Infant mortality is defined as the death of an infant prior to his or her first birthday. The infant mortality rate represents number of infant deaths for every 1,000 live births. In the United States, infant mortality rate was 5.9 deaths per 1,000 live births as of 2016. However, of the developed countries, the United States persistently has among one of the highest rates of infant mortality. Despite the overall decline in mortality rate, there remains significant disparities among populations that are likely attributed to multiple barriers to health care, from prenatal to postnatal care. Therefore, it is imperative as pediatricians to identify and address these barriers in order to improve maternal health care and subsequently reduce infant mortality.
The Center for Disease Control and Prevention (CDC) reported over 23,000 infant deaths in 2016. The leading causes of infant deaths include birth defects, preterm births and low birth weight, sudden infant death syndrome (SIDS), maternal pregnancy complications, and injuries (i.e. suffocation). The rates of deaths also vary based on multiple factors, such as socioeconomic status, education, neighborhood safety, race and ethnicity, and access to transportation. Non-Hispanic black infants remain disproportionately affected by infant mortality. Nationwide, the mortality rate of non-Hispanic black infants is 11.4 compared to 4.9 among non-Hispanic white infants in 2016. In the state of Texas, significant variability in mortality rates are even found within a particular group among different communities. Race and ethnicity alone are unlikely to create significant differences in rates.
The alarming rates of infant mortality have fortunately caught the public’s attention, and through the years actions have been taken to improve birth outcomes. Notably, overall infant mortality rate had a greater than 10% decline, from 6.86 deaths in 2005 to 5.9 deaths per 1,000 in 2015. With the development of safe sleep practices in the 1990s, there has been dramatic decline in the rates of SIDS across the country.
Armed with awareness that infant mortality rates in the United States are higher than many developed countries (i.e. Canada, France, Switzerland, and Australia), Congressman Steve Cohen (D-TN) recently introduced H.R.117 in Congress, the Nationally Enhancing the Wellbeing of Babies through Outreach and Research Now (NEWBORN) Act. This proposed legislation focuses on implementing pilot programs in high risk metropolitan areas to provide maternal care and address the leading causes of infant deaths. This could aid the targeted areas in the country that are subject to highest risk of infant mortality.
While there are no definitive measures to prevent many of the leading causes of infant mortality, there are ways to lower the risks. Providing maternal education prior to and during pregnancy, such as the importance of receiving adequate folic acid supplementation can prevent neural tube defects. To address preterm birth and low birth weight with their associated outcomes, our communities must provide adequate and accessible prenatal care for mothers.
Pediatricians should continue to advise safe sleep practices in households throughout the first year of life during clinic visits to reduce SIDS. We must continue to counsel parents on infant care, feeding and parenting in addition to postpartum care during well baby visits.
Consistent parental counseling and education at the local clinical setting along with advocacy at the legislative level will further contribute to nationwide efforts to seek solutions to improve birth outcomes and wellbeing of mothers and infants.
Melody Chiu, M.D.