Social Policy in Ontario

Once able to boast about its high world ranking for low infant mortality, Canada has now dropped from sixth to 24th place – just above Hungary and Poland.

The death rate of infants less than one year of age – 5.1 per 1,000 live births – has been called “shockingly high” and translates into 1,881 mortalities in 2007, according to the most recent data collected by the Organization for Economic Co-operation and Development.

About three-quarters of those deaths occurred in the first 27 days of life.

The drop in ranking below countries such as Sweden, Japan, Finland, France, Ireland and Greece has prompted a prominent doctors group to request an urgent meeting with the federal Health Minister to push for a national birthing strategy.

“We’re losing our reputation,” said André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada. “We have fallen way behind.”

The main causes cited by researchers are poverty, isolation, premature births and to some degree, the way the data are collected. For example, in Canada, infant mortality includes the death of any breathing infant, even very early births and terminations due to congenital abnormalities after 20 weeks gestation, but other countries have different measures.

Still, experts say Canada could learn from other countries – Japan and Sweden among them – that have low infant death rates. Japan is successful in resuscitating premature babies, while Sweden has regulations dictating that with IVF treatments, only one embryo can be transferred into the womb at a time. (Other countries implant multiple embryos, leading to more multiple births and higher risk.) Canada’s aboriginal community has traditionally seen high infant death rates due to poverty and remote locales, but those numbers alone do not explain the country’s low ranking, says Michael Kramer, scientific director of the Institute of Human Development, Child and Youth Health, Canadian Institutes of Health Research.

“The concern is that we’re not really making any impact on reducing the incidence of these spontaneously born very pre-term infants,” Mr. Kramer said. “We don’t really know enough about what causes them, that’s the challenge – that’s where we need to make improvements.”

Premature babies are at increased risk for infant mortality. About 54,000 out of 350,000 babies were born prematurely or small for their gestational age in 2006-07, according to the latest Canadian Institute for Health Information figures.

Part of a solution, according to Dr. Lalonde, is a national birthing plan, which he estimates would cost $43.5-million over five years. It recommends 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.

Tim Vail, spokesman for Health Minister Leona Aglukkaq, said representatives from the minister’s office will meet with the doctors group, and are currently working on a date.

Prakesh Shah, a neonatologist at Mount Sinai Hospital, belongs to an advisory group for Ontario’s strategy on late pre-term births. Socioeconomic factors – such as impoverishment – are a big part of preterm births, he says, as are delaying pregnancy and the increasing number of in-vitro fertilization pregnancies.

Dr. Shah recently sent a team to Estonia – which was tied in 2005 with Canada for its infant mortality – and found that other countries treat premature babies and their mothers much differently than in Canada.

“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 the 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.”

Even the Conference Board of Canada has described this country’s rate of infant mortality as “shockingly high,” causing many to wonder: How can such a rich country do so poorly with its most vulnerable citizens?

“It should always be a little bit embarrassing if you are not number one,” said Douglas McMillan, a neonatologist at the IWK Health Centre in Halifax. “You are dealing with the most precious thing the family will have in their whole life; we need to be cognizant of that.”

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