Lessons from Cuba on Infant Mortality

Published January 13, 2005

Dear Editor,

Recently released statistics on the infant mortality rate in Cuba leads op-ed columnist Nicholas D. Kristof to write, “Babies are less likely to survive in America with a health care system that we think is the best in the world, than in impoverished and autocratic Cuba.” [“Health Care? Ask Cuba,” 1/12/05]

While the 6 deaths per 1,000 rate compared to our 7.2 per 1,000 deserves applause, what Kristof calls “a wrenching fact” is also a wrenching misunderstanding of fact.

One reason Cuba has a lower infant mortality rate is because we have the most intensive system of emergency intervention to keep low birth weight and premature infants alive. We are one of a few countries that records data on early fetal mortality.

How does this create the wrong impression? In the United States if an infant is born low weight (400 grams or less) and not breathing, a physician will usually spend lot of health care money trying to revive the baby. If the infant does not survive, the event will be recorded as a live birth and then a death.

In most countries such extraordinary medical care would not even be attempted, much less productive of a positive medical outcome. In those countries, the death of that infant never shows up in infant mortality statistics because it is documented as a fetal death instead of a live birth.

Cuba does much the same thing many other countries do and does not register low-birth weight babies under 1000g. The World Health Organization itself recommends that for official record keeping purposes, only live births of greater than 1,000g should be included. Because we record events more preciously, the result makes us look worse than Cuba while we attempt expensive, heroic medical intervention in an effort to save a life.

Having said that, Cuba’s progress on infant mortality is commendable improvement over the years. At the same time, trying to compare statistics across cultural differences is at best difficult and at worst, misleading.

Conrad F. Meier
Columbia, MO

Editor: Conrad F. Meier ([email protected]) is a senior fellow for health care policy at The Heartland Institute in Chicago. He is also the editor emeritus of Health Care News.