Wednesday, January 12, 2005

Infant Mortality as a National Security Issue

God, lots of interesting stuff to write about today. First: Nicholas Kristof writes in the New York Times today about the U.S. infant mortality rate. Apparently, it's been rising; Kristof dramatically points out that it's now higher than Cuba's. He considers this to be unacceptable, and so do I: the fact that other countries are so much better than we are in that respect is evidence that we could also be better, and therefore we should. But I find some of Kristof's rhetoric surprising. I think he may be taking things a little too far. He writes:
If we had a rate as good as Singapore's, we would save 18,900 babies each year. Or to put it another way, our policy failures in Iraq may be killing Americans at a rate of about 800 a year, but our health care failures at home are resulting in incomparably more deaths - of infants. And their mothers, because women are 70 percent more likely to die in childbirth in America than in Europe. Of course, deaths in maternity wards occur one by one, and don't generate the national attention, grief and alarm of an explosion in Falluja or a tsunami in Sri Lanka. But they are far more frequent: every day, on average, 77 babies die in the U.S. and one woman dies in childbirth. Bolstering public health isn't as dramatic as spending $300 million for a single F/A-22 Raptor fighter jet, but it can be a far more efficient way of protecting Americans.
Apparently Kristof thinks that 'protecting Americans' means something like 'minimizing the number of deaths of Americans'. But I just don't see why this should be so. Isn't it worse for an adult to be killed than it is for an infant to die of natural causes? If you have the resources to either (1) save the life of an American soldier who has been injured in combat or (2) prevent two infants from dying of natural causes within their first year, shouldn't you pick the former? Infant mortality is bad. When a young child dies, it is a tragedy. But I think it's a mistake to spin this as a national security issue.


  1. A few things. First, I think you're right that it's poor judgment to call infant mortality a "national security threat," but it's in the right ballpark. It's a threat especially to those of us who are pregnant, might one day be pregnant, or have a wife, daughter, sister, or friend who is or might one day become pregnant, and those of us who have young children or a young niece, nephew, grandchild--which is to say, just about all of us. Why, after all, do we care about national security threats? Presumably in large part because they threaten us (thus the name!), those we love, and innocent people generally. Ditto for infant mortality and poor health care. So really what we've got here is a genus, "Security," and two species, "National" and "Health." That's how it should be presented. (A similar argument could be run for poverty, access to affordable drugs, environmental sanity, etc.)


    "If you have the resources to either (1) save the life of an American soldier who has been injured in combat or (2) prevent two infants from dying of natural causes within their first year, shouldn't you pick the former?"

    But Kristof's statistics have it that if we were to rise to the level of Singapore, the ratio would be about 23 infants to one soldier per year, not 2 to 1.

    Also, it's worth keeping in mind that one needn't approach this as a zero sum game. If we're willing to put X amount of resources into a botched, illegal, immoral, and bloody occupation, we should be willing to put X amount of resources into saving the lives of our women and children (and men, too!) by improving health care. It's not like we only have X amount of dollars and we're asking: now should we continue the occupation with these X dollars, or invest in health care? Both could be done--though, of course, only the latter ought to be done.


  2. Lots of good points, John. Obviously I don't endorse the war -- I happen to think it's doing nothing whatsoever to save any lives of Americans or anyone else. I was just objecting to a simple 'minimize deaths' calculus as a measure of national security. I agree that there are lots of good reasons to work hard to keep infant mortality rates down -- among these are, as you cite, *our* interest in the well-being of our infants. And I'll even concede a bit more -- the infants probably have an interest in staying alive, too; they are harmed when they die.

    I agree with almost everything you say, John.

  3. I think this is a very intersting phenomenom, but I feel that the media may have presented the statistics poorly so that they presented a better story.

    The U.S. health care system also allows more very high risk pregnancies to come to full term. Overcoming toximia, gestational diabetis, heart and lunch defects in infants is not terribly unusual. This superior prenatal care allows many babies to be born that would have miscarried in other countries (like cuba). Some of them are allowed to be born just for the chance of living, but not all of them make it.

    Miscarries do not count against the infant mortality rate, but infants who are born with a hole in their heart and cannot survive the opporation to repair that defect do.

    Whether or not these babies should be brought to full term is a completely different argument.

  4. I'm not sure he wants to implement the kinds of policies Singapore has. There's a reason their crime rate is so low, and I suspect their low infant mortality rate is for related reasons. Their society is very restricted. My friends there don't mind (and don't understand American ways), but they all tell me that most Americans would not like living there.