U.S. Infant Mortality Rates What Methodological Explanations

U.S. Infant Mortality Rates

What methodological explanations have been offered for the relatively high infant mortality rate in the U.S.

There have been a variety of methodological explanations for the relatively high infant mortality rate in the United States. The most obvious criticism of the conclusion that the U.S. has a higher infant mortality rate than other industrialized nations is that the figures reported by the various countries are not the same. For example, while the World Health Organization (WHO) defines a live birth as any newborn showing signs of life, such as heart beat or a gasp of breath, not all countries follow that definition. The definition of live birth is critical; because the infant mortality rate is the number of all deaths to babies under one-year-old, divided by the number of live births that year. Therefore, the higher the number of live births, the higher the number of total deaths because those babies count in the numbers, and the higher the infant mortality rate. The United States follows WHO's recommendations. In contrast, many of the industrialized nations against which the United States is compared do not follow WHO's recommendations, which drives down their live birth rate and their death rate. Austria and Germany do not count extremely low birth weight infants, Switzerland does not count infants that are less than 12 inches long, and Belgium and France both only count babies that are at least 26 weeks old (Behind the Headlines).

In addition, there are methodological concerns because the birth rates do not compare births among similar groups. For example, the U.S. has a high percentage of people who delay childbearing until they are older, and use fertility treatments to conceive, which results in more multiple pregnancies and higher mortality rates. Furthermore, neonatal care in the United States appears to be comparable to other industrialized nations. Most infants who die in the United States are born critically ill, with 40% of all infant deaths taking place in the first day of life (Behind the Headlines).

2. What social explanations have been given for the infant mortality rate in the U.S.

It is impossible to ignore the social differences in infant mortality rates in the United States. While there may be methodological concerns impacting the U.S. infant mortality rate when compared to other industrialized nations, the reality is that, using the same measures and standards, the infant mortality rate for African-American babies in the United States is almost double the overall American infant mortality rate. "The relatively high rates among black babies reflect poor prenatal care, which is a serious problem for women who lack health insurance. Other factors include social, economic, and health problems affecting young African-American women. For instance, teenage pregnancy and obesity -- which disproportionately strike black women -- are risk factors for having a low weight or premature birth, and babies who are born at low weight or prematurely are precisely the babies at greatest risk of death" (Behind the Headlines). Furthermore, race seems to be a risk factor in and of itself. For example, "even when all other significant risk factors were taken into account, the odds of newborn infants dying were 3.4 times higher in blacks, 1.5 times higher in Latinos, and 1.9 times higher for non-whites in general" (Spence). According to Lester Spence, one of the reasons for this is that the U.S. fails to provide adequate prenatal and preventative health care to mothers and potential mothers, especially in impoverished or minority communities. He believes this is because the U.S. "government has been far more concerned with moral pronouncements regarding procreation than it has been with the reasonable policies needed in order to ensure the protection of mothers" (Spence).

3. Explain the issue from each of the sociological theories outlined in the chapter.

Market-oriented theories assume that the best possible economic consequences come as the result of individual freedom and a free market. In other words, market-oriented theories are based on the supremacy of unrestricted capitalism. According to market-oriented theory, government bureaucracy should not dictate the cost or availability of goods. Therefore, the fact that impoverished people cannot afford adequate prenatal care, resulting in disparity in infant mortality rates between classes and between races, while lamentable, is not something that should prompt government interference. In fact, a pure market-oriented theorist may go so far as to suggest that higher infant mortality rates among lower-income groups is the best possible economic consequence because these families are the least able to afford to support an infant. In contrast, the families who are able to access good prenatal care and good healthcare prior to pregnancy are the ones who are economically the most likely to be able to support a baby. Therefore, the relatively high infant mortality rate in the United States, which is largely driven by excessively high infant mortality rates among non-white minorities, who are also much more likely to be members of the lower socio-economic class, are simply an understandable economic consequence.

Dependency theories suggest that the failure of Third World states to achieve higher levels of development is due to their dependence on the capitalist world. Dependency theories could also be applied to impoverished communities within developed nations. In fact, critics of the welfare state are basically applying dependency theory to suggest that by providing long-term aid to people, the government is creating a dependency that will prevent a group of people from ever achieving economic independence. Dependency theories in the United States would suggest that high infant mortality rates are due to over-reproduction without sufficient planning in lower-income minority groups because these groups are paid to reproduce. The more children in these families, the greater the family income. However, the increase in family income is never sufficient to move the family outside of the culture of poverty, therefore nutrition and medical care is never better than adequate, contributing to a much higher infant mortality rate.

World system theory discusses the growth of the capitalist economic system, from its center in Europe to its periphery in what is now much of the third world. It looks at the growth of capitalism on capitalist and pre-capitalist societies. World system theory gives some fantastic explanations of colonialism and post-colonialism, which can help explain some of the lingering impacts of racism, even years after legalized systems of racial oppression have been erased. Certainly, when one looks at how colonialism led to the marginalization of brown-skinned people throughout the Americas, and how slavery led to impoverishment for blacks in the United States for years, one can see the beginnings of a culture of oppression. Lingering predictors of poverty, such as single-parent households, drug abuse, and illiteracy make more sense when people understand that many of these phenomena are strongly predicted by household of origin. In fact, when considering the impact of Jim Crow on African-Americans, and the fact that there may be a cultural distrust of doctors due to the fact that the American government performed medical experiments on unwitting African-Americans, it becomes even easier to understand how even affluent African-Americans may neglect to get appropriate prenatal care. All of these factors help explain why African-Americans are still disproportionately impoverished and why they have higher infant mortality rates, which greatly contributes to America's rank in infant mortality rates.