Last week, the Centers for Disease Control and Prevention released data on birth rates for 2013. The biggest headline is that America’s birthrate hit a historic low — bad news for a country faced with a government budget crunch and poorly funded entitlement systems. America needs a healthy birthrate for many reasons, including development of the next generation of workers and taxpayers to keep our economy going.
But hidden in the report is some good news. Births to teenage mothers decreased 10 percent from 2012 to 2013, continuing the downward trend of recent years. The rate of premature births also decreased slightly nationwide and now stands at 11.39 percent. Healthcare professionals should take pride in this statistic. Surely, part of the reason for these falling numbers is their hard work helping mothers carry babies to term.
A nasty rumor persists that America’s infant mortality rate — and therefore its prenatal care and healthcare system more broadly — is subpar. This rumor originates in international rankings that would suggest that the U.S. infant mortality rate is higher than that of 54 other countries.
These rankings are seriously flawed. As explained in a report published by the American Enterprise Institute, “U.S. physicians often go to great efforts — at the prenatal and postnatal stages — to save a baby with poor survival chances.” We have significantly more neonatal intensive care units than other industrialized countries.
Ironically, this extra effort and the additional resources the United States uses to deliver and save premature babies makes our infant mortality rate look worse than countries that do less. The report concluded that this “additional health care may actually worsen reported infant mortality rates and misleadingly suggest poor care in the United States.”
Not only do Americans work hard to save every life, we also count more infants as born alive than other countries do. Some countries have weight or term requirements that reduce their denominators in the infant mortality equation. That means they declare many babies stillborn that would be counted as live births here.
One doesn’t really need a breakdown of the statistics to know that there is something wrong with these international rankings. Use your common sense: Would you rather deliver a baby in the United States or in Serbia, South Korea, French Polynesia, or Cuba? All of those countries rank better than the United States on international infant mortality rankings.
The United States can still do more to help families with preterm babies. You may find this surprising, but many state governments — through “certificate of need” laws — restrict the number of neonatal intensive care units available to care for preterm babies.
For example, in Virginia, this poses a problem. Many hospitals (58%) in the state that have a maternity ward do not have a neonatal intensive care unit (NICU), meaning premature babies must be transported for care. This puts these already-vulnerable infants at a higher risk of bad outcomes, even death. And the Virginia Department of Health continues to deny permits for NICU projects each year, artificially limiting the supply of health care for preemies.
Certificate of need laws are one result of America’s healthcare policy of overregulation: They presume that government officials, rather than medical facilities and the patients they serve, know best whether they should offer NICUs. In part, these regulations are a reaction to other government interventions in healthcare, but the effect of CON laws is to limit the supply of healthcare, which protects established interests (such as hospitals and existing neonatal care units) from new competition.
The federal government once required states to have CON programs to evaluate needs for beds and medical equipment. But since this requirement was repealed in 1986, many states have wisely dropped their CON laws. There is simply no need for government to micromanage healthcare supply; providers are best positioned to evaluate demand, and they respond with much more agility and to the benefit of the little guys — in this case, quite literally.
Hadley Heath Manning is health policy director at the Independent Women's Forum.