FOR more than a century, the infant mortality rate – the proportion of babies who die before their first birthday – has stood as a primary measure not just of health, but of a nation or region’s economic and social functioning.
Industrialised countries with stable governments, high employment and adequate health and welfare systems do best. Sweden, Japan and Singapore are the current stars, losing fewer than 3 infants per thousand live births. The UK’s infant death rate is 5 per thousand. Countries with faltering or failed governments or endemic poverty, and those experiencing social, economic or political disruption, fare far worse. In Afghanistan and Sierra Leone, to name two tragic examples, 1 in 7 babies die before reaching 1 year of the age.
What then should we make of the fact that in Mississippi and a handful of nearby states in the southern US, infant mortality rates appear to be rising? And that at the same time, President Bush has vetoed legislation expanding a popular and successful national health insurance programme for children?
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“In Mississippi and a handful of other southern states, mortality rates appear to be rising”
In 2005, Mississippi’s infant death rate rose by 17 per cent, from 9.7 to 11.4 deaths per thousand. Five other southern states – Alabama, Louisiana, North Carolina, South Carolina and Tennessee – also saw increases in their infant mortality rates, though by smaller amounts.
Not surprisingly in a region where poverty is particularly entrenched among African Americans, the infant death rate for blacks in Mississippi rose even more steeply, from 14.2 per thousand in 2004 to 17 per thousand in 2005, a 20 per cent surge. The rate for whites in Mississippi rose by 10 per cent to 6.6 per thousand live births. Just-released figures from Mississippi show a slight improvement from 2005 to 2006 for blacks, but overall infant death rates are still higher than they were a decade ago. “Instead of making progress, we’re getting worse,” says Ed Thompson, director of Mississippi’s Department of Health, “and that’s clearly unacceptable.”
Experts point to a variety of causes, including more preterm and low-weight newborns, plus a high incidence of birth defects, sudden infant death syndrome, disease and accidents. Many mothers are in poor health and get inadequate prenatal care through lack of money, insurance, transportation and, for some, motivation.
In Mississippi, state government policy may well be one of the factors contributing to the dismal statistics. Haley Barbour, elected governor in 2004, kept his campaign promise to cut welfare costs. To meet it, he made it harder to qualify for social services, causing enrolment in key programmes, including those for mothers and children, to fall by more than 50,000.
The increases in infant mortality in Mississippi and nearby states are part of a much broader and deeper pattern throughout the US. According to recent findings from a multinational study of household income called the Luxembourg Income Study, the US is the “worst performer” among 31 developed countries in terms of the percentage of children and families living in poverty. Not surprisingly, the six southern states mentioned above are among the worst on that measure. Mississippi, where 30 per cent of children are impoverished, ranks last.
Making matters worse, the most recent figures from the US Census Bureau show that the ranks of the severely poor – individuals or families receiving less than half of the federally established poverty-line income – have swelled significantly during this decade. The number grew by 16 per cent from 2000 to 2006, one-third faster than the number of Americans who are merely poor.
Here, federal policies are clearly involved. According to the same study, only two of those 31 developed countries – Mexico and Russia – expend a smaller proportion of their gross domestic product on anti-poverty programmes than the US.
Rising rates of infant mortality may be confined to the South, but a black infant mortality rate twice that of whites, plus rising rates of poverty, severe poverty, and children growing up in poverty, are national problems. They are not likely to be addressed in the remaining 15 months of the Bush administration. As żěè¶ĚĘÓƵ went to press, for example, the president was expected to veto for the second time legislation to renew and expand SCHIP, a decade-old programme that provides healthcare coverage to children of the “working poor”. Bush claims the expanded programme is fiscally irresponsible and might “open up an avenue for people to switch from private insurance to the government”.
That is a remarkable statement, given that nearly 47 million Americans, including 8.7 million children, have no health insurance, public or private.
When babies are dying needlessly, something is clearly wrong. When babies are dying needlessly in a nation that prides itself on being the richest on earth, a nation that is home to 482 billionaires, a nation that has poured more than $400 billion into the war in Iraq with $190 billion more to come, something is very wrong indeed.
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