Cuba vs. the United States on Infant Mortality

Recently released statistics on the infant mortality rate in the Western hemisphere yielded an odd conclusions — Cuba’s infant mortality rate, 16 6.0 per 1,000, is now lower than the U.S. infant mortality rate, at 7.2 per 1,000. Given Cuba’s poverty level, its 6.0 rate is very impressive, but is it accurate to say that Cuba now has an infant mortality rate lower than the United States? No.

The problem is that international statistics on infant mortality are helpful in revealing large differences, but when it comes to small differences such as that between Cuba and the United States, often other factors are really behind the numbers.

The primary reason Cuba has a lower infant mortality rate than the United States is that the United States is a world leader in an odd category — the percentage of infants who die on their birthday. In any given year in the United States anywhere from 30-40 percent of infants die before they are even a day old.

Why? Because the United States also easily has the most intensive system of
emergency intervention to keep low birth weight and premature infants alive
in the world. The United States is, for example, one of only a handful countries that keeps detailed statistics on early fetal mortality — the survival rate of infants who are born as early as the 20th week of gestation.

How does this skew the statistics? Because in the United States if an infant is born weighing only 400 grams and not breathing, a doctor will likely spend lot of time and money trying to revive that infant. If the infant does not survive — and the mortality rate for such infants is in excess of 50 percent — that sequence of events will be recorded as a live birth and then a death.

In many countries, however, (including many European countries) such severe medical intervention would not be attempted and, moreover, regardless of whether or not it was, this would be recorded as a fetal death rather than a live birth. That unfortunate infant would never show up in infant mortality statistics.

This is clearly what is happening in Cuba. In the United States about 1.3 percent of all live births are very low birth weight — less than 1,500 grams. In Cuba, on the other hand, only about 0.4 percent of all births are less than 1,500 grams. This is despite the fact that the United States and Cuba have very similar low birth rates (births where the infant weighs less than 2500g). The United States actually has a much better low birth rate than Cuba if you control for multiple births — i.e. the growing number of multiple births in the United States due to technological interventions has resulted in a marked increase in the number of births under 2,500 g.

It is odd if both Cuba and the U.S. have similar birth weight distributions that the U.S. has more than 3 times the number of births under 1,500g, unless there is a marked discrepancy in the way that very low birth weight births are recorded. Cuba probably does much the same thing that many other countries do and does not register births under 1000g. In fact, this is precisely what the World Health Organization itself recommends that for official record keeping purposes, only live births of greater than 1,000g should be included.

The result is that the statistics make it appear as if Cuba’s infant mortality rate is significantly better than the United States’, but in fact what is really being measured in this difference is that the United States takes far more serious (and expensive) interventions among extremely low birth weight and extremely premature infants than Cuba (or much of the rest of the world for that matter) does.

This does not diminish in any way Cuba’s progress on infant mortality, which is one of the few long term improvements that the Cuban state has made, but infant mortality statistics that are that close to one another are often extremely difficult to compare cross-culturally.

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21 thoughts on “Cuba vs. the United States on Infant Mortality”

  1. Wow what are they doing that were not? My son was born with a very rare birth defect called esophageal atresia and down syndrome so im into reading all of these things.

  2. why not also consider and admit that there is a higher likelihood that an American woman will have access to, and use, illegal drugs? All these babies born at 20 weeks are not due to nature alone.

  3. I’m no expert, but it seems to me that when international organizations like the World Health Organization (WHO) compare countries, they don’t accept each country’s definitions and statistics at face value and compare apples with oranges. They attempt to develop statistics for uniform definitions and compare apples with apples. At least that’s the impression I got from reading the Statistical Annex to the WHO’s World Health Report 2000.

    Also, I believe prenatal care is a big factor in reducing the incidence of low birth weight. In theory, the universal availability of free (meaning at no out-of-pocket expense to the patient) preventive care in Cuba could account for at least part of Cuba’s “surprisingly” high performance in this area.

    P.S. All of the “related post” links above are dead — for me, at least.

  4. I study medicine in Cuba. I think that an extremely important point is left out here. Cuba has one of the world’s best systems of preventative health care. The public health system recognizes that having free, mandatory prenatal care (like all preventative health care) pays off in the long run. In Cuba, having food rations, i.e. enough food, counseling for EVERY mother to not smoke or drink alcohol, doctors & nurses who go to people’s homes if they don’t come in for important appointments, and of course prenatal care as needed has a profound affect on reducing the need for emergency procedures. Sure, they lack the technology and equipment that we have in the United States, and the way they have compensated for that has improved the overall health and education of their population yet uses a fraction of the resources. They have a lower infant mortality rate because they actually use all of the resources they have to make that happen. Furthermore, their international medical school is among the largest in the world, one of the specific goals being to reduce the infant mortality rate in the Americas. Too bad we don’t dedicate more toward improving the health and well being of ALL Americans. I hope Obama can help us get it together!

  5. Cuba has the highest abortion rate in the world. 77 of 1000 babies are aborted. The US is 22 per 1000, and Canada is 15 per 1000.

    If there is a sign of a defect with a child, the doctor recommends abortion.

    That is why when they actually do give birth, they are healthy in weight.

    Rebecca: You are brainwashed.

  6. Hi, Clayton.

    You called Rebecca “brainwashed.” The thing is, I haven’t been able to find any evidence that rigorous pre-natal diagnosis is what drives Cuba’s higher abortion rate or that it leads to their good infant mortality statistics. You didn’t cite a source for your abortion rate statistics, but they closely match the rates given here:

    According to that report:

    “The relatively high rate in Cuba (78 per 1,000) includes menstrual regulation, an early abortion procedure carried out without pregnancy testing, as well as termination of known pregnancies. In 1996, 60% of the procedures were menstrual regulations.”

    * * *

    “The high rate in Cuba may be attributed to a desire for low fertility combined with access to a limited range of contraceptive methods, use of low-quality IUDs and irregular contraceptive supplies. A high proportion of abortions are obtained by teenagers (33% in 1990), suggesting a high rate of sexual activity among adolescents who wish to postpone childbearing.”

    * * * *

    In short, over half of Cuba’s abortions are hormonally induced and done without so much as a pregnancy test, let alone prenatal diagnosis. Moreover, the high number of abortions is due to lousy contraception, not eugenics.

    If you believe that Cuba is doctoring its infant mortality statistics or that something other than good maternity care is responsible for them, by all means say so — but back up your claims, cite your sources, and don’t call other contributors names.

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  9. @Clayton:

    I don’t know whether you are trying to mislead others, were actually brainwashed, or are far too ignorant when you fabricated such number out of thin air. Please refer to this table by UN to fact check your statement , or if you are simply prefer to enjoy your version, I will spell it out here for other people’s sake:
    Data: UNPD_World Abortion Policies_2007
    For Female 15-44 yr
    Cuba, 2004 24.8 abortion per 1000
    United States of America, 2003 20.8 abortion per 1000

  10. Doesnt mention most important factor. All nations make up their own standards for counting infant mortality-it is NOT a global uniform counting system for reporting any health stats-entirely up to every nation to decide what it will report and how they will determieraser stats. And with absolutely no way to verify what any naton reports. It is strictly “honor system” using whatever standard they have devised. Most health statisitics come from governments, not the most reliable source since what nation wants to brag about their poor statistics?

    The REAL reason for the difference is Cuba only counts infants wo die in the first 3 months following birth as part of their infant mortality stats. MANY nations, possibly most, do not report as a live birth any baby who dies in less than 24 hours after birth. Cuba only counts as a live birth babies born alive after 28 weeks gestation because babies born earlier than that aren’t going to survive anyway. Our stats are not generated by government. The US counts all infant deaths that occur in the first 12 months-we have the longest counting period in the world. We count as a live birth any child who takes even a single breath before dying regardless of its gestational age. Given the US has the longest counting period in the world as well as counting all live births regardless of gestational age and does not require an infant to survive at least 24 hours before counted as a live birth, tells you all you need to know about where your extremely premature baby has the best odds of survival. It ain’t Cuba which has a two tiered health care system-one for the politically powerful elites and tourists which citizens are not allowed to access although they are the ones who pay for it. And the one the elite created for all other Cubans-the one that suffers a chronic shortage of medical supplies, medicines, clean facilities and qualified quality personnel. That system is not capable of producing better infant mortality rates than the US wnich is why they refuse to use our system for producing honest, accurate statistics.

  11. “child who takes even a single breath”

    Interesting (dishonest) “single breath theory”.

    But it cld explain the lousy US mortality rates, more important than PRENATAL CARE!!

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    If they could actually keep track of the dead registered voters, we wouldn’t have Obama for a second term

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  14. another reason’s cuba has a low infant mortality rate is because they let nature take it’s course, and babies are frequently born at 41 weeks …babies who are bigger fare better.
    most babies in the u.s are born at 38 weeks…labor is often induced to benefit the provider or the mother, but does not benefit the baby.

  15. @susan:

    Actually it is fairly common for complications to occur in pregnancy. There was a reason for a good portion of history that it was the LEADING CAUSE of DEATH for females. So no, it does not have to do with a prevalence of illegal drugs and instead has more to do with the nature of pregnancy.

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