Infant mortality - why is America in 51st place?

[Picture by Brian Hall, Wikimedia Commons]

After I blogged about expensive American childcare earlier this week, my daughter Molly directed me to a March of Dimes web page showing the extremely high rate of preterm births in the United States. "Born Too Soon," a 124-page report issued in 2012, "ranks the U.S. 131st in the world in terms of its preterm birth rate of 12.0 per 100 live births, almost tied with Somalia, Thailand, and Turkey. Nearly half a million babies are born too soon in the U.S. each year."

According to a 2009 report from the Centers for Disease Control, "the main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States" - in spite for the fact that "infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries." In addition, "infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries."

It costs a lot to keep those preterm babies alive and healthy.  According to a 2012 article in The Lancet as reported by US News, infants born prematurely account for "12 percent of U.S. live births per year, but their care consumes close to 60 percent - or $6 billion - of total spending on initial neonatal care."

How effective is the spending? Quite, if you compare America to Poland: for every 10 preterm American babies who die, says a CDC report, about 15 Polish babies die. Not so much, if you compare America to Sweden: for every 10 preterm American babies who die, fewer than 8 preterm Swedish babies die.

Here's the question: why does America have so many preterm babies?

• Is it because American mothers are waiting to have babies until they're older? So are Western European mothers. In fact, the birthrate for women ages 40-49 is higher in most Western European countries than in America (you can check it out here).
• Is it because Americans are really into assisted reproductive technology, which is more likely to produce twins or triplets? According to the CDC, just over 1% of American babies born in 2011 were the result of ART. However, "in Belgium, Slovenia, Denmark, Netherlands and Sweden more than 3.0% of all babies born [in 2009?] were conceived by ART" (source: European Society of Human Reproduction and Embryology).
• Is it because "20 percent of U.S. women (18.7 million) ages 19-64 were uninsured in 2010, up from 15 percent (12.8 million) in 2000, according to a new [2012] Commonwealth Fund report on women's health care"?

That's my best guess: a lot of our babies come early because their mothers can't afford prenatal care. And because so many of us think it's somehow un-American to provide good quality healthcare for everyone, we end up spending huge amounts to save the babies who, lacking prenatal care, are born before their time.

Sadly, our efforts are too much, too late. Though we spend more than twice as much on childbirth-related expenses as any other country in the world, our newborn infants have a higher death rate than newborns in some 50 other countries.

Economically, this is a stupid approach to childbirth. Morally, it is reprehensible. For bereaved families, it is tragic.