what source did you use? here's the cia's for the last two years
https://www.cia.gov/library/public
ations/the-world-factbook/
180 United States 6.26 2009 est.
181 Cuba 5.82 2009 est.
182 European Union 5.72 2009 est.
183 Italy 5.51 2009 est.
184 Isle of Man 5.37 2009 est.
185 Taiwan 5.35 2009 est.
186 San Marino 5.34 2009 est.
187 Greece 5.16 2009 est.
188 Ireland 5.05 2009 est.
189 Canada 5.04 2009 est.
190 Wallis and Futuna 5.02 2009 est.
191 Monaco 5.00 2009 est.
192 New Zealand 4.92 2009 est.
193 United Kingdom 4.85 2009 est.
194 Gibraltar 4.83 2009 est.
195 Portugal 4.78 2009 est.
196 Australia 4.75 2009 est.
197 Jersey 4.73 2009 est.
198 Netherlands 4.73 2009 est.
199 Luxembourg 4.56 2009 est.
200 Guernsey 4.47 2009 est.
201 Belgium 4.44 2009 est.
202 Austria 4.42 2009 est.
203 Denmark 4.34 2009 est.
204 Korea, South 4.26 2009 est.
205 Liechtenstein 4.25 2009 est.
206 Slovenia 4.25 2009 est.
207 Israel 4.22 2009 est.
208 Spain 4.21 2009 est.
209 Switzerland 4.18 2009 est.
210 Germany 3.99 2009 est.
211 Czech Republic 3.79 2009 est.
212 Andorra 3.76 2009 est.
213 Malta 3.75 2009 est.
214 Norway 3.58 2009 est.
215 Anguilla 3.52 2009 est.
216 Finland 3.47 2009 est.
217 France 3.33 2009 est.
218 Iceland 3.23 2009 est.
219 Macau 3.22 2009 est.
220 Hong Kong 2.92 2009 est.
221 Japan 2.79 2009 est.
222 Sweden 2.75 2009 est.
223 Bermuda 2.46 2009 est.
224 Singapore 2.31 2009 est.
here's a copy of the list up to the US for 2008, we were 42nd from the least that year.
181 United States 6.30 2008 est.
182 Cuba 5.93 2008 est.
183 Isle of Man 5.62 2008 est.
184 Italy 5.61 2008 est.
185 Taiwan 5.45 2008 est.
186 San Marino 5.44 2008 est.
187 Greece 5.25 2008 est.
188 Monaco 5.18 2008 est.
189 Ireland 5.14 2008 est.
190 Canada 5.08 2008 est.
191 Jersey 5.01 2008 est.
192 New Zealand 4.99 2008 est.
193 United Kingdom 4.93 2008 est.
194 Gibraltar 4.91 2008 est.
195 Portugal 4.85 2008 est.
196 Australia 4.82 2008 est.
197 Netherlands 4.81 2008 est.
198 Luxembourg 4.62 2008 est.
199 Guernsey 4.53 2008 est.
200 Liechtenstein 4.52 2008 est.
201 Belgium 4.50 2008 est.
202 Austria 4.48 2008 est.
203 Denmark 4.40 2008 est.
204 Slovenia 4.30 2008 est.
205 Korea, South 4.29 2008 est.
206 Israel 4.28 2008 est.
207 Spain 4.26 2008 est.
208 Switzerland 4.23 2008 est.
209 Germany 4.03 2008 est.
210 Czech Republic 3.83 2008 est.
211 Malta 3.79 2008 est.
212 Andorra 3.68 2008 est.
213 Norway 3.61 2008 est.
214 Anguilla 3.54 2008 est.
215 Finland 3.50 2008 est.
216 France 3.36 2008 est.
217 Iceland 3.25 2008 est.
218 Macau 3.23 2008 est.
219 Hong Kong 2.93 2008 est.
220 Japan 2.80 2008 est.
221 Sweden 2.75 2008 est.
222 Singapore 2.30 2008 est.
also- while I agree maternal choices is always going to have an effect on the numbers further research shows that the common practices we use in birthing are disproven and, and not used by countries like Japan because of this. For example, when I was dealing with extreme gestational hypertension they wanted to do a cesarean, even though reserach clearly shows that a cesarean increased the risks of complications and death during birth and recovery from gestational hypertension over carefully monitored vaginal births. Another example, despite thousands of studies over two decades and statistics showing clearly that vaginal births after cesareans are safer, including this being the official guidelines of the American College of Obstetricians and Gynecologists (ACOG) and should be the routine it is still nearly impossible to find a hospital that will allow a woman with a previous cesarean to try for a VBAC, most routinely are forced into another Cesarean because it's 'safer' despite every fact we khave saying the opposit. The most common reason for a repeat cesarean remains being because the women has had one before. The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. In 2007 ours was 31.8 according to the cdc.
And this data just deals with cesareans, there is data like this across the board for practices used in the US., from our birthing position forced in most hospitals (bithing on the back actually increased the destress of the baby, raises mothers blood pressure, increases risk of failure to progress because the human body is meant to birth in an upright forward position so the pelvis can not open up correctly on the back and the baby has to up and over, instead of slide down) to regularly administered drugs that clearly show increased mortality and complication risks, to not allowing women to eat and drink even though again research shows this to greatly increase the risks (imagine running a marathon only allowed ice chips and no substance).
So to me it's not just that there's room for improvement, the room for improvement is clearly outlined and shown but for some reason American conventional medicine refuses to follow where the overwhelming research and studies take us.
A good solid place to start research on this subject is with the book Obstetric Myths Versus Research Realities by Henci Goer. It has clear easy to read info and cites credible research and studies. It's a good jumping off point. Another good book also by Henci Goer along with Rhonda Wheeler is The Thinking Woman's Guide to a Better Birth. It lists the info as a guide book to help women make informed decisions about their births every step of the way divided into applicable categories. It also clearly lists research and study citations w/ credible source. There are many other good books on the subject, but these two I have found have very thorough info with easy to look up yourself references, so you aren't just having to trust the author knows their stuff. They are good jumping off points, but not end alls.