In what some consider to be an indictment of our healthcare system, a recent article in the New York Times has revealed that the United States has one of the highest rates of infant mortality among industrialized nations, much of which is tied to a high rate of premature births. According to the report, most countries in Europe have lower rates, as well as Australia, Canada, and many Asian countries, including Hong Kong, Singapore and Japan.

Infant mortality is often cited as a measure of a countries health because it is often linked to the availability of healthcare. While premature infants stand a better chance of survival in the United States, they have an overall greater risk of mortality than full term babies, and the large number of premature births increases the overall infant mortality rate.

Why there are so many premature births in the United States is not completely clear, but experts point to several possible explanations. Premature infants are often born to poor and minority women who have no access to healthcare or social services. The birth of more than one child (i.e., twins) raises the risk of early delivery, and multiple births are becoming more common with the increased utilization of infertility treatments.

The reason for this is because lack of any national healthcare to cover the costs, patients generally have to pay out of pocket for these very expensive procedures. In order to maximize the chances of conception and therefore minimize the number of procedures, doctors tend to use as many embryos as possible, despite a call to reign these numbers in. On the other hand, in Europe, they have been more successful at limiting the number of embryos used, a fact some people tie to government coverage of healthcare costs.

Finally, another potential culprit is the greater reliance on caesarian sections and labor inducing drugs to deliver babies. This in fact is the fastest growing segment of premature births and represents a fundamental shift in the approach to medicine as more doctors feel the need to deliver babies earlier in order to protect mother and child. It has been suggested that in the past, doctors were more inclined to wait out maternal conditions like high blood pressure or diabetes, but now do not want to take any chances and will deliver the baby at the first sign of a problem.

Many of these problems might possibly be avoided if expectant mothers had greater access to healthcare or social services. Doctor and patient might then make informed decisions based less on costs and more on the health of the mother and child. With the debate over healthcare reform currently raging, these are important topics worth examining as we consider the overall health of this country.