"Premature birth is the primary medical cause of infant mortality." American doctors try really hard to turn premature births into living babies, spending massive resources on NICU treatment, then sending them home to still die at high rates compared to other wealthy countries. I used to challenge international infant mortality comparisons on the basis that other countries didn't include deaths of babies born after less than, say, 30 weeks gestation, while the US counted anything over maybe 24-27, depending on who's reporting. Lately, though, the comparisons have been careful to use the same gestation criteria across countries, I think with five hold-outs. What I do not know is the proportions of births by country that are premature. If America has higher rates of premature births, that could explain much of the higher infant mortality rate.
I believe that race washes out as a factor when the model includes SES, parenting, education, religion, and geography. Children develop into healthier, smarter, better-thinking people when they have affectionate, stable parents. Girls who grow up without dads, or without affectionate parents, make bad decisions about relationships, and are more likely to get pregnant early by another poorly raised teen or an exploitative adult. Remember to look at this model pangenerationally. The young people having kids that survive are the bad parents of the next generation of young parents; with poor brain development, making bad decisions, working poor jobs if at all, poorly educated, stressed out because they are incapable of managing effective lives. Religion contributes to ineffective education about birth control, and to preventing abortions. It is notoriously difficult for teens to get abortions in some areas of the US (like the South), so many babies are born to parents who do not want them and/or are completely unable to properly raise them. A recent TIME magazine chart showed that the South and Southwest have vastly higher teen pregnancy rates compared to other regions (New England has the lowest), and the chart was nearly identical to the earlier chart on infant mortality. Despite the media frenzy about the Massachusetts "pregnancy pact", the teen pregnancy rate in that area is very low for the US. Interestingly, mortality is only higher for the first-born of teens.
What can we do?
Obviously, a good start would be to get the areas with the worst problems to do more of what the areas with the best outcomes do. It blows my mind that the South wallows in problems while trash-talking New England. It also blows my mind that America wallows in problems while trash-talking Europe. Stop being blindly arrogant. Look at the outcomes. Apply best practices. Stop abstinence-only sex-ed. Promote safe sex. Provide social services that work. Make welfare-recipients buy vegetables (make them accessible, too) instead of chips and cigarettes. Make abortions and condoms accessible to teens. Provide drug rehabilitation instead of throwing addicts in jail. Provide incentives for the populations of people who can't make good decisions and resist being told what to do, so that they are more subtly influenced to do what is good for them. Not only would these things reduce infant mortality, but also reduce teen pregnancy, crime, and poverty, increasing national productivity and overall quality of life for the citizens of our country.
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