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http://www.nytimes.com/2009/11/04/health/04infant.html

November 4, 2009
 Premature Births Behind Higher Infant Death Rates in U.S., Report Says.
By DENISE GRADY<http://topics.nytimes.com/top/reference/timestopics/people/g/denise_grady/index.html?inline=nyt-per>

High rates of premature birth are the main reason the United States has
higher infant mortality<http://topics.nytimes.com/top/reference/timestopics/subjects/i/infant_mortality/index.html?inline=nyt-classifier>than
do many other rich countries, government researchers reported Tuesday
in their first detailed analysis of a longstanding problem.

In Sweden, for instance, only 6.3 percent of births were premature, compared
with 12.4 percent in the United States in 2005 — the latest year for which
international rankings are available.

Infant mortality also differed markedly: for every 1,000 births in the
United States, 6.9 infants died before they turned 1, compared with only 2.4
in Sweden. Twenty-nine other countries also had lower rates.

If America could match Sweden’s prematurity rate, the new report said,
“nearly 8,000 infant deaths would be averted each year, and the U.S. infant
mortality rate would be one-third lower.”

Dr. Alan R. Fleischman, medical director of the March of
Dimes<http://www.marchofdimes.com/>,
said the new report <http://www.cdc.gov/nchs/data/databriefs/db23.pdf> was
“an indictment of the U.S. health care system” and the poor job it had done
in taking care of women and children.

Infant mortality is widely used as a way to gauge the health of a nation,
and the relatively high rates in the United States have long dismayed health
officials.

The high rates of prematurity in the United States have various causes. The
smallest, earliest and most fragile babies are often born to poor and
minority women who lack health care and social support. The highest rates of
infant mortality occur in non-Hispanic black, American Indian, Alaska Native
and Puerto Rican women.

When it comes to prematurity, fertility treatments — drugs that stimulate
ovulation, and procedures that implant more than one embryo in the uterus —
also play a role, by raising the odds of
twins<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/twins/index.html?inline=nyt-classifier>or
higher multiples, which have an increased risk of being born too soon.

Another factor is the increasing use of Caesarean sections and
labor-inducing drugs to deliver babies early, said Marian F. MacDorman, a
statistician at the National Center for Health
Statistics<http://www.cdc.gov/nchs/>and an author of the report.
“I don’t think there are doctors doing preterm Caesarean sections or
inductions without some indications, but there sort of has been this shift
in the culture,” Dr. MacDorman said. “Fifteen or 20 years ago, if a woman
had high blood pressure<http://health.nytimes.com/health/guides/disease/hypertension/overview.html?inline=nyt-classifier>or
diabetes<http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier>,
she would be put in the hospital and they would try to wait it out. It was
called expectant management. Now I think there’s more of a tendency to take
the baby out early if there’s any question at all.”