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72     17 Countries Top the U.S.
       In Low Infant Mortalities
       The Washington Post  Saturday, November 25, 1967

      The rate of infant mortality is one of the most poignant social
indicators.  The official U.N. statistics, recently analyzed by the
U.S. National Center for Health Statistics, give little cause for
self-congratulation to an affluent country like the United States.

     This country had 24.8 infant deaths per 1000 live births in 1964
Seventeen other countries showed superior performances, down to 14.2
in Sweden , with the Scandinavians, Dutch and British leading the
list.  The United States would have to strive to match Japan (20.4) 
Czechoslovakia (21.2) and Taiwan (23.9).

    Throughout the world, infant mortality rates have constantly
improved over the past half-century.  In the developing countries,
this trend has, of course sparked the population explosion.
In the United States between 1915 and 1950, the index dropped steadily
from 100 to 30. Since then the improvement has been much less
spectacular, perhaps because of the hard-core residence of infant
deaths from causes beyond the reach of simple treatment like anti-
biotics. 

    Variations of the infant mortality index within the United States by
region and by color are often quoted as measures of the unequal 
distribution of human rights.  The index for nonwhites, mainly Negroes,
in  1963 was 41.5 compared to 22.2 for the white population.

     For rural non-whites, it was 47.3, and in Mississippi, the index
reaches the scandalous peak of 58.3.  This is indeed an index of
discrimination.  Among Mississippi whites, the urban and rural rates
are not very different, 22.6 versus 23.1.

     At the other extreme, rural white Iowa returns an index of 18.6,
just ahead of Denmark and Switzerland.

     These socio-economic discrepancies are a challenge to whatever
decent humanity a great nation can implement through the force of 
government.  However, a vital attack on this kind of problem demands
better insight than we now have about the detailed causes of 
differences in the mortality index.  There can be little doubt that the 
most elementary needs for medical care, maternal education and decent 
nutrition and sanitation will account for much of the discrepancies
within the United States.

     On the other hand, we should not be too quick to assume that
these account for the differences between the white-urban  United
States and northern Europe.  Unfortunately, we do not have sufficiently
detailed and comparable vital statistic to give satisfactory
clues on this question. 

     Among the visible variables, the incidence of very small
babies is the only one that gives any interesting correlation
with the infant mortality rates.  In fact, the effects
of color and of the number of high-risk babies weighing less than
five pounds will completely account for the disparities between the
United States and Europe.

     We have very little insight into the reasons for these undersized
infants. Many of them are undoubtedly prematurely delivered well be-
fore the normal term of nine months.  Others may have been carried for
full term but have developed backwardly. These immature babies are of-
ten more serious risks than the premature ones.

     The statistics on gestation times are too unreliable to be very 
useful.  It is even conceivable that more strenuous efforts to save a
threatened pregnancy may produce a higher rate of infant mortality at
the expense of prenatal deaths.

     At any rate, the study of variation in birthweights now has a
high priority in our efforts to understand and control avoidable 
infants deaths.

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