Leadership, Education & Training Program (LET)

Infant Mortality

Infant mortality is one of the most important indicators of the health of a nation.  It is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices.

The U.S. infant mortality rate generally declined throughout the 20th century, from 100 infant deaths per 1,000 live births in 1900 to 6.89 infant deaths per 1,000 live births in 2000. 1

In 2011 the United States of America is ranked 41st in the world with an infant mortality rate of 6.0 per 1,000 being behind many other countries such as:

Rank Country
Rate per 1,000
1 Monaco
1.79
2 Singapore
2.32
3 Bermuda
2.47
13 Germany
3.54
23 Denmark
4.24
24 Austria
4.32
25 Belgium
4.33
29 United Kingdom
4.62
33 New Zealand
4.78
34 Cuba
4.90
35 Canada
4.92
36 Greece
5.00
37 Hungary
5.3

* Adapted from The CIA World Factbook

The U.S. infant mortality rate did not decline significantly from 2000 to 2005, which has generated concern.1

Healthy People 2020 Objective
Baseline Rate (2006)
Target Rate
Infant Deaths per 1,000 live births
6.7
6
Infant deaths attributed to birth defects per 1,000 live births
1.4
1.3
Infant deaths attributed to congenital heart and vascular defects per 1,000 live births
0.38
0.34
Infant deaths attributed to SIDS per 1,000 live births
0.55
0.5
Infant deaths attributed to unexpected/unexplained causes per 1,000 live births
0.93
0.84

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26


Leading causes of infant deaths:

  • Congenital malformations, deformations and chromosomal abnormalities
  • Disorders related to short gestation and low birth weight: not elsewhere classified
  • Sudden infant death syndrome4


Risk Factors for Infant Mortality

Key risk factors contributing to high-risk pregnancies and infant deaths:

  • Previous premature or low birth weight baby
  • Less than optimal health before a woman becomes pregnant
  • Pre-pregnancy obesity
  • Hypertensive disorders.8
  • Smoking during pregnancy12 or Exposure to secondhand smoke during pregnancy
  • Inadequate nutrition and insufficient intake of folic acid (a B vitamin) before and during pregnancy
  • Infants born to unmarried mothers
    • Black mothers were three times as likely as white mothers and more than four times as likely as Asian and Pacific Islander mothers to be unmarried9
  • Using street drugs and alcohol during pregnancy
  • Baby's exposure to secondhand smoke after birth
  • Infant sleeping on his stomach
  • Close spacing between pregnancies
  • Infections - including reproductive tract infections, sexually transmitted diseases and periodontal (oral) infections during pregnancy

 

Chronic psychosocial stress may be associated with low birth weight neonates in a low-income population of women. In a study that looked at self reported Chronic psychological stress by low income women several indicators are associated with low birth weight including:

  • Food insecurity
  • Living in a home with at least one child with a chronic illness
  • Living in a crowded home
  • Being unemployed
  • Having poor coping skills
  • Also reported by women who delivered low birth weight but not statistically significant:
  • The existence of poor social support
  • A diagnosis of depression
  • Perceived economic hardship 10

 

Infant mortality rates are higher than the U.S. average among infants born to mothers who are:

  • Adolescents
  • Unmarried
  • Smokers
  • Lower educational levels
  • Had a fourth or higher order birth
  • Did not obtain adequate prenatal care12

 

Nutrition Related Risk Factors:

Inadequate intake of natural folate, or its synthetic form, folic acid, before and during early pregnancy, is associated with an increased risk of spina bifida, anencephaly, and other neural tube defects.13

Gestational diabetes can increase the risk of fetal macrosomia, birth trauma, newborn hypoglycemia, and hyperbilirubinemia15

  • 5.2% of all women get gestational diabetes. It is higher for American Indians/Alaska Natives at 8.1% and Asian/Pacific islanders at 8.0%.14

 

Strong evidence exists for an association between maternal hemoglobin concentration and birth weight, as well as between maternal hemoglobin concentration and preterm birth.16

  • 33. 9% of women are anemic in their third trimester of pregnancy. 14
% Women Pregnant in 3rd Trimester with Anemia
(Low Hb/Hct)
Race/Ethnicity
3rd Trimester %
White, Not Hispanic
26.8
Black, Not Hispanic
49.4
Hispanic
30.9
American Indian/Alaska Native
35.0
Asian/Pacific Islander
28.3
Multiple Races
32.1
All Other/Unknown
32.3
Total
33.9

* Adapted from 2010 Pregnancy Nutrition Surveillance.

In the Preterm Prediction Study, low pre- pregnancy BMI was strongly associated with an increased risk of preterm birth, with relative risk above 2.517

2010 Pregnancy Nutrition Surveillance

Maternal Health Indicators by Race/Ethnicity
Prepregnancy BMI
Race/Ethnicity
Underweight %
Overweight %
White, Not Hispanic
5.2
51.2
Black, Not Hispanic
3.8
58.7
Hispanic
3.4
54.7
American Indian/Alaska Native
2.9
62.2
Asian/Pacific Islander
8.7
31.9
Multiple Races
4.8
52.4
All Other/Unknown
5.1
49.1
Total
4.5
53.4

* Adapted from 2010 Pregnancy Nutrition Surveillance.

Infant Mortalitiy Rates by Race/Ethnicity

United States Infant Mortality Rate
by Race (per 1,000)-2008
Non-Hispanic White
5.5
Black or African American
12.7
American Indian
8.1
Asian and Pacific Islander
3.7
Hispanic or Latino
5.7
Total
6.6

*Adapted from the Kids Count Data Center at: http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?ind=21

 

Infant mortality rates by race:
US, 2005-2007 Average

White
5.6
Black
13
Native American
8.5
Asian
4.7
Total
6.8

*Adapted from National Center for Health Statistics, period
linked birth/infant death data. www.marchofdimes.com/peristats.

Quick Facts

  • African American mothers were 2.3 times as likely as non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
  • American Indian/Alaska Natives have 1.6 times the infant mortality rate as non-Hispanic whites.
  • Puerto Rican infants were twice as likely to die from causes related to low birth weight, compared to non-Hispanic white infants.
  • The infant mortality rate is 1.7 times greater for Native Hawaiians than for non Hispanic Whites.5

 

Infant mortality rate per 1,000 live births, 2002*
Race of Mother
Infant Mortality
Rate
Ratio vs.
Non-Hispanic White
Non-Hispanic White
5.8
--
Total Asian/Pacific Islander
4.8
0.8
Native Hawaiian
9.6
1.7
Other Asian/Pacific Islander
4.7
0.8

Source: CDC 2007. Health United States, 2007. Table 19. http://www.cdc.gov/nchs/data/hus/hus07.pdf

African Americans

  • African Americans are four times as likely to die as infants due to complications related to low birth weight as compared to non-Hispanic white infants.
  • African Americans had 1.9 times the sudden infant death syndrome mortality rate as non-Hispanic whites, in 2007.
  • African American mothers were 2.3 times more likely than non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
  • The infant mortality rate for African American mothers with over 13 years of education was almost three times that of Non-Hispanic White mothers in 2005.5

 

Infant mortality rate per 1,000 live births in 2007 of Non-Hispanic Black is 13.3.

Non-Hispanic Black infants have 2.4 times the infant mortality rate as Non-Hispanic Whites.

Maternal perception of exposure to racial discrimination during pregnancy may be associated with very low birth weight in their infants.6

Infant deaths and mortality rates for the top 3 leading cause of death for African Americans, 2007
(Rates per 100,000 live births)
Cause of Death
(By rank)
African American Death Rate
African American/ Non-Hispanic White Ratio
Low-Birthweight
297.2
3.9
Congenital malformations
165.3
1.3
Sudden infant death syndrome (SIDS)
107.9
1.9
Maternal Complications
95.5
2.9

Source: CDC 2011. Infant Mortality Statistics from the 2007 Period
Linked Birth/Infant Death Data Set. National Vital Statistics Reports.
Table 7. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf


American Indians/Alaska Natives

  • American Indian/Alaska Natives have an infant mortality rate in 2007 of 9.2 per 1,000 live births.
  • American Indian/Alaska Natives have 1.6 times the infant mortality rate as non-Hispanic whites.
  • American Indian/Alaska Native infants are 2.5 times as likely as non-Hispanic white infants to have mothers who began prenatal care in the 3rd trimester or not receive prenatal care at all.5

 

One study of SIDS in an American Indian population found 3 factors that public health action could impact and further research would be advisable:

  1. visits by PHNs
  2. periconceptional maternal alcohol drinking and first trimester binge drinking
  3. infant layers of clothing7

 

Infant deaths and mortality rates for the top 3 leading cause of death for American Indian/Alaska Native, 2007. (Rates per 100,000 live births)
Cause of Death (By rank)
American Indian/Alaska Native Death Rate
American Indian/ Alaska Native/Non-Hispanic White Ratio
Congenital malformations
184.1
1.5
Sudden infant death syndrome (SIDS)
141.6
2.4
Low-Birthweight
95.1
1.2

Source: CDC 2011. Infant Mortality Statistics from the 2007 Period Linked
Birth/Infant Death Data Set. National Vital Statistics Reports.
Table 7. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf

Asians and Pacific Islanders

  • Asian/Pacific Islanders in 2007 have an infant mortality rate of 4.8 per 1,000 live births.
  • Asian/Pacific Islanders infant mortality rate is .9 times that of the Non-Hispanic White Infant mortality rate
  • The infant mortality rate for Asian/Pacific Islanders was twice as great for mothers under 20 years old, as compared to mothers, ages 25-29 years old. 5

 

Infant deaths and mortality rates for the top 4 leading cause of death for Asians/Pacific Islanders, 2007. (Rates per 100,000 live births)
Cause of Death (By rank)
American Indian/Alaska Native Death Rate
American Indian/ Alaska Native / Non-Hispanic White Ratio
Congenital malformations
111.6
0.9
Low-Birthweight
83.3
1.1
Maternal complications
30.6
0.9
Sudden infant death syndrome (SIDS)
21.6
0.4

Source: CDC 2011. Infant Mortality Statistics from the 2007 Period
Linked Birth/Infant Death Data Set. National Vital Statistics Reports.
Table 7. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf

Infant Mortality/SIDS and Hispanic Americans

Among Hispanic Americans, the infant mortality rate ranges from 4.8 per 1,000 live births for Central and South Americans to 7.7 per 1,000 live births for Puerto Ricans.

  • In 2007, infant mortality rates for Hispanic subpopulations ranged from 4.8 per 1,000 live births to 7.7 per 1,000 live births.
  • In 2006, Puerto Ricans had 1.4 times the infant mortality rate of non-Hispanic whites.
  • Hispanic mothers are almost twice as more likely to begin prenatal care in the 3rd trimester or not receive prenatal care at all as compared to non-Hispanic white mothers.

 

Infant deaths and mortality rates for the top 4 leading cause of death for Hispanics/Latinos, 2007. (Rates per 100,000 live births)
Cause of Death (By rank)
Hispanic Death Rate
Hispanic/ Non- Hispanic
White Ratio
Congenital malformations
141.3
1.1
Low-Birthweight
84.7
1.1
Sudden infant death syndrome (SIDS)
29.2
0.5
Maternal complications
26.9
0.8


Source: CDC 2011. Infant Mortality Statistics from the 2007 Period Linked
Birth/Infant Death Data Set. National Vital Statistics Reports.
Table 7. http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_06.pdf


References

  1. MacDorman MF, Mathews TJ. Recent trends in infant mortality in the United States. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2008. NCHS Data Brief no. 9. Available at http://www.cdc.gov/nchs/data/ databriefs/db09.pdf.
  2. CIA World Factbook. https://www.cia.gov/library/publications/the-world-factbook/ (Accessed May 15th 2012)
  3. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Available at www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=33. Accessed 4/28/2012.
  4. CDC National Center for Health Statistics. Fast Stats: Infant Mortality. Available at: http://www.cdc.gov/nchs/fastats/infant_health.htm
  5. U.S. Department of Health and Human Services. Office of Minority Health: Infant Mortality/SIDS Data and Statistics. Washington, D.C. Available at: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=3&lvlid=8 Accessed: May 20, 2012.
  6. Collins JW Jr, David RJ, Symons R, Handler A, Wall SN, Dwer L. Low- income African American mothers' per- ception of exposure to racial discrimina- tion and infant birth weight. Epidemiology. 2000;11:337–339.
  7. Iyasu S, Randall LL, Welty TK, et al. Risk factors for sudden infant death syndrome among northern plains indians. JAMA. 2002;288(21):2717-2723.
  8. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf
  9. Waldron I, Hughes ME, Brooks TL. Marriage protection and marriage selection – prospective evidence for reciprocal effects of marital status and health. Soc Sci Med. 1996;43:113-23.
  10. Borders, A.E.B., W.A. Grobman, L.B. Amsden & J.L. Holl. 2007. Chronic stress and low birth weight neonates in a low-income population of women. Obstet. Gynecol. 109: 331–338.
  11. DeNavas-Walt C, Proctor BD, Lee CH. Income, poverty, and health insurance coverage in the United States: 2005. Washington, DC: US Census Bureau; 2006. Current Population Reports no. P60-231. Available at http://www.census.gov/prod/2006pubs/p60-231.pdf
  12. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2010. National Vital Statistics Reports Vol. 58, no. 17. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr58/ nvsr58_17.pdf.
  13. Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS. Spina bifida. Lancet. 2004 Nov 20- 26;364(9448):1885-95.
  14. Polhamus B, Dalenius K, Mackintosh H, Smith B, Grummer- Strawn L. Pediatric Nutrition Surveillance 2009 Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011. Found at
  15. Gabbe SG, Graves CR. Management of diabetes mellitus complicating pregnancy. Obstet Gynecol. 2003;102:857-68.
  16. Rasmussen K. Is There a Causal Relationship between Iron Deficiency or Iron-Deficiency Anemia and Weight at Birth, Length of Gestation and Perinatal Mortality? J Nutr. 2001 Feb;131(2S- 2):590S-601S.
  17. Hendler I, Goldenberg RL, Mercer BM, Iams JD, Meis PJ, Moawad AH, MacPherson CA, Caritis SN, Miodovnik M, Menard KM, Thurnau GR, Sorokin Y. The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth. Am J Obstet Gynecol. 2005 Mar;192(3):882- 6.
  18. CDC 2011. Infant Mortality Statistics from the 2007 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports

 

Health Disparities

Outside