The primary reason Cuba has a lower infant mortality rate than the United States is that the United States is a world leader in an odd category — the percentage of infants who die on their birthday. In any given year in the United States anywhere from 30-40 percent of infants die before they are even a day old.
Why? Because the United States also easily has the most intensive system of
emergency intervention to keep low birth weight and premature infants alive
in the world. The United States is, for example, one of only a handful countries that keeps detailed statistics on early fetal mortality — the survival rate of infants who are born as early as the 20th week of gestation.
How does this skew the statistics? Because in the United States if an infant is born weighing only 400 grams and not breathing, a doctor will likely spend lot of time and money trying to revive that infant. If the infant does not survive — and the mortality rate for such infants is in excess of 50 percent — that sequence of events will be recorded as a live birth and then a death.
In many countries, however, (including many European countries) such severe medical intervention would not be attempted and, moreover, regardless of whether or not it was, this would be recorded as a fetal death rather than a live birth. That unfortunate infant would never show up in infant mortality statistics.
