Maybe the dingo ate ‘em. Or at least that would be a plausible suggestion, for all of the context provided by The Globe & Mail‘s front page article “Why are our babies dying?” on Saturday (interesting that the online edition has a less incendiary title). The article addresses our drop in the OECD’s 2007 (latest data) infant mortality rate (IMR) league tables from 6th to 24th place – which would certainly seem to be a newsworthy event. So what does the Globe get wrong? Well, just about everything.
Let’s start here: since there’s no indication of the time frame in which we made this drop, and since it is after all a current news story, the reader is left to assume that the drop has occurred since the prior year, 2006. Yet such a large drop in such a short time span seemed implausible, so I went to the OECD’s website to look at the raw data. While I couldn’t find the report that prompted the article, the consolidated data was readily available, and lo and behold, our ranking in 2006 was 23rd, making our “drop” to 24th in 2007 not nearly so alarming. In fact, we haven’t been in 6th place since 1990, as the chart below shows.
Of course, that doesn’t make nearly so interesting a story. But it begs a far more interesting question, because it shows that our decline has not been linear — look at the big steps at 1992-1993 and 2002-2003.
We were in the low single digits, and then we jumped to the mid-teens, and then we jumped to the low 20s, but the article gives us no indication of why that might have occurred. It’s possible it was a statistical anomaly, such as a change of definition, either by Canada or by a large block of other OECD countries such as the EU. It’s possible there were new standards of care that were adopted elsewhere but not in Canada. It’s even possible that other countries simply caught up to our standard of care, but were able to implement it more uniformly because they don’t have as geographically and economically diverse a landscape to contend with (consider the differences between Toronto hospitals and those serving — though perhaps not particularly proximate to — aboriginal communities in northern Manitoba). That’s the kind of question we expect our fourth estate to answer, and the Globe failed miserably here.
The next problem with the article is that it makes it appear as if our absolute IMR is getting worse. Consider the second paragraph: “The death rate of infants less than one year of age — 5.1 per 1000 live births — has been called ‘shockingly high’ and translates into 1881 mortalities in 2007…” “Shockingly high” is not an opinion on our ranking, it’s an opinion on our absolute rate — and the author clearly thinks it’s important, because it’s repeated in the article’s final paragraphs (in the online edition, it appears a third time in the subhead). It comes from the Conference Board of Canada, certainly a respected source, but it’s telling that the Globe omits the rest of their statement: “for a country at Canada’s level of socio-economic development.” In other words, the Conference Board was giving their opinion about our relative position, not our absolute position. Which is good, because our IMR has in fact continued to decline — not just over the last century, but also in the last decade, as the data from Statcan clearly shows:
There are other strange parts of the article, such as the 3 paragraphs devoted to birthing practices in Estonia, a sweeping generalization based on one doctor’s assessment that barely even relates to the topic at hand, while casting aspersions at the Canadian standard of care. Consider:
‘In Estonia, mothers stay in hospital until baby is discharged home and provide most of the care for their babies. Nurses act as consultant to mothers,’ said Dr. Shah. ‘Here, we have medicalized that care in such a way that parents are less involved during hospitalization, and suddenly, one day when baby comes home, they are expected to provide complete care. It’s an entirely different concept.’
Uh, where do I start? How about:
- Estonia isn’t in the OECD, so they’re not part of the ranking this story is allegedly covering.
- No evidence is provided to show that the birthing process in Estonia is leading to lower infant mortality rates. After all, the article states in the prior paragraph that they were tied with us at 5.1 in 2005. And other experts in the same article have suggested that socio-economic factors are the main reasons behind our rate.
- Based on that description, Estonia doesn’t sound particularly different than my experience with the births of my own 2 children at Mt. Sinai (where, incidentally, Dr. Shah is a neonatologist). Mother stayed until baby was discharged? Check. Mother responsible for the care? Well, the babies were in the room with us and my wife nursed them, so…check. I suppose there are nuances I could be missing, but it reminds me more of the type of complaint usually heard from midwives rather than neonatologists.
Of course, failure to follow the Estonian model is only one of a dizzying array of reasons presented for our “shockingly high” rate. Others include: (1) poverty, (2) isolation, (3) statistical anomalies, (4) premature births, (5) not resuscitating premature births the way Japan does, (6) delaying pregnancy, (7) increased IVF, and (8) not restricting IVF the way Sweden does. Some of these reasons are anecdotal, some merely opinions, and some are probably backed by data; how I’m supposed to figure out which is which is beyond me.
So where does this leave the poor reader? We “know” that things are bad in Canada and getting worse. We “know” that there are a bunch of reasons why our system is failing us. And we know that someone wants money to fix it: André Lalonde of The Society for Obstetricians and Gynaecologists has recommended a National Birthing Plan to the tune of $43.5M to provide
“federal leadership in seven key areas, including a mechanism to accurately gather data, a focus on maternity patient safety, implementing national standardized practice guidelines, and a coalition that would create a model of sustainable maternity and newborn care.”
Maybe we need that, maybe we don’t; maybe we need a different plan or no plan at all. I’m certainly no expert on the subject. It doesn’t seem like a lot of money, and I’m inspired by Mark Crislip’s Epiphany to think that maybe we should strive not just for the top of the league tables, but for a cost-effective path to zero infant deaths. Unfortunately, the Globe article doesn’t provide me with even the rudiments of the data required to form an educated perspective on the topic. And shouldn’t that be the point of journalism?