U.S. Low on List of Best Places for Moms: Reports of Infant Mortality Rates Flawed?

Due to strict laws on the number of children, studies have found that live births are often go unreported. Photo by: Foudeelau

Due to strict laws on the number of children in China, studies have found that live births are often go unreported. Photo by: Foudeelau

Infant and Maternal Health: Reporting Requirements

Each country has different reporting requirements and this has been a concern over comparing countries to each other for a while now. In a study published in the American Journal of Public Health in 1994, Dr. Howell and Dr. Blondel looked at the birthweight and fetal deaths from different countries to show how registration and reporting bias may affect mortality rates. They discovered that how low-birthweight babies and fetal deaths were classified and reported “may substantially bias international comparisons.”

In addition to this study, there have been many others highlighting the discrepancies between reporting methods between nations.

  • China Infant Mortality: In another study published in the International Journal of Women’s Health in 2012 examined the quality behind the maternal mortality ration (MMR), infant mortality rate (IMR), and under-five mortality rate (U5MR). Researchers randomly selected Guizhou Province in China. They compared data from the routine records from the health bureaus with surveys completed by mothers, father, grandparents, and other caregivers. Researchers discovered that the number of births and deaths in the survey were more than the births and deaths in the national reporting data in both rural and urban areas. This study highlighted the problem with under-reporting of live births and neonatal deaths; especially in China where strict laws limit the number or children a family is allowed to have.
  • Live Birth Reporting: In another study published in Obstetrics and Gynecology in 1995, researchers examined the difference in definitions of live births that impact infant mortality. Researchers compared infant mortality rates in England, Wales, France, Japan, and the United States, and discovered that the United States high infant mortality rate at that time was due to the fact that the U.S. reported infants at low-birth weight (weigh less than 1kg) and infants that died from congenital anomalies. According to researchers, these types of cases are generally excluded from infant mortality statistics. Researchers came to the conclusion that, “infant mortality provides a poor comparative measure of reproductive outcome because there are enormous regional and international differences in clinical practices and in the way live births are classified. Future international and state comparisons of reproductive health should standardize the definition of a live birth and fatal congenital anomaly, and use weight-specific fetal-infant mortality ratios and perinatal statistics.”
  • Registration Differences: In 2012, an article published in the British Medical Journal examined the variation in the registration of very-low-birth weight babies and early gestation to assess their effect on infant mortality rates of industrialized countries. Researchers looked at New Zealand, Australia, Canada, European countries, and the United States. Researchers concluded, “International differences in reported rates of extremely low birthweight and very early gestation births probably reflect variations in registration of births and compromise the validity of international rankings of perinatal and infant mortality.

Best Place to Have a Baby?

So where is the best place to have a baby? The question, may just have to go unanswered due to countries having different standards and reporting guidelines, not to mention a lack of reporting in some regions. Unfortunately, without accurate data, there is really no way to statistically compare countries against one another when it comes to the health and quality of care of the mother and baby.


Save the Children. State of the World’s Mothers Report 2013. (2013). Accessed May 9, 2013.

Du, Q., Naess, O., Bjertness, E., et al. Differences in reporting of maternal and child health indicators: A comparison between routine and survey data in Guizhou Province, China. (2012). International Journal of Women’s Health. Accessed May 9, 2013.

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Joseph, K., Liu, S., Rouleau, J., et al. Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study. (2012). British Medical Journal. Accessed May 9, 2013.

U.S. News and World Report. Behind the Baby Count. (2006). Accessed May 9, 2013.

Howell, E., Blondel, B. International Infant Mortality Rates: Bias from Reporting Differences. (1994). American Journal of Public Health. Accessed May 9, 2013.

Sachs, B., Fretts, R., Gardner, R., et al. The Impact of Extreme Prematurity and Congenital Anomalies on the Interpretation of International Comparisons of Infant Mortality. Obstetrics and Gynecology. (1995). Accessed May 9, 2013.

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  1. If we can’t depend on the most up-to-date reports for accuracy, what can we depend on??

  2. The question of statistics are interesting, but I doubt women will move to different countries in order to give birth where the infant mortality rate is lower. Clearly there’s a problem with reporting, but I’m more concerned with the “why” rather than “where.” Why are most babies born full-term in some countries; why do babies survive longer after birth in some countries, etc. And I’m not trying to bring up a painful subject here, but do these countries consider abortions in their statistics? This could also change the numbers considering what happens in abortion clinics.

  3. chandra kanta subedi says:

    why babies are not protected from his/her mother?

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