Among 33 industrialized nations examined in a new report, the United States tied with Hungary, Malta, Poland and Slovakia with a death rate of nearly 5 per 1,000 babies. Only Latvia had higher mortality figures, with 6 per 1,000, according to the report by the U.S.-based Save the Children.
"We are the wealthiest country in the world, but there are still pockets of our population who are not getting the health care they need," said Mary Beth Powers, a reproductive health adviser for Save the Children, which compiled the rankings based on health data from countries and agencies worldwide.
The report was released Monday, ahead of Mother's Day.
Researchers noted that the United States is more racially diverse and has a greater degree of economic disparity than many other developed countries, making it more challenging to provide culturally appropriate health care.
The report, which was released Monday, also said a lack of national health insurance and short maternity leaves likely contribute to the poor U.S. rankings.
Other possible factors in the U.S. include teen pregnancies and obesity rates, which both disproportionately affect African-American women and also increase risk for premature births and low birth weights.
Among U.S. blacks, there are 9 deaths per 1,000 live births, closer to rates in developing nations than to those in the industrialized world.
"Every time I see these kinds of statistics, I'm always amazed to see where the United States is because we are a country that prides itself on having such advanced medical care and developing new technology ... and new approaches to treating illness. But at the same time not everybody has access to those new technologies," said Dr. Mark Schuster, a Rand Co. researcher and pediatrician with the University of California, Los Angeles.
In the analysis of global infant mortality, Japan had the lowest newborn death rate, 1.8 per 1,000 and four countries tied for second place with 2 per 1,000 — the Czech Republic, Finland, Iceland and Norway.
Still, it's the impoverished nations that feel the full brunt of infant mortality, since they account for 99 percent of the 4 million annual deaths of babies in their first month. Only about 16,000 of those are in the United States, according to Save the Children.
The highest rates globally were in Africa and South Asia. With a newborn death rate of 65 out of 1,000 live births, Liberia ranked the worst.
In the United States, about half a million babies are born prematurely each year, data show. African-American babies are twice as likely as white infants to be premature, to have a low birth weight, and to die at birth, according to Save the Children.
The lack of national health insurance and short maternity leaves in the U.S. can lead to poor health care before and during pregnancy, increasing risks for premature births and low birth weight, which are the leading causes of newborn death in industrialized countries. Infections are the main culprit in developing nations, the report said.
On the group's "Mother's Index," which ranks health and wellness conditions for mothers and children in 125 countries, the United States ties with Great Britain for 10th in 2006. Ranked higher are Sweden, Australia and Canada. Burkina Faso and Niger rank last.
In past reports by Save the Children, U.S. mothers' well-being has consistently ranked far ahead of those in developing countries but poorly among industrialized nations. This year the United States tied for last place with the United Kingdom on indicators including mortality risks and contraception use.
According to the report, across the globe infections account for 36 percent of newborn deaths, prematurity explains a further 27 percent, and complications from birth asphyxia cause another 23 percent.
While the gaps for infants and mothers contrast sharply with the nation's image as a world leader, Emory University health policy expert Kenneth Thorpe said the numbers are not surprising.
"Our health care system focuses on providing high-tech services for complicated cases. We do this very well," Thorpe said. "What we do not do is provide basic primary and preventive health care services. We do not pay for these services, and do not have a delivery system that is designed to provide either primary prevention, or adequately treat patients with chronic diseases."