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Member Research & Reports

Member Research & Reports

UAB: Why Is the U.S. Preterm Birth Rate So Much Higher Than the Rates in Canada, Great Britain, and Western Europe?

Emeritus Professor Dr. Janet Bronstein and associate professor Dr. Martha Wingate from the department of Health Care Organization and Policy at the University of Alabama at Birmingham School of Public Health teamed with Dr. Anne Brisendine, a post-doctoral fellow from UAB’s department of Psychology to compare birthrates among different countries.

They found that the portion of newborns delivered before term is considerably higher in the United States than in other developed countries. We compare the array of risk exposures and protective factors common to women across national settings, using national, regional, and international databases, review articles, and research reports.

Women from the U.S. have higher rates of obesity, heart disease, and poor health status than women in other countries. This is in part because more U.S. women are exposed to the stresses of racism and income disparity than women in other national settings, and stress loads are known to disrupt physiological functions. Pregnant women in the United States are not at higher risk for preterm birth because of older maternal age or engagement in high-risk behaviors. However, to a greater extent than in other national settings, they are younger and their pregnancies are unintended. Higher rates of multiple gestation pregnancies, possibly related to assisted reproduction, are also a factor in higher preterm birth rates.

Canada, Great Britain, and the Western European countries all have social welfare systems that were established earlier and are broader in scope than the system in the United States. Following World War II, these countries developed packages of public policies that were explicitly framed to support families. Family support policies include cash transfers to households to reduce the impact of poverty, compensation to families for the costs of having children, and labor laws intended to balance work and family obligations, including paid maternity and parental leave. In contrast, U.S. social welfare policies are not oriented towards supporting families but instead are designed to encourage and sometimes mandate individual workforce participation. For example, eligibility for cash transfer programs and food stamps expires if adults do not seek employment. In the United States, large employers are required to provide parental leave but are not required to continue to pay parents while they are on leave. There is no requirement for workplaces to provide paid leave during pregnancy.

Reproductive policies that support intentional childbearing and social welfare policies that reduce the stress of income insecurity can be modeled from those in place in other national settings to address at least some of the elevated U.S. preterm birth rate. Reproductive health policies that support families in choosing the timing of pregnancies that go to term and in choosing to limit multiple embryo implantation during fertility treatments would also have beneficial effects.

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