Well I'm glad you brought up that it's not that simple, because you are right, it's not.
We're great at fixing broke things.
In fact we are the best that ever was.
We're NOT good at keeping people healthy.
Because we live in the most self-indulgent society that the world has ever known.
And we're not good at delivering babies.
I think that if we honestly compared the incidence (per capita) of drug/alcohol abuse, STD exposure, single-parent pre-natal difficulties, over-eating/bad eating habits [including adolescent/early adulthood anorexia/bulemia], work stress while pregnant, sedentary lifestyle, late-life pregnancy and self-indulgent indifference to the "fetus" among Americans to the incidence of same among the countries we are being compared to in these so-called studies, we would find that the variable control for these so-called studies is virtually non-existent.
A lot of American guys think they can drink a twelve-pack every night, and not have their child be born with birth defects. They are wrong. A lot of American women think they can have their first child at 38, and not have the child suffer for it. They too are wrong. It can be done, but the child is the person that will pay.
As much as I despise European culture, when it comes to simple things like not doing Xtasy all night every night for 5-6 years before having a baby, they beat us hands down.
And as for nutrition, can anyone that lives in this country (the one country most obsessed with producing health and nutrition oriented books/magazines/multi-media for general consumption than any other I am aware of) honestly say they aren't aware that they should follow easily available guidlines for good pre-natal health? A doctor can (and does in my experience) give the patient the necessary information, but I can't expect the doctor to follow the patient around and see to it that they follow their advice.