Question special

I think that the home birth or out-of-hospital outcomes from Oregon need to be looked at in the context of overall perinatal mortality rates. USA perinatal mortality rate is ~6.6/1000.
Canada ~6 or lower. We in Canada, despite different healthcare systems from USA are similar to USA and both worse than many other countries. 26 countries better than USA. Japan 4/1000. Western Europe ~6/1000. Asia ~4.89/1000. Developing nations 40-50/1000. Outcomes from Oregon look pretty good from all settings. How to explain?