When we talk about health care for women, we seem to focus an inordinate amount of time, both politically and certainly in the media, on the topic of birth control for those women. Often we focus on abortion, or on various states' attempts to make abortion more difficult or even impossible for women. We spend far less time talking about the babies that are actually born, and rather little time talking about how those babies are born. But new data released by the World Health Organization from a three-year report comparing premature birthrates in 184 countries brings a different topic to the standard baby conversation in the United States. Donald G. McNeil Jr. writes in The New York Times on this new "trend," which is that the U.S. is now on par with developing countries in terms of preterm babies born, "worse than any western European country and considerably worse than Japan or the Scandinavian countries."
Why? It's a combination of things as disparate as the pieces that recently ran in The Times about, contrastingly, the celebrity baby bump business and the criminalization of bad moms, and it has to do with the ever-growing divide between the wealthy and middle class, and the poor. On one hand, women over 35 who have had in vitro and go on to deliver twins or triplets, and on the other, pregnant teens. In the case of the former, often the early births are on purpose, with the babies delivered by C-section to avoid the risks of having multiple full-term babies vaginally. For the pregnant teens, on the other hand, it's a different story.
There are an array of risk factors for American women of childbearing age that may lead to premature births: "obesity, diabetes, high blood pressure or smoking habits" to name a few. These risk factors tend to hew to socio-economic status, which goes back to talk of health insurance. Women who don't have it, poor women, aren't getting the care they need to manage or avoid health problems that lead to early deliveries. What's worrisome about preterm births in addition to possible health problems for the child is the fact that early deliveries can lead to higher infant mortality rates. And though U.S. hospitals are very good at "saving premature infants," writes McNeil, the U.S. still has higher death rates for infants than do other wealthy countries.
This reflects an overall disparity both within the U.S., and between the U.S. and other developed countries. Per The Times:
Nine of the 11 countries in which 15 percent or more of all births are preterm are in Africa; the other two are Pakistan and Indonesia.
The United States shares the 12 percent range with Kenya, Turkey, Thailand, East Timor and Honduras, meaning one in 9 births is early. The rate in the United States has risen 30 percent since 1981.
Most European countries, Canada and Australia are in the 7 to 9 percent range.
In contrast, though, the problems in poor countries usually involve factors like women having many babies, girls getting pregnant at very young ages, and infections. And, in wealthy countries like the U.S., "a fetus in danger" will be delivered early, on purpose, to help keep the child alive. That tends not to happen in poorer countries, where the infant would instead be likely to die. The contrast is stark:
In the United States, an infant born before 28 weeks has a 90 percent chance of surviving, though often with disabilities, while in most of Africa such a child has a 90 percent chance of dying, according to the report.
What's most strange about this, though, is that the triggers for premature labor aren't really completely understood. And in one recent study of Mexican-Americans and Mexican immigrants, preterm birth expert Dr. Radek K. Bukowski found that the chance of having a premature baby actually grew the longer a woman lived in the U.S.: "Recent immigrants had a 4 percent risk, those living here less than a decade were at 7 percent, and citizens were at 10 percent," writes McNeil. This is not genetic, says Dr. Bukowski, but something acquired, and can't be explained even after controlling for the various standard risk factors like smoking, health problems, and age.
Which means, as the experts say, more research—and more discussion—is needed.