Infant Mortality Rate in the US Compared to Sweden

Running Head: INFANT MORTALITY RATE COMPARISON 1

Infant Mortality Rate in the United States Compared to Sweden

Karissa Braden

Purdue University

INFANT MORTALITY RATE COMPARISON 2

Infant Mortality Rate in the United States Compared to Sweden

The United States is the seventh richest country in the world, spends the most money on

health care, and yet ranks only 56th out of 224 territories for lowest infant mortality rate (Central

Intelligence Agency, 2014). To put this in perspective, even though 1 million less babies are born

in the U.S. each year, twice as many will die on their first day of life than in all the 27 European

Union nations combined (Williams, 2013). More specifically, a baby born in the U.S. is almost

2.5 times more likely to die within their first year of life compared to a baby in Sweden, which

ranks 6th for lowest infant mortality rate (Central Intelligence Agency, 2014). How do two

highly developed countries, United States and Sweden, have such drastically different infant

mortality rates? The United States’ high inequality and preterm birth rate play a large part in

their high infant mortality rate, while Sweden’s low rate of inequality and universal health care

coverage play resilient roles to the same risk factors that affect the U.S. so harshly.

Background on Infant Mortality

The Central Intelligence Agency (2014) defines infant mortality rate as “the number of

infant deaths under one year old in a given year, per 1,000 live births in the same year”.

According to MacDorman and Mathews (2008), it is one of the most important indicators of a

nation’s health because it is associated with multiple factors such as quality of and access to

healthcare (p. 1). Factors that are impacting the death of an infant in a country are also affecting

the health of the entire population. We expect industrialized countries to have the lowest rates

because they have advanced technology, cutting-edge research, high incomes, and access to

resources, even resources as simple as clean water. The United States is one of the most

developed countries, yet has one of the highest infant mortality rates of the industrialized world.


The U.S. did have a consistent downward trend between 1935 to 2000, with the infant

mortality rate declining from 55.7 per 1,000 live births to 6.9. However, over the past fourteen

years, the rate has only dropped to 6.17 (Singh & van Dyck, 2010). Also, all of the major causes

of infant death have had a downward trend in mortality, except for a recent upturn in mortality

from prematurity. In the U.S., the occurrence of preterm births before 37 weeks gestation

increased 36% from 1984 to 2006. The U.S. now ranks 6th for the greatest number of preterm

births worldwide (World Health Organization, 2013). Many other countries are also showing an

increase in preterm birth rate over the past 20 years, and it remains the leading cause of newborn

deaths worldwide (Williams, 2013).

Risk Factors for Infant Mortality

According to Williams (2013), there are five main causes of infant mortality: “birth

defects, sudden infant death syndrome, maternal health complications, unintentional injuries, and

preterm-related causes of death.” There are multiple risk factors that certain countries, such as

the U.S., are more susceptible to because of the characteristics of their population and economy.

Key risk factors contributing to infant mortality include: maternal smoking, secondhand smoke,

inadequate nutrition of the mother, street drugs and alcohol during pregnancy, infections during

pregnancy, and an overall less than optimal health of the mother (North Carolina Healthy Start

Foundation, 2013). Many of these risk factors lead to a low birth weight baby and a shorter

gestation, which are two of the most important determinants of survival in a newborn (Singh and

van Dyck, 2010).

Wennemo (1993) states, “a country’s level of economic development reflects its capacity

to reduce infant mortality” (p. 431). Here, economic development not only means whether a

country is considered rich or poor, but also includes the extent of distribution of economic


resources, social security, and health care throughout the country. A country, such as the U.S.,

can have an abundance of economic resources, but if the distribution is not equal there can be a

large portion of the population that is unemployed, uninsured, uneducated, or living below the

poverty line. All of these characteristics put an individual at high risk for infant mortality.

Therefore, on a macro-level, an important risk factor for infant mortality is increased social and

income inequality throughout the country (Wennemo, 1993).

Factors Affecting the United States’ Infant Mortality Rate

High Inequality

Income inequality. As stated previously, the United States has high levels of social

inequality, one of the highest among the developed countries to be specific. According to Noah

(2012), "among the industrial democracies where income inequality is increasing, it's much

worse in the United States than it is almost anywhere else.” Among the 34 highly developed

countries surveyed by the Organization for Economic Co-operation and Development (OECD),

only Turkey, Mexico, and Chile had a higher income inequality than the U.S, and all three are

much less economically developed than the U.S.

Many indicators are used to measure income inequality including the Gini coefficient and

household income after taxes and government transfers. The Gini coefficient, measuring income

distribution, is the most commonly used measure of inequality because it summarizes inequality

in a single number: 0 representing complete equality, everyone has the same income, and 1

representing complete inequality (World Bank, 2011). The U.S. ranks 31 out of the 34 countries

in the OECD, with a Gini coefficient of 0.45. This is the highest the U.S. has been since 1967

when inequality first started to be measured. The Gini coefficient differs drastically from state to

state, which could play a role in the United States’ high value. For example, in 2011 the state


with the lowest inequality was Wyoming with an estimated coefficient of 0.437, and the highest

inequality was in District of Columbia with an estimated coefficient of 0.5338 (U.S. Department

of Commerce, 2011).

The household income measurements for the U.S. are also concerning. According to the

Congressional Budget Office’s (2011) study from 1979 to 2007, income rose by 275% for the

top 1 percent and only 18% for the bottom 20 percent of the population. When comparing the

U.S. to the other 21 richest countries in 2006, the U.S. had the second highest ratio of top 20%

income to the bottom 20% income (20/20 ratio). This illustrates that there is a very large gap

between the rich and the poor, in other words high inequality (Pizzigati, 2009). Also, the poverty

rate in the U.S. is 39th in the world with 15% of the population living below the national poverty

line. (Central Intelligence Agency, 2010). If this trend continues, the gap between the rich and

poor in the United States will become even larger and income inequality will rise further.

Income inequality negatively impacts infant mortality because of limited resources to a

large portion of the population and limited cohesiveness throughout a country. Decreased

cohesiveness leads to more social aggressiveness, stress, and ultimately a divide between the

community, with each side prioritizing different wants and needs. David (2011) argues that a

national policy in favor of income redistribution would improve the overall population health by

“relieving the fate of the poor” (p. 4). The U.S. may be the seventh richest country in the world,

but when the poverty rate and 20/20 ratio are so high compared to other developed countries, the

infant mortality rate begins to reflect the bottom 20% instead of the top 20%

Health insurance inequality. The number of uninsured also adds to the level of

inequality in the United States. Of the 34 countries in the OECD, 20 countries have 100% of

their population insured. The U.S. is second to last with only Chile behind the U.S. (OECD,


2013). Overall, 15.4% of the U.S. population is uninsured, but the percentage of uninsured from

state to state differs greatly. For example, only 4% of the population is uninsured in the state of

Massachusetts, but 24% of Texas is uninsured (Henry J. Kaiser Family Foundation, 2012). Texas

not only has the highest percentage of people uninsured in the U.S. but also the largest number of

children uninsured and the highest rate of adults under the poverty line that are uninsured

(Aaronson, 2013).

Having no health insurance forces people to postpone necessary health services, like

prenatal care. A study by the Institute of Medicine (2002) showed a correlation between lack of

insurance, fewer prenatal care visits, low birth weight infants, and infant mortality. A mother can

have a treatable condition, such as hypertension or gestational diabetes, that when goes

untreated, causes her to go into preterm labor or leads to health complications for her newborn.

Racial inequality. Even though the income gap between races is smaller than in the past,

there are still racial differences, according to the U.S. Census Bureau. In 2012, the median

income for Asian Americans was $68,636, White Americans was $57,009, Hispanics was

$39,005, and African Americans was $33,321 (DeNavas-Walt, Proctor, & Smith, 2012). African

Americans are not only paid the least, but they also have the highest infant mortality rate among

racial groups. Racial income inequality has been a significant predictor of African American

infant mortality rate in nation-wide studies (Jesmin, 2008). According to a report by Stanford

Medicine, “African Americans had — and continue to have — almost double the rate of infant

deaths as Caucasians” (Williams, 2013).

From 1935 to 2007, the infant mortality rate for black infants compared to white infants

went from 38% higher to 134% higher (Singh & van Dyck, 2010). Currently, the infant mortality

rates in the U.S. range from 3.57 per 1,000 live births in Alaska, with only 4% of their


population African American, to 9.62 per 1,000 live births in Mississippi, with 37% of their

population African American (CDC, 2010). Mississippi has the largest percentage of African

Americans and also the highest infant mortality rate in the U.S. There are multiple factors

complicating the causes of their increased mortality rate including the highest rates of obesity,

preterm birth rates, teen pregnancies, and poverty in the country (Landau, 2012). The state of

Mississippi has the greatest racial inequality in the U.S. when it comes to infant mortality rates.

Overall, there are multiple factors leading to the higher infant mortality rate among

African Americans in the U.S. African American women have a higher stillbirth and preterm

birth rate, on average have lower income and less education, are more often uninsured, and are

less likely to breastfeed compared to White American mothers (Braunstein, 2012). The increased

African American infant mortality rate has a larger affect on the U.S. rate since they make up

approximately 13% of the United States population, while African Americans comprise only 1%

of the total population in all of Europe (Central Intelligence Agency, 2011).

High Premature Birth Rate

According to Stanford Medicine, when comparing infant mortality rate between the

United States and other industrialized countries, the factor making the most significant difference

is premature births. In the U.S., almost one in eight babies is born premature, between 22 and 37

weeks gestation, which is the second highest rate in the industrialized world (Williams, 2013).

There are multiple reasons for the United State’s increased preterm birth rate. There is a

high proportion of African Americans in the U.S. compared to other developed countries, and

their preterm birth rate is 5.3% above the national rate (Braunstein, 2012). Also, in an attempt to

lower the U.S. stillbirth rate, physicians are inducing mothers before their due date more often

than in the past. This leads to a premature birth. Lastly, the United States has the highest teenage


birth rate in the industrialized world. It is four times the European Union average. Teenagers are

more likely to have low birthweight babies, and majority of these babies are born premature

(March of Dimes Foundation, 2012).

As one can see, there are many factors contributing to the increased preterm birth rate in

the United States. If the U.S. decreased it’s preterm birth rate to the same rate as Sweden, the

infant mortality rate would decrease by 33% (Williams, 2013). This shows how large the role of

preterm births affects the infant mortality rate in the U.S.

Sweden Infant Mortality Rate

Sweden is ranked 6th in the world for lowest mortality rate and 11th in the world for

lowest preterm birth rate. Compared to the United States, they have almost 49% less of a class

divide, spend almost 53% less money on health care, and have 55% less chance of infant

mortality (Lintner, 2010). There are multiple reasons why Sweden has a much lower infant

mortality rate than the United States including social equality and their universal health care

system.

Equality

According to Arntzen and Nybo Andersen (2004), social equity in health is a vital goal of

public health policies in Nordic countries, including Sweden. The statistics regarding their

population and economy confirm they are achieving that goal. With the most recent data on

Sweden’s Gini coefficient from 2005 being 0.23, they have the lowest inequality in the world

(World Bank, 2011). To add to their equality, the top 20% of earners only have an income four

times that of the bottom 20% of earners, compared to the U.S. where the difference is eight times

(Jones, 2012). Also, even with the mere 3.7% of their population who lives below the poverty

line, 100% of their population has health insurance (Central Intelligence Agency, 2010).


Health Care System

Sweden has universal healthcare coverage where health services are uniform for

everyone. The county councils at the regional level are responsible for delivering healthcare to

their residents, and only 10% of Sweden’s GDP goes towards healthcare costs (Wright, 2004).

There are small fees to help avoid abuse of their inexpensive healthcare system such as 100

kronor (USD 14) to visit a primary care provider or 80 kronor (USD 11) for a hospital stay per

day. If a citizen cannot afford the costs, the government will provide financial assistance

(Swedish Institute, 2013). Also, the majority of Swedish physicians are salaried and thus have no

incentive for performing more procedures or ordering unnecessary tests. Sweden will also only

provide treatments if there is evidence of its effectiveness. People can spend privately on

unproven treatments if they wish. There is also a large focus on trained midwives, which is

thought to play an important role in Sweden’s low maternal and infant mortality rates (Swedish

Institute, 2013).

Caregiver credit. In recent years, caregiver credits have become nearly universal in the

higher-income OECD countries. In Sweden, the caregiver credit is for any parent caring for a

child four years or younger. The parent can receive one of three options, whichever is most

favorable at that time for the individual’s situation: earnings equal to their income the year

before childbirth, 75% of the average earnings in Sweden, or a fixed amount of 52,1000 kronor

(USD 8,028). Sweden’s caregiver credit is unique because it offers three different options that

fits three different types of workers: those who had a high income before childbirth, those who

had a low income before childbirth, and those who are still working after childbirth. Also, the

program only uses 2% of total pension expenditures for the country (Jankowski, 2011). One

might not think that caregiver credits after a newborn’s birth can decrease infant mortality rate,


but social security systems such as this function as safety nets. They compensate for losses of

income that can impact a family’s risk for poverty, which would increase income inequality in

the country, and thus increase the infant mortality rate (Wennemo, 1993).

Conclusion

The high rates of inequality and preterm birth have a large impact on the United States’

high infant mortality rate. In comparison, Sweden’s low rates of inequality and universal health

care coverage make them resilient to the same risk factors that affect the U.S. so harshly. The

United States has made strides, but it is still falling behind the other industrialized countries.

When discussing the United States’ infant mortality rate, Paul Wise, a health policy analyst at

Stanford, stated, “The infant mortality rate in many ways is a synoptic judgment on our health-

care system and our society. It’s telling us that we must do better — and we can do better,

especially when it comes to eliminating social disparities in medicine” (Williams, 2013, p. 46).

Sweden may have the perfect recipe: income redistribution and increasing social security for

vulnerable groups (Wennemo, 1993). But will the United States’ large and diverse population

continue to act as a barrier to decreasing their high infant mortality rate, or will they finally find

a way to overcome it?


References

Aaronson, B. (2013). Texas again has highest uninsured rate in nation. The Texas Tribune.

Retrieved from https://www.texastribune.org/2013/09/18/

texas-maintains-highest-uninsured-rate-nation/

Arntzen, A., & Nybo Andersen, A. (2004). Social determinants for infant mortality in the nordic

countries, 1980-2001. Scandinavian Journal of Public Health. Retrieved from

http://sjp.sagepub.com/content/32/5/381.full.pdf+html

Braunstein, G. (2012). Shame on us: Intolerable inequality in u.s. infant mortality. Huff Post Los

Angeles. Retrieved from http://www.huffingtonpost.com/glenn-d-braunstein-md/

infant-mortality_b_1283390.html

CDC. (2010). Infant mortality rates by state, 2010. NCHS Press Room. Retrieved from

http://www.cdc.gov/nchs/pressroom/states/

INFANT_MORTALITY_RATES_STATE_2010.pdf

Central Intelligence Agency. (2010). Population below poverty line. The World Factbook.

Retrieved from https://www.cia.gov/library/publications/the-world-factbook/fields/

2046.html

Central Intelligence Agency. (2011). Ethnic groups. The World Factbook. Retrieved from

https://www.cia.gov/library/publications/the-world-factbook/fields/2075.html

Central Intelligence Agency. (2014). Country comparison: Infant mortality rate. The World

Factbook. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/

rankorder/2091rank.html

Congressional Budget Office. (2011). Trends in the distribution of household income between

1979 and 2000. Congressional Budget Office. Retrieved from http://www.cbo.gov/


publication/42729

David, R. (2007). Inequality matters: Infant mortality in the global village. Joint Center for

Political and Economic Studies Health Policy Institute. Retrieved from

http://www.jointcenter.org/hpi/sites/all/files/IM-Inequality%20Matters.pdf

DeNavas-Walt, C., Proctor, B., & Smith, J. (2012). Income, poverty, and health insurance

coverage in the united states: 2012. United States Census Bureau. Retrieved from

http://www.census.gov/prod/2013pubs/p60-245.pdf

Henry J. Kaiser Family Foundation. (2012). Health insurance coverage of the total population.

State Health Facts. Retrieved from http://kff.org/other/state-indicator/total-population/

Institute of Medicine. (2002). Health insurance is a family matter. Washington, DC: The

National Academies Press.

Jankowski, J. (2011). Caregiver credits in france, germany, and sweden: Lessons for the united

states. Social Security Bulletin. Retrieved from

http://ftp.ssa.gov/policy/docs/ssb/v71n4/v71n4p61.pdf

Jesmin, S. (2008). Income inequality and racial/ethnic infant mortality in the united states.

University of North Texas. Retrieved from http://digital.library.unt.edu/ark:/67531/

metadc9770/m1/1/

Jones, O. (2012). Why Inequality Matters. Retrieved from http://www.equalitytrust.org.uk/sites/

default/files/Why%20Inequality%20Matters.pdf

Landau, E. (2012). Infant deaths: Searching for answers in mississippi. CNN Health. Retrieved

from http://www.cnn.com/2012/11/13/health/infant-mortality-mississippi/

Lintner, A. (2010). Compare the u.s. to sweden. If It Were My Home. Retrieved from

http://www.ifitweremyhome.com/compare/US/SE


MacDorman, M., & Mathews, T. (2008). Recent trends in infant mortality in the united states.

National Center for Health Statistics. Retrieved from http://rbabyfoundation.org/PDFs/

InfantMortalityupdate.pdf

March of Dimes Foundation. (2012). Teen Pregnancy. Retrieved from

http://www.marchofdimes.com/materials/teenage-pregnancy.pdf

Noah, T. (2012). Can domestic policy affect income distribution. New Republic. Retrieved from

http://www.newrepublic.com/blog/timothy-noah/101648/can-domestic-policy-affect-

income-distribution

North Carolina Healthy Start Foundation. (2013). Infant mortality in north carolina. In North

Carolina Healthy Start Foundation. Retrieved from http://www.nchealthystart.org/

infant_mortality/causes.htm

OECD. (2013). OECD health data: Social protection. OECD. Retrieved from

http://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics/

oecd-health-data-social-protection_data-00544-en

Pizzigati, S. (2009). Inequality and health. Program on Equality and the Common Good.

Retrieved from http://inequality.org/inequality-health/

Singh, G., & van Dyck, P. (2010). Infant mortality in the united states: 1935-2007. Rockville,

Maryland: U.S. Department of Health and Human Services.

Swedish Institute. (2013). Healthcare in sweden. Sweden. Retrieved from

http://sweden.se/society/healthcare-in-sweden/

U.S. Department of Commerce. (2011). Gini index of income inequality. United States Census

Bureau. Retrieved from http://factfinder2.census.gov/faces/tableservices/jsf/pages/

productview.xhtml?src=bkmk


Wennemo, I. (1993). Infant mortality, public policy and inequality: A comparison of 18

industrialized countries 1950-85. Sociology of Health and Wellness. Retrieved from

http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.1993.tb00354.x/pdf

Williams, S. (2013). What’s behind the high U.S. infant mortality rate. Stanford Medicine.

Retrieved from http://stanmed.stanford.edu/2013fall/article2.html

World Bank. (2011). Measuring inequality. Poverty Reduction and Equity. Retrieved from

http://go.worldbank.org/3SLYUTVY00

World Health Organization. (2013). Preterm birth. Retrieved from http://www.who.int/

mediacentre/factsheets/fs363/en/

Wright, B. (2004). Universal Access to Healthcare: Lessons from Sweden for the United States.

Retrieved from http://www.unc.edu/~wedavid/web/

Comparative%20HC%20Systems%20Paper.pdf

Infant Mortality Rate in the US Compared to Sweden

Documents

Transcript of Infant Mortality Rate in the US Compared to Sweden