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CMAJ recently drew attention to Alberta's high infant mortality rate and implicated babies from neighbouring provinces, multiple births and “a large First Nations population that experiences higher rates of alcohol and tobacco use.”1 However, as the Canadian Perinatal Surveillance System has consistently maintained, infant mortality comparisons are compromised if they do not account for differences in birth registration practices, especially those pertaining to live births at the borderline of viability.2,3,4,5,6 For instance, an increasing temporal trend in the registration of live births less than 500 g (without a corresponding increase in other low-birth-weight categories) was deemed responsible for the increase in Canada's infant mortality rate in 1993.2
The registration of live births less than 500 g and less than 24 weeks gestation is more meticulous in Alberta than elsewhere in Canada (Table 1).2,7,8 Such differential registration (of a subgroup at very high risk of infant death) explains Alberta's poor infant mortality ranking and also the increase in mortality rates in Alberta (in 2002) and in Canada (in 1993 and 2002).
Although more detailed analyses are warranted, it is evident (and ironic) that the province with good birth registration practices is being singled out for criticism. On the other hand, Ontario, which has a dismal record in terms of registering births, is rarely mentioned by the news media. Problems in Ontario include under- registration of births (especially among vulnerable subpopulations such as single mothers) because of fees for birth registration,9 missing birth registrations for 25% of infant deaths6 and delays in reporting that affect the timeliness of Canadian vital statistics and surveillance reports.