The infant mortality rate was 6.6 deaths per 1,000 live births in the United States in 2008, compared with an average rate of 4.6 among other countries in the Organization for Economic Cooperation and Development (OECD), according to a recent report from the Congressional Research Service (CQ HealthBeat April 6, 2012). The United States ranks 31st out of the 34 OECD countries in infant mortality. Selected countries and ranks as follows: Luxembourg with an infant mortality rate of 1.8, ranked first; Slovenia (1.8, rank 2); Iceland and Sweden (2.5, rank 3); Japan and Finland (2.6, rank 5); Norway and Greece (2.7, rank 7); The Netherlands, France, and Israel (3.8, rank 17); Australia (4.1, rank 22); United Kingdom (4.7, rank 23); New Zealand (4.9, rank 25); Canada (5.7, rank 29); Mexico (15.2, rank 33).
The report also noted that infant mortality in the United States has leveled off after four decades of decline. Three of the main causes of infant mortality in the United States are congenital malformations, low birthweight, and prematurity. The two latter factors could likely be improved by policy interventions, the report noted. The mother's health—as well as race, education, economic status, and other demographic factors—plays a role in infant mortality, according to the report. The black infant death rate was 12.7 per 1,000 live births in 2008, compared with 5.5 deaths per 1,000 live births for white babies. The report also noted that southern states, which tend to have higher rates of low birthweight and short gestational age births compared with other states, had the highest infant mortality rates. New Hampshire and Vermont had the lowest rates.
The global maternal mortality rate fell by 47 percent over the past two decades, from an estimated 543,000 deaths in 1990 to about 287,000 in 2010, according to a report by a group of United Nations agencies (D.G. McNeil New York Times May 16, 2012). The lower rate is related to increases in contraception use, women with HIV/AIDS taking antiretroviral drugs, and more births being supervised by health care practitioners, such as physicians, nurses or midwives. Nearly 99 percent of maternal deaths, most of them preventable, occurred in developing countries.
According to the United Nations report, maternal deaths in the United States have increased by an average of 2.5 percent annually over the past 20 years, with a rate of 21 maternal deaths per 100,000 live births in 2010 versus 12 deaths in 1990. In 2010 the United States ranked closely with Russia, Central and South America, and parts of northern Africa, falling behind western Europe, Canada, and Australia (AP/NECN, May 16, 2012). Some of this increase may be due to changes in the coding and classification of maternal deaths, according to the Centers for Disease Control (Child Health USA 2008–2009). In 2006, the maternal mortality rate varied by race—among non-Hispanic black women it was more than three times the rate among non-Hispanic white women (34.8 vs 9.1 per 100,000 live births).
The maternal mortality rate in Canada was 7.8 deaths per 100,000 deliveries over the period from 2008/09 to 2009/10, according to a recent report from the Public Health Agency of Canada (Maternal Mortality in Canada Fact Sheet, 1996–2010). The rate excluded Quebec. The maternal mortality rate over the period from 1996/97 to 2009/10 fluctuated from a low of 6.8 maternal deaths per 100,000 deliveries from 2004/05 to 2005/06 to a high of 11.9 maternal deaths from 2000/01 to 2001/02. Maternal mortality rates varied by province and territory, ranging from 0 to 20.3 deaths per 100,000 deliveries. Rates also varied by age—women over 40 years of age had 3.7 times the rate experienced by women aged 20 to 24 years.
A pardon for the sentenced Hungarian midwives was called for by the Royal College of Midwives (RCM) in a letter by RCM President Lesley Page on April 20. The letter to incoming President of Hungary Dr. Janos Ader requested a full pardon and cancellation of all criminal charges against Hungarian midwife Ágnes Gerèb and four other midwives. Gerèb, founder of the Napvilág birthing center, is a highly experienced gynecologist, midwife, and internationally recognized home birth expert. She has successfully helped deliver 3,500 babies at home. Hungarian law prevents midwives from attending births outside hospitals, and Gerèb was charged with “reckless endangerment of life committed in the line of duty.” On October 5, 2010, Gerèb was subjected to intense interrogation before being called to a closed court at 10 p.m. She appeared in an open court on 12 October, shackled in leg chains and handcuffs, accused of negligent malpractice. In her letter, Dr. Page wrote, “We are aware that on February 10th, 2012, the Budapest Appeal Court announced the verdict in the case of Dr. Ágnes Geréb and four other Hungarian midwives. The terms of Ágnes Geréb's sentence of two year imprisonment were tightened, and a ban on practising doubled to ten years. The Royal College of Midwives was deeply concerned to hear of this harsh verdict. We believe that allegations of negligence should not be judged by a criminal court, but by a professional regulatory body.” The College also hoped “that the granting of clemency will help create the conditions for further reforms of maternity care in Hungary….It is also our hope that Hungary might become an example to other countries in the region, still burdened with the legacy of authoritarian systems of medical care, left over from the Communist period,” wrote Dr. Page.
Teen birth rates in the United States declined to historical lows for all age groups in 2010, according to the National Center for Health Statistics (MMWR May 11, 2012). Figure 1 shows birth rates for teens aged 15–19 years, by age group, in the United States during the period from 1960 to 2010; data for 2010 are preliminary. The rate for teens aged 15–19 years fell 62 percent from 1960, when the birth rate was 89.1 per 1,000 women, and 44 percent from a rate of 61.8 in 1991 to 34.3 in 2010. Decreases in birth rates for teens aged 18–19 years generally were greater than the decreases for teens aged 15–17 years from 1960 through 1978. From 1991 to 2010, decreases in birth rates for teens aged 15–17 years were greater. “Childbearing by teenagers continues to be a matter of public concern because of the elevated health risks for teen mothers and their infants,” noted the National Center for Health Statistics.
Nine consensus statements about maternity care and birth place in the United States were developed by delegates at the Home Birth Summit held in Virginia, United States, at a meeting in October 20–22, 2011. Participants, who included clinicians, consumers, health policy makers, health educators, insurers, lawyers, researchers, ethicists, public health experts, and others, represented themselves and not the position of any organization or institution. The following list is a shortened version of the nine statements, which can be found at http://www.homebirthsummit.org/summit-outcomes.html:
- We uphold the autonomy of all childbearing women.
- We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary.
- We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes.
- It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.
- We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.
- Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.
- We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers.
- We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.
- We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.