states tend to differ regarding the type reporting measure of births within a viability threshold. Chen, Oster & Williams (2016) asserts that such a difference in reporting thus generates a misleading comparison of how the maternal and infant mortalities vary across other nations and in the US. Secondly, even with suitable comparable reported samples, the outcome that the infant death rates differs by a year post-birth offers less direction on precise elements that drive the US disadvantages.
Conclusion
The ultimate goal of discussing and analyzing literature that focuses on why the US has high maternal death rate and high infant mortality compared to other comparable countries is to understand the best policy. Adoption of the best policy would be suitable in reducing the maternal and infant mortality rates that have been reported as one of the major problems that the country is facing today despite having one of the largest GDP in the world. The neonatal mortality outcomes apparently propose that the disparity in the provision and access to technology-intensive medical care accessed immediately after delivery is improbable to the US IMR disadvantages. Much of the evidence that showed a drop in mortality between 1950 and 1990 were primarily as a result of significant improvements in the NICU technology.
The policy, in this case, should be focused on the prevention of the preterm births and cutting down postneonatal mortality. Reducing postneonatal mortality in the US to a level comparable to that of the Austria has the potential of lowering the US mortality rates by about one death per 1000. Social programs in various countries which offers free home visit by the medical practitioners and nurses for all new mothers will play a critical role in improving the protective aspects while decreasing the risk factors. Home nurse visits would be suitable for managing the rising rates of maternal and infant mortalities. Such a policy fails to address the issue of alleviating resource limitation; however, on the provision of support and vital information that targets the infants and mothers. The nurses will give infant checkups and advice the mothers and inspect homes for any hazards. Home visits often have been linked to higher rates of breastfeeding and might be suitable for the most vulnerable segments of the society. Several countries including Austria and Finland and several others in Europe have strategic policies in place that brings nurses to visit infants and mothers home.
References
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