Save the Children Rates the Countries

Save the Children has published its annual rankings of countries that are best for women and children. Watch the news stories over the next few days; most will be like this item on the Health Central web site, headlined: “U.S. Again Misses Top Tier on Global Nurture List.” Health Central’s story begins:
“The United States has again failed to reach the top tier of countries considered the best for mothers and their children.
“For the fourth year running, the international relief organization Save the Children ranked the United States 11th in its annual Mothers’ Index, released Tuesday. Mary Beth Powers, a senior reproductive health advisor at Save the Children and one of the authors of the report, explains that the biggest reason the United States hasn’t been able to move into the top 10 is because every woman doesn’t have equal access to quality health care.”
Hmm. I always like to check the actual data on reports like this; you can find the numbers here in PDF format.
The problem with rankings of this sort is that advocacy groups nearly always put their thumbs on the scale by including factors that are mostly political. Thus, the data show the U.S. ranking 4th on the “Children’s Index,” but only 13th on the “Women’s Index.” (The two are combined to form the “Mothers’ Index.”) Why this difference?
It doesn’t take long to figure out. In the “Women’s Index,” along with such logical items as “percent of pregnant women with anemia” and “adult female literacy rate,” Save the Children includes a “political status” column, measured by the percentage of seats in the national legislature held by women. This accounts for most of the difference between the U.S. and European countries like Sweden, Norway and Switzerland, which rank at the top of the index and have more women in their legislatures.
There is also a sneakier reason. The “Women’s Index” includes maternal mortality as a factor–as it should, given the purported purpose of the study. But the mortality rate is measured as the “lifetime risk of maternal mortality.” That language puzzled me for a moment, until I realized what was going on. The birth rate in the U.S. is much higher than in European countries like Sweden and Switzerland. By adding up the total “lifetime” maternal mortality risk, instead of assessing the risk on a per-baby basis, as would be logical, Save the Children is penalizing American mothers for having more children. This can hardly be unintentional.
Over the next few days, expect to see dozens of news articles and op-ed columns on this study. Every one of them will bemoan America’s allegedly mediocre standing and the opinion pieces will call for more government programs as a remedy. None will mention the real reasons for America’s modest standing in the “Mothers’ Index.”