However, the method of calculating IMR often varies widely between countries, and is based on how they define a live birth and how many premature infants are born in the country. Infant mortality rates can be flawed depending on a nations’ live birth criterion, vital registration system, and reporting practices.[22] Certain practices of measurements have the potential to be underestimated. Measurements provide a statistical way of measuring the standard of living of residents living in each nation. Increases and decreases of the infant mortality rate reflect social and technical capacities of a nations’ population.[5] The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, heartbeat, umbilical cord pulsation or definite movement of voluntary muscles.[23] This definition is practised in Austria, for example.[24] In Germany the WHO definition is practised as well but with one little adjustment: the muscle movement is not considered as a sign of life.[25] Many countries, however, including certain European states (e.g. France) and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[26] In the Czech Republic and Bulgaria, for instance, requirements for live birth are even higher.[27]
Although many countries have vital registration systems and certain reporting practices, there are a great number of inaccuracies, particularly in undeveloped nations, in the statistics of the amount of infants dying. Studies have shown in comparing three information sources: official registries, household surveys, and popular reporters, the “popular death reporters” show the greatest amount of accuracy. Popular death reporters include indigenous midwives, gravediggers, coffin builders, priests, and more—essentially people who knew the most about the child’s death. In developing nations, access to vital registries, and other government run systems pose difficulties for poor families to record births and deaths due to a variety of reasons. These struggles force stress on families, and make them take drastic measures in unofficial death ceremonies for their deceased infants, as well as inaccurately reflect a nations infant mortality rate. Popular death reporters provide information first hand from inside sources gaining reliable facts that: provide a nation with accurate death counts, meaningful causes of deaths that can be measured/studied, and allow a sense of relief and meaning to a child’s death which may give families less pain/grievance.[28]
UNICEF uses a statistical methodology to account for reporting differences among countries:
“ UNICEF compiles infant mortality country estimates derived from all sources and methods of estimation obtained either from standard reports, direct estimation from micro data sets, or from UNICEF’s yearly exercise. In order to sort out differences between estimates produced from different sources, with different methods, UNICEF developed, in coordination with WHO, the WB and UNSD, an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. Since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official IMR estimates used at the country level. However, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time.[29] ”
Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries. It suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths, but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[30]
The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden and Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[32] which are used throughout the European Union.[33] However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[34][35][36]
