Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries. It suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths, but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths. Another seemingly paradoxical finding, is that when countries with poor medical services introduce new medical centers and services, instead of declining, the reported IMRs often increase for a time. This is mainly because improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area, and not been reported to the government, might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase. Collecting the accurate statistics of infant mortality rate could be an issue in some rural communities in developing countries. In those communities, some other alternative methods for calculating infant mortality rate are emerged, for example, popular death reporting and household survey. The country-to-country variation in child mortality rates is huge, and growing wider despite the progress. Among the world's roughly 200 nations, only Somalia showed no decrease in the under-5 mortality rate over the past two decades. The lowest rate in 2011 was in Singapore, which had 2.6 deaths of children under age 5 per 1,000 live births. The highest was in Sierra Leone, which had 185 child deaths per 1,000 births. The global rate is 51 deaths per 1,000 births. For the United States, the rate is eight per 1,000 births. Infant mortality rate (IMR) is not only a group of statistic but instead it is a reflection of the socioeconomic development and effectively represents the presence