ABSTRACT

Much can be learned by examining the many ways maternity is organized and by looking at the different outcomes associated with various systems of care, but we must not forget that comparisons between countries can conceal important variations that exist within countries. Consider, for example, rates of infant mortality. These rates are widely used to assess the quality of a nation’s maternity care system, a measure of how well different nations are caring for their youngest citizens and their mothers. However, when looking at mortality rates it is also important to know the extent of variation in those rates across different regions and population groups within a single country. Looking at the two countries examined in this chapterSweden and the United States-we find a telling difference in intracountry variation. The infant mortality rate in Sweden accurately reflects the risk for most Swedish women, but the U.S. rate represents an average computed from wide variations by social class, race/ethnicity, and immigration status. For some U.S. women the infant mortality risk is akin to that in low-income countries, while for others it resembles the low rates of Sweden and other Western European social democracies.