National Geographic Daily News
Young parents hold their stillborn daughter in Charlotte, North Carolina.

Ryan and Sandra Doherty cuddle the blanket that their daughter was placed in after a stillborn delivery.

Photograph by Layne Bailey, Charlotte Observer/MCT/Getty Images

Alexis Manning

National Geographic News

Published May 8, 2013

The United States has the highest rate of first-day deaths in babies than any other industrialized nation, according to a report released this week by the humanitarian group Save the Children.

Throughout the world, the first day of life is the most hazardous time for a baby; just over one million children die each year within 24 hours of being born.

Save the Children's annual "State of the World's Mothers" report ranks 176 countries on levels of well-being among children and mothers. This year's edition puts a special emphasis on newborn health, featuring its first-ever Birth Day Risk Index. The index ranks countries from the safest to the most dangerous for a baby to be born in.

In the United States, babies are 50 percent more likely to die on the same day they were born than in all of the other industrialized countries combined, according to the report. Each year, nearly 11,300 babies die on the day they were born in the United States, making American babies twice as likely to die in their first 24 hours as European Union babies.

Why the Gap?

The findings don't surprise Save the Children president and CEO Carolyn Miles, who said in an e-mail interview that the U.S. consistently has a preterm birth rate far above those of other industrialized countries.

Its high rate of premature births and its large population may partially explain why the U.S. tops other industrialized nations in first-day deaths for babies. Factors like poverty, stress, and teenage pregnancy also play a role, Miles said.

Babies born to the poorest mothers are 40 percent more likely to die than babies born to wealthy mothers, said Miles.

"African-American women face much greater risks, and there are also reasons relating to chronic health conditions and obesity, to older mothers, to elective C-sections," she said.

The health dangers that poor and minority women face—like a high rate of premature birth and low birth weights—are compounded by the difficulties they have getting high-risk care in the United States, Miles said.

But questions remain about why the United States is in a league of its own for first-day deaths. "We can really only explain about half of the discrepancy," Miles said, "and more research is needed."

Developing Nations

Fixing the problem, according to Save the Children, rides largely on education and access to medical care.

"It comes down to making sure all women can access health services before and during pregnancy," Miles said. Save the Children is calling on Congress to establish a new National Commission on Children to address the issues that children in poverty face every day—in the United States and in developing countries.

Those countries see the vast majority of first-day deaths, due to factors like birth complications and infections, which rarely cause death in babies in rich countries, according to the Save the Children report. Only 1 percent of the world's newborn deaths occur in industrialized countries.

The United States places 30th in overall best conditions for mother and baby, according to the Save the Children index. The Democratic Republic of the Congo is at the bottom of the list.

Paul Stewart
Paul Stewart 1 Like

No additional research is needed...simply visit any hospital in California...This entire article is flawed from the start- 

 First, none other "rich" nation shares a 1000 mile long border with a 3rd World nation.  Thus, America inherits the babies of Mexico and other failed south-of-the-border nations virtually by the millions.  When we were having our first child in Los Angeles my wife was admitted and all of her stats, her pre-natal visits etc were all listed on a massive white board.  Also listed on that board were Jane Doe #1, #2, #3 # 4 and #5...all here illegally, all without a single pre-natal visit, no vitamins, no doctor, nothing...  There were no states...and all 5 were having premies...and all will contribute to the ever-skewed statistics that is this slowly dying country which is going to go belly-up from inattention to the obvious...

He Priv
He Priv

In fact, all four states that border Mexico have *lower* infant mortality rates than the nationwide average.

Xira Arien
Xira Arien

Simply put: America is no longer a 1st world nation.

We don't even belong in the same class as great nations such as Canada or Germany. Soon that will include China too.

L. Madison
L. Madison

There have been various reasons for first-day deaths.  Circumcision is done routinely in the USA and would likely account for some first-day deaths with baby boys anyway. Circumcision is done with 24 hrs, there have been cases where its caused fatal bleeding and infection.

Win me
Win me

The US works to keep preterm babies alive, especially in the case of very early preterm babies this can affect statistics.  The US is very good at keeping preterm babies alive and healthy.  I have a niece who was so small she could fit easily in her fathers hand, now she is a health seven year old.    That is thanks to a great health care system.

He Priv
He Priv

@Win me Clearly the US is *not* very good at keeping preterm babies alive and healthy, as more of our preterm babies die than those of any other rich nation. 

Win me
Win me

Otis Dog, perterm birth affects more then the first day, first month or even first year statistics.  Perterm children often have health problems that affect them throughout life.  The US health care system is not to blame here.  The US also has programs like WIC, medicaid and others to help pregnant mothers and children.  Along with programs to quit drugs, smoking, alchohol and more especially durning pregnancy.  And programs to give out free birth control. 

Otis Dog
Otis Dog

Aconcerned Person, you are right, a stillbirth is not a live birth.  It is intrauterine fetal death.  Looking at the study's methodology, they did not consider stillbirths in their calculations.  The only part of this article that talked about stillbirth is the photograph caption.  However, Ken Cox's point is valid in that there are not standard definitions for live birth and still birth reporting through industrialized nations.  I do, however, find his argument to be too dismissive to make at this point.  Considering the many other birth and neonate statistics in which the U.S falls far behind, it is possible that the U.S. has significantly more first day deaths than other industrialized nations.

Ken, I agree with you about letting babies die.  Letting anyone die, for that matter.  Families put so much effort into keeping a person alive that it can seem that they aren't considering that letting the person die in peace, as you said, is a valuable and loving gift they can give.  I work in research on medical technologies, specifically people's views of those technologies, and I find that people believe they have to "do everything possible." They then throw the medical book at the person in question, be it themselves or a loved one.  They think that if they don't "do everything possible," they are to blame for illness or death.  This is reinforced by medical professionals; a lot of subtle pressure can be exerted on people making these decisions.  The assumption is that maximizing medical technologies is "doing everything possible," but what about quality of life?  People do die.  Everyone, in fact.  So is it essential that life is prolonged through technology, or is it essential that life be a joy?

Li You Hu, however you would like to minimize it by saying it's 2 vs 3,  a 50% increase in first day death is significant.  It indicates that U.S. medical care is not competitive with other systems. In other words, it's not as good.

Ken Cox
Ken Cox

With all respect, this article seems terribly misleading; whether out of ignorance or out of sensationalism, I cannot say.

The statistically  high number of American first-day infant deaths per 1,000 births comes as a result of the American practice of counting extremely premature births as live births; whereas other countries do not.

Further, many nations with socialized medicine do not aggressively treat extreme premature births, and instead count them as still births, because of the enormous expense of caring for premature babies. Socialized medicine means rationed medicine. Public medicine can get away with allowing extremely premature babies to die naturally and peacefully.

Because of America's litigious culture, American hospitals must treat premature babies, and count them as live births, even though these babies have little chance of survival. In the best of all possible worlds, as a kindness to all, the American system would better serve parent and child if they allowed the child to die in peace, as a stillborn child. That won't happen in America for the foreseeable future.

This topic comes back around every few years. Check with your local birth center or pediatrician for the truth of the matter.

He Priv
He Priv

@Ken Cox You are incorrect. Most European nations have the exact same criteria for defining a live birth as the US.

Requirements for reporting a live birth, United States and selected European countries:

All live births:

Austria, Denmark, England and Wales, Finland, Germany, Hungary, Italy, Northern Ireland, Portugal, Scotland, Slovak Republic, Spain, Sweden, United States

Live births at 12 weeks of gestation or more:


Live births at 500 grams birthweight or more, and less than 500 grams if the infant survives for 24 hours:

Czech Republic

Live births at 22 weeks of gestation or more, or 500 grams birthweight or more:


All live births for civil registration, births at 500  grams birthweight or more for the national perinatal register:


Live births at 22 weeks of gestation or more, 500 grams birthweight or more if gestational age is unknown


Live births at 500 or more grams birthweight


Garm Hound
Garm Hound 1 Like

@Ken Cox the infant mortality statistic is not an outlier. The US places similarly in matternal mortality, under-5 mortality, fetal mortality, etc.

If the infant mortality was due to counting a greater share of infants as live, the US should be counting fewer as dead. This is not the case, the US  simply has more deaths at every step. More stillbirths, more infants dead, more under-5 children dead, moree mothers dead in childbirth.

Finally, most would say that the million with no access to healthcare in the US in themselves represent a  harsher rationing than any other nation produces. (Public health professionals and health care economists agree that much of the US poor results stem from the allocation of resources by ability to pay reather than by medical need, leading to a scarcity unknown in the rest of the world.

Lowell Hubbs
Lowell Hubbs

This is obviously a lot bigger than just involving the issue with stillbirths.

Hum Exp Toxicol. 2012 October

Relative trends in hospitalizations and mortality among infants by the number of vaccine doses and age, based on the Vaccine Adverse Event Reporting System (VAERS), 1990–2010

Li You Hu
Li You Hu 2 Like

" In the United States, babies are 50 percent more likely to die on the same day they were born than in all of the other industrialized countries combined"

This is an unclear way of saying there are (3) 1st-day deaths per 1000 live births in the US versus 2 per 1000 in a host of other developed nations (Canada, Austria, New Zealand, etc.).

Although, if you had reported that Canada, Austria and New Zealand COMBINED had twice the rate of 1st-day deaths per 1000  as the US, the story probably wouldn't have made it to Google News.

Danny OBrien
Danny OBrien

@Li You Hu It may not sound significant to you when you say per 1,000. But it is very significant when you add up all the thousands.

Flo Samuels
Flo Samuels

And let us all ignore the fact that the other "rich" countries have universal health care coverage. And that many Republican-led states in the United States have virtually eliminated pre-natal health care for the poor.

Mary C
Mary C

We also have a poverty of informed choice education as well as a lack of practice updating/hospital regulation going on in the U.S. hospital business.  Various routine interventions such as pitocin (just this week announced by the ACOG that new findings say it put sneonates at risk) and long-exposure bipovocaine epidural (a cocaine derivative, as reported by Mt. Sinai Medical Center as definitely crossing over into neonatal systems at the 6 hour mark).

Many if not most U.S. hospitals still do not conform to the WHO's Mother-Friendly Initiative, that calls for one hour of undisturbed bonding for opitmal maternal-child health & successful breastfeeding. 

Robin Lim CPM, an American-trained midwife and birth center director at two NON-PROFIT centers in Bali (the Bumi Sehat Yayasan centers), has had phenomenal results serving mostly at-risk women and many premature babies - and lotus birth & Kangaroo Care is a basic protocol.  CNN awarded her their 2011 Hero of the Year award due to the centers' fantastic stats, but you wouldn't guess it, judging by our American aversion for low-tech solutions to maternal-child health issues.

There are vested interests in this slowness of American hospital practice reform, and it is deleterious to long-term public health and social health. 

Aconcerned Person
Aconcerned Person 1 Like

This article is inaccurate. A still born baby is not a live birth. If first day deaths were so high in the US, don't you think the infant mortality rate might be a bit higher than it is? A first day death is considered an infant mortality! 

2nd....How do you calculate that were twice as likely as any other country combined? Likelyhood gives a percentage chance of it happing. That is a percent chance based off the population or the number of babies born per 100 or 1000. You can't add up all the other countries percentage chances without also adding up their population! Does anyone get what I am saying here?

Adam Knapp
Adam Knapp 1 Like

@Aconcerned Person Our infant mortality rate is tremendously high - one of the highest of ANY industrialized nation... and it has been for several years.

Michele Angelucci
Michele Angelucci 3 Like

Hmmm...wouldn't have anything to do with inductions, unnecessary interventions, unnecessary c-sections, immediate cord clamping, hepatitis b vaccine within hours of birth, not placing baby with mom right away, pushing formula instead of encouraging breast feeding...shall I go on? There is so much wrong with how this country routinely handles birth!!!

Gwendolyn Mugliston
Gwendolyn Mugliston

Who ever said the US is rich?  It is not when it does not provide adequate prenatal care to, I would estimate, 60-80% of the very young, the non-whites, and the ill-educated.  We have states thinking it is O.K. for 12 yo to not receive birth control in the face of knowledge a good %age of those kids are sexually active. Even 1% is too many to not have good birth control and knowledge of how to use it.  Diet and education are being driven by our political system that believes if if the kids don't have it already they don't deserve it.  Human life is very cheap here.

Walter Dexter
Walter Dexter 1 Like

There may be significant differences in reporting methodologies contributing to this finding. 

In the US, if the child is alive for even a moment after birth, that is a live birth.  In some countries, a child that dies within some period of time after birth isn't considered a live birth. So of course that country is going to have a lower first-day death rate than the US; by their definition the child was never alive.

Given that this is a report from a humanitarian group, not a group of professional researchers, things like this may have been overlooked in their findings.

I wish I knew where I'd seen this information about differences in reporting methodology of infant mortality, but I only remember the information, not the source.

Aconcerned Person
Aconcerned Person

Great Point. Glad someone here can think objectively. Why doesn't everyone google "infant mortality rate" and see what pops up. Just saying!

Daniel Stoner
Daniel Stoner 2 Like

It's not rocket science.... horribly crappy diets, horribly crappy sedentary lifestyle (lack of exercise), pumped full of unneeded drugs from big pharma, poisoned by Monsanto chemicals in our foods, and stressed out from high federal taxes and the loss of the middle class and American dream.

He Priv
He Priv

@Daniel Stoner Our federal taxes are much lower than other wealthy nations, so that point makes no sense at all. 

Kenny P.
Kenny P.

@Daniel Stoner 

Don't forget getting a second mortgage just to deliver a child. Average cost for a vaginal birth wo complications 10.1k...add a cesarean 17k.

 U.S. Agency for Healthcare Research and Quality, HCUPnet, Healthcare Cost and Utilization Project. Rockville, MD: AHRQ. Available at:

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