U.S. newborn mortality rate higher than South Korea, Cuba, Malaysia, Lithuania, Poland and Israel: Report

By Dr. Ananya Mandal, MDAug 31 2011

According to a new report babies in the United States have a higher risk of dying during their first month of life than do babies born in 40 other countries. Some of the countries that outrank the United States in terms of newborn death risk are South Korea, Cuba, Malaysia, Lithuania, Poland and Israel, according to the study.

Researchers at the World Health Organization estimated the number of newborn deaths and newborn mortality rates of more than 200 countries over the last 20 years. The results show that, while newborn mortality rates have decreased globally over that period, progress to lower these rates has been slow, the researchers said.

The WHO report suggests that in 2009, an estimated 3.3 million babies died during their first four weeks of life, compared with 4.6 million in 1990. . About 41 percent of all deaths of children under 5 occur in the first month (the neonatal period). Progress to reduce newborn deaths has been particularly slow in countries in Africa, the researchers said.

“We know that solutions as simple as keeping newborns warm, clean and properly breast-fed can keep them alive,” said study researcher Joy Lawn of the Save the Children Foundation, which worked with the WHO on the report. “It isn't that you have to build invasive care units to halve your neonatal mortality.” More health care workers, including midwives, are needed to teach and implement these lifesaving practices, she said.

In the new study, Lawn and colleagues estimated national neonatal mortality rates from 1990 to 2009. For 38 countries, they made these estimates using information in databases that track births and deaths. But for 155 countries, they had to rely on information from household surveys, and create a statistical model to make their estimates. The global neonatal mortality rate decreased 28 percent over the 20 years, from 33.2 deaths per 1,000 live births to 23.9 deaths per 1,000 births, the researchers found.

“It's good news, but it's not enough,” Lawn said. Deaths of children between the ages of 3 and 5 and maternal deaths are going down 30 to 40 percent more quickly than neonatal deaths, Lawn said. The difference may be due in part to a lack of attention, funding and policy changes related to reducing neonatal deaths, Lawn said.

In the United States, the drop over the last 20 years was less than the average drop — 26 percent. And the United States dropped from No. 28 to  No. 41 in the rankings of newborn death risk. It is now tied with Qatar, Croatia and United Arab Emirates.

Five countries account for more than half of the world's newborn deaths: India, Nigeria, Pakistan, China and Democratic Republic of Congo. India has the most newborn deaths, with 900,000 per year, the researchers said. Globally, Afghan babies face the greatest risks, with one of every 19 dying in the first month of life, according to the statistics.

“It is essential that national governments, international agencies, and civil society increase attention to systematically preventing and tracking neonatal deaths,” the researchers wrote in the study published today (Aug. 30) in the journal PLoS Medicine.

The London School of Hygiene and Tropical Medicine also participated in the study, which covers all 193 WHO member countries over 20 years.