David F Lancy Ph.D.

Benign Neglect

Is the U.S. Like a Third World Nation?

Choosing between groceries and medicine.

Posted Jun 27, 2017

There is a contrast between the culture of childhood in the West, particularly the U.S., compared to other cultures and nations, and it is a theme that runs through several of my books. I wrote in 2008:

“Our willingness to spend billions on high-tech neonatal medicine in one sector of society is offset by an unwillingness to spend far smaller sums of money on preventing prematurity and other gestation and birth problems. Nor do we pay enough attention to children's health needs.  Of every 100 children recently surveyed in East St. Louis, 55 were incompletely immunized for polio, diphtheria, measles and whooping cough. Compared to nations in Europe, our support for family planning, including contraception, genetic counseling, and pre- and postnatal care is paltry. As a result of this ideologically motivated parsimony, our infant mortality rate places us 27th on a list of developed nations.” (1)

When it comes to maternal and child health care, the U.S. is ranked with Third World countries (2) and well below other wealthy, peer nations in Europe.  But, the U.S. rate of 6.1 infant deaths per 1,000 live births masks considerable state-level variation. If Alabama were a country, its rate of 8.7 infant deaths per 1,000 would place it slightly behind Lebanon in the world rankings. Mississippi, with its 9.6 deaths, would be somewhere between Botswana and Bahrain. To put it bluntly, babies born to poor moms in the U.S. are significantly more likely to die in their first year than babies born to wealthier moms.

While the U.S. may be ranked no higher than 27th in infant mortality, our rank for child immunization (measles, specifically) is 114. (3) Another frightening statistic is maternal mortality.

“The United States, one of the wealthiest nations in the world, is now one of only eight countries -- including Afghanistan and South Sudan -- where the number of women dying as a result of pregnancy and childbirth is going up. There is no question that lack of access to affordable and good quality care is playing a role in the overall increasing maternal mortality rate.” (4)

The Affordable Care Act (ACA, often called Obamacare) of 2010, including the expansion of Medicaid, specifically addressed these issues in expanding access to affordable, quality health care for the millions of American mothers and their children who lack such access. The ACA has been successful in expanding coverage leading to the promise of improved outcomes for mothers and their infants and a refutation of the embarrassing “third-world country” designation.  Now, of course, those potential improvements are threatened by the new federal government’s passionate commitment to rolling back President Obama’s progressive initiatives. Here is the assessment of the “new” Republican health care plan from a friend of mine who happens to be an accomplished pediatrician:

“You have probably heard about the health care bill just released in the Senate. In short, it seeks to decrease health care costs by making massive cuts to Medicaid. As you may know, Medicaid is the primary insurer of poor children and those with disabilities, including the elderly. If this bill is passed, millions of children will lose their insurance, and their parents will need to pay out of pocket when they get sick. You have all experienced how difficult emotionally and financially it is to have a child with medical problems. Now imagine if you didn’t have health insurance, and you had to choose between buying groceries and buying medicine. This is a decision no family in our country should struggle with. As you can expect, we pediatricians are absolutely appalled by this bill, and held a gathering at our hospital auditorium today to rally people against it.”

In thinking about the phrase “choose between buying groceries and buying medicine,” I was reminded of a new book I’d just read by Aaron Denham entitled Spirit Children: Illness, Poverty, and Infanticide in Northern Ghana (University of Wisconsin Press). While the term “third-world country” is frequently used as a point of comparison, few Americans have much of an understanding of what the designation means, particularly in reference to maternal-child health. Denham’s book presents, in great detail, several cases illustrating the almost mandatory eugenics that occurs in an impoverished third-world community.

The Nankani inhabit a remote area of Northern Ghana with very poor conditions for farming. Communities are beset by frequent drought but, even in a good year, their sorghum and millet (arid crops) harvests are depleted before the next harvest, leading to chronic malnutrition, particularly in children. During “hungry time,” families use their sparse supply of cash to purchase exorbitantly priced foodstuffs. Incidentally, this is the same “bank account” that must be drawn on for medical care, children’s schooling, and taxes. Over time, conditions have steadily worsened, with overpopulation and climate change-induced extreme weather patterns—drought being followed by torrential rains and flooding.

Living on the thin edge of starvation, the Nankani place each newborn on probation. The infant is not given a permanent name—that comes much later. On the one hand, a healthy, vigorous child promises to quickly grow out of the need for maternal care and, even as a toddler, begin to help out with chores like fetching water or firewood. Further in the future, a “good” child will care for elderly parents, take care of their funeral, and insure they will make it to the world of the ancestors.  On the other hand, a deformed, handicapped, or sickly child promises to be a continuing burden on its mother—who, ideally, puts in a full day’s work in the fields and at home—preventing her from doing her work and delaying her next, hopefully more successful, pregnancy. Aside from incurable, congenital problems like cerebral palsy, Nankani children are frequent victims of malaria, severe diarrhea, respiratory problems, and meningitis—all of which lead to further complications if not promptly and effectively treated.   

Aside from the need for extra care, the family must weigh the decision to make some investment in medical care for the child. Local healers and their remedies are the first line of defense, as they’re cheaper and readily available. Western-inspired medical facilities are typically distant, costly, and often a case of too little, too late. Being sent home from the clinic with the admonition to accept the child’s condition as permanent is unacceptable.

The Nankani culture, like many others, sees the child as coming from the world of spirits to the human realm. (5) Spirit children are those who fail to complete this transition. In the “diagnosis” of the Spirit Child by the Dongodaana, various anomalies exhibited by children with serious health issues become malevolent.

“People refer to spirit children as snakes because many cannot walk; are perceived as elusive, cunning, and deceptive; and are as deadly as snakes. The snake is not only a metaphor for spirit children; it is their embodiment.”

The spirit child is held responsible for calamities that beset the family including sickness, death, crop failure and, familial discord. The spirit child is especially a threat to present and future siblings as it desires to monopolize the mother’s attention.  Because the spirit child’s malevolence and need for care impacts a wide circle of extended family, it is identified and “treatment” commenced following family consensus—irrespective of the mother’s stance. This decision—often after months of discussion and failed intervention—leads to the child being given “medicine” by the Dongodaana which is stored in the highly ritualized cow’s horn Dongo. “Not having any link to the social world, spirit children are disposed of in the bush, often where other spirits are known to dwell.” (6)

According to Wikipedia, the U.S. has 565 billionaires, considerably ahead of other major economic powers, including Germany, China and India. And the US ranks fourth in the width of the income inequality gap, behind Chile, Mexico, and Turkey. In terms of structural inequality, the U.S. looks much more like India and China than Germany. As the wealthiest nation in the world both in terms of GNP and the number of truly wealthy individuals, we can certainly afford universal health care. From a moral standpoint, can we afford not to?


1. D. F. Lancy, The Anthropology of Childhood. Cambridge University Press, 2008.

2. Health Care is not the only metric that places the US in the Third World category. The designation can be applied also to our economy (Peter Temin The Vanishing Middle Class. MIT Press, 2017) and to the trend towards autocratic leadership.

3. Ingraham, Christopher 2014. Our infant mortality rate is a national embarrassment.  The Washington Post. September 29th https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/?utm_term=.7ce1376dd225

4. Wallace, Kelly 2015. Why is the maternal mortality rate going up in the US? CNN, December 11th http://www.cnn.com/2015/12/01/health/maternal-mortality-rate-u-s-increasing-why/index.html

5. D. F. Lancy, Raising Children: Surprising Insights From Other Cultures. Cambridge University Press, 2017.

6. A. R. Denham Spirit Children: Illness, Poverty, and Infanticide in Northern Ghana.  University of Wisconsin Press, 2017.

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