THE GLOBAL CITIZEN: The State of the World as Seen by its Babies

Politicians and economists look at the latest GDP reports to see how their nations are doing. I look at the IMR reports.IMR stands for infant mortality rate. It's the number of babies out of every thousand born who die before they reach their first birthday. To give you an idea of the range of this index, Finland had the world's lowest IMR -- 3.5 -- in 1998. That means 996.5 out of 1000 infants born reached age one. The highest infant mortality rate -- 195 -- was in Sierra Leone in West Africa. About one baby in five did not survive its first year.Babies die because their mothers get poor health care, poor nutrition, little education. They die because of unclean air and water. They die because they have been exposed to disease or pollutants before or after they are born. Which is to say, the IMR is a sensitive measure of the degree to which a society has mastered the basics of life and health and made them available to its most vulnerable members.IMR data are full of surprises, among them the relatively high number for the United States. Our babies are twice as likely to die as Finnish babies; our IMR of 7.0 is higher than Canada's (6.3), Israel's (6.7), Taiwan's (6.7) or Portugal's (6.9). It is far higher than the infant mortality rates of Japan (3.8), Germany (4.9), France (5.1), Italy (5.8), Spain (4.7), the Netherlands (5.7), or Sweden (3.9).If it looks like the difference between an IMR of 7.0 and 3.5 is small, multiply it by the annual 4 million births in the U.S. and you see that if our rate were as low as Finland's, we would save 14,000 babies each year, 38 each day, 1.6 each hour.People can look at those numbers and come up with different explanations for why some countries score so much better than we do. The explanation that leaps out to me is that we don't treat all our citizens fully as citizens. Infant mortality for our white population is 6.0; for our black population it is 14.2. For whites in Massachusetts it is 4.7, for blacks in Washington DC it is 19.2. We know perfectly well how to take care of mothers and babies. We're just not extending that care to everyone.The Hunger Project once set an IMR value of 50 as an arbitrary but reasonable target for all the world's nations. Below 50 a country can be said to have at least basic social and economic coherence. Above 50 a country that allows more than five percent of its babies to die can hardly be called developed.All Europe is below 50, even Croatia (IMR 8.0), Russia (17), Albania (20) and Romania (22.6 -- the highest IMR in Europe).Asia has made astonishing progress in infant survival, especially such countries as Malaysia (IMR 10), South Korea (11) Sri Lanka (16.5), Thailand (25), Iran (35), and China (31 -- an amazingly low rate for a poor country that produces over 20 million babies a year). The Asian nations that don't make the target of 50 are few enough to list: Yemen (77), Afghanistan (150), Bangladesh (82), Bhutan (71), India (72), Nepal (79), Pakistan (91), Cambodia (116), Laos (97), Myanmar (83),and Iraq (127 -- that terribly high number due to a combination of a vicious government and an international trade embargo).Latin America has been even more successful in bringing infant mortality below 50. All Central America has achieved that goal except Guatemala, which is on the edge of doing so (51). All the Caribbean except Haiti (74). All South America except Bolivia (75) and Guyana (63). Cuba's IMR (7.2) is comparable to that of the United States, in spite of its economic hardships.When I first started paying attention to IMR statistics, no country in Africa scored below 50 except some island nations of the Indian Ocean. (Mauritius 21, Reunion 9, Seychelles 7.) Slowly, however, some African nations are getting close to or past the goal. Algeria 44, Tunisia 35, South Africa 52, Zimbabwe 53, Botswana 60., Kenya 62. However far too many African countries still lose more than one in ten of their newborns -- Niger 123, Mali 123, Ethiopia 128, Malawi 140, Mozambique 134, Somalia 122, Angola 124. These are also countries without the resources to keep statistics on such everyday events as the deaths of babies, so actual mortality numbers could be even higher than the official ones listed here.Some people, understandably worried about the problem of population growth, would say, but what if all those babies lived? Of the 138 million children born worldwide each year, 8 million die. If the mortality rates of Finland or Sweden applied everywhere, 7.5 million of them would live. That would definitely swell the world population (which is currently adding 84 million a year), if it were all that happened.But the very measures that bring down infant mortality rates also bring down birth rates. Sierra Leone, with its IMR of 195, averages 6.5 births per woman. Afghanistan averages 6.1, Haiti 4.8, Kenya 4.5. The U.S. averages 2.0, Cuba 1.4, Germany 1.3, Thailand 2.0, China 1.8, Finland 1.7.It takes very little money to save babies, especially when compared to money spent for weapons. What it mostly takes is caring. The GDP may measure how economically active a nation is; the IMR measures how well it cares for its people.(Donella H. Meadows is director of the Sustainability Institute and an adjunct professor of environmental studies at Dartmouth College.)

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