U.S. has second worst newborn death rate in modern world, report says

Research: 2 million babies die in first 24 hours each year worldwide

By Jeff Green
CNN

http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/

(CNN) -- An estimated 2 million babies die within their first 24 hours each year worldwide and the United States has the second worst newborn mortality rate in the developed world, according to a new report.

American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.

Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.

"The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn rate is higher than any of those countries," said the annual State of the World's Mothers report.

The report, which analyzed data from governments, research institutions and international agencies, found higher newborn death rates among U.S. minorities and disadvantaged groups. For African-Americans, the mortality rate is nearly double that of the United States as a whole, with 9.3 deaths per 1,000 births.

Sub-Saharan Africa remains the worst place in the world to be a mother or child, with Scandinavian nations again taking the top spots in the rankings by the Connecticut-based humanitarian group.

Sweden heads the list, with Niger last. (10 worst and best)

The "Mothers' Index" in the report ranks 125 nations according to 10 gauges of well-being -- six for mothers and four for children -- including objective measures such as lifetime mortality risk for mothers and infant mortality rate and subjective measures such as the political status of women.

Charles MacCormack, president and CEO of Save the Children, said the report card "illustrates the direct line between the status of mothers and the status of their children."

"In countries where mothers do well, children do well," he said in a written statement accompanying the report.

But each year, according to the report, more than a half-million women die as a result of pregnancy and childbirth difficulties, 2 million babies die within their first 24 hours, 2 million more die within their first month and 3 million are stillborn.

An unhealthy start

As Americans celebrate Mother's Day on Sunday, "5,000 mothers will mourn the loss of the newborn they bear that very day in the developing world," said Anne Tinker, director of Save the Children's Saving Newborn Lives initiative.

"All children, no matter where they are born, deserve a healthy start in life," Melinda Gates wrote in a foreword to the report, which was funded in part by the foundation she runs with her husband, Microsoft co-founder Bill Gates.

MacCormack said "significant progress" had been made in reducing deaths in children under age 5 in recent years, but "we have made little progress in reducing mortality rates for babies during the first month of life."

Causes of death in the developing world were dramatically different from those in the developed world, the report said. In industrialized nations deaths were most likely to result from babies being born too small or too early, while in the developing world about half of newborn deaths were from infection, tetanus and diarrhea.

The newborn mortality rate in the United States has fallen in recent decades, the report said, but continues to affect minorities disproportionately.

Only 17 percent of all U.S. births were to African-American families, but 33 percent of all low-birthweight babies were African-American, according to the report.

The research also found that poorer mothers with less education were at a significantly higher risk of early delivery. The study added that in general lower educational attainment was associated with higher newborn mortality.

Tinker said some nations ranked high in part because they offer free health services for pregnant women and babies, while the United States suffers from disparities in access to health care.

"We can do better here, but what's really important is that we do something" in the developing world, she said.

The report said almost all newborn and maternal deaths take place in developing nations -- 99 percent and 98 percent, respectively. The newborn mortality rates were particularly high in countries with a recent history of armed conflict, including Liberia and Sierra Leone.

But the report also concluded that political will was more important than national wealth. A "newborn scorecard" ranking 78 developing nations found that some relatively impoverished countries -- including Colombia, Mexico, Nicaragua and Vietnam -- fare better than others.

Ranking at the bottom of the scorecard were Liberia, Afghanistan, Angola and Iraq -- countries where armed conflict and cultural practices impede newborn survival.

"It's tragic that millions of newborns die every year, especially when these deaths are so easily preventable," Gates wrote. "Three out of four newborn deaths could be avoided with simple, low-cost tools that already exist, such as antibiotics for pneumonia, sterile blades to cut umbilical cords and knit caps to keep babies warm."

'The good news'

The Mothers' Index -- which excluded some nations that lacked sufficient data -- highlights huge disparities between the nations at the top and the bottom of the list.

Compared with mothers in the top 10 countries, a mother in the bottom 10 was found to be more than 750 times more likely to die in pregnancy or childbirth.

In top-ranked Sweden, skilled personnel are present at nearly all births, but in bottom-ranked Niger, such help is available for only 16 percent of women in labor.

"The good news," said MacCormack, "is that we know what it takes to help these moms and children survive and thrive."

The report highlights the three areas it says have the most influence on child well-being: female education, presence of a trained attendant at birth and use of family planning services.

Educated women, the report said, are more likely to marry and give birth later in life, to seek health care and to encourage education for their children, including girls.

The report said that family planning and increased contraception use leads to lower maternal and infant death rates. Many women and children in developing nations, it said, die as a result of births that come at the wrong time -- too close together, too early or too late in the mother's life.