The lives and deaths of infants: America’s disturbing disadvantage

An American woman’s right to an abortion is receiving a good deal of political, judicial and social debate, making news headlines and leading to marches across the country. In contrast, comparatively little attention, protests or news is being given to the country’s disturbing disadvantage in its rate of deaths during a baby’s first year of life.   

Among more developed countries, America’s infant mortality rate is nearly the highest. The rate for the United States does not even fall among the top 40 countries in the world with the lowest infant mortality rates. 

As one American comedian once acerbically remarked about the differential emphasis that some social conservatives place on pregnancy and an infant, “They will do anything for the unborn. But once you’re born, you’re on your own.”

With approximately 3.7 million births registered in the United States in 2019, America’s infant mortality rate is close to 6 deaths per 1,000 births. In contrast, no less than 20 countries have infant death rates of three or less, including Iceland, Italy, Israel, Japan, Norway, Spain and Sweden. 

America’s infant mortality rate of six is nearly 70 percent higher than the average rate of about three for the European Union countries. And a baby born in the United States is nearly three times as likely to die during their first year of life as a baby born in Iceland, Japan or Sweden.

Despite America’s comparatively high infant mortality rate, noteworthy improvements have been achieved over the recent past. For example, the number of infant mortality deaths in 2019 is about 6 percent less than in 2017 and the infant mortality rate has declined by 17 percent since 2005.

Also, the U.S. rate of infant deaths is substantially below its level a century ago. America’s current infant mortality rate is less than 10 percent of the 1921 rate of 76 infant deaths per 1,000 births. The high rate of infant deaths a century ago contributed to the government passage of the Sheppard-Towner Act, which was the first major piece of U.S. federal legislation focused on improving maternal and infant health.

The two leading causes of infant deaths in America in 2018 were congenital malformations or birth defects, accounting for 21 percent of infant deaths, followed by disorders related to short gestation and low birthweight, at 17 percent. Other notable causes, each responsible for about 5 percent of infant deaths, were maternal complications, sudden infant death syndrome and unintentional injuries.

Mortality rates were highest for infants of women under age 20, with approximately 9 infant deaths per 1,000 births. The lowest infant mortality rate was among women aged 30 to 34 years, about 5 infant deaths per 1,000 births. After age 35, the rates increased progressively, reaching 7 infant deaths per 1,000 births for women aged 40 years and over

Considerable variation and differentials in the infant mortality rate exist across the country. Among the states, for example, the lowest infant mortality rates, with 4 or fewer deaths per 1,000 births, are in New Hampshire, Massachusetts, California and Washington.

The highest infant mortality rates, above 7 deaths per 1,000 births, are observed largely in southern states, including Mississippi, Louisiana, Alabama and Tennessee. Stated slightly differently, a baby born in Mississippi is three times more likely to die before reaching the age of 1 than a baby born in New Hampshire.  

Notable differences in infant mortality rates also exist among America’s major ethnic/racial groups. In 2018, America’s rates ranged from lows of 4 to 5 infant deaths per 1,000 births for Asians, non-Hispanic whites, and Hispanics to highs of approximately 8 to 11 infant deaths per 1,000 births for American Indians, Pacific Islanders and non-Hispanic Blacks. 

Significant differences in infant death rates also occur across educational groups. In some states, such as Kentucky, Tennessee and West Virginia, infants whose mothers have not completed high school are more than twice as likely to die as those born to college-educated mothers. 

Increased education, both formal and informal, offers pregnant women and mothers more connections and skills to access resources for infant and maternal health, especially after the mother and child have left the hospital. It also leads to increased awareness of healthy behaviors, such as prenatal and postnatal care, proper nutrition, breastfeeding, good sanitation, immunizations, exercise and cessation of smoking, alcohol and drug consumption. 

America’s disturbing disadvantages in infant mortality rates and disparities among its population are believed to be primarily related to the country’s socioeconomic inequality. Over the recent past, the widening social and economic inequalities in infant mortality are a major factor contributing to the worsening of America’s international standing and contrary to U.S. health policy of reducing health inequalities.

Addressing social and economic inequalities by improving access to quality health care and maternal education and increasing social expenditures, particularly aimed at preventing preterm births and reducing post-neonatal mortality, would likely have the greatest impact on America’s infant mortality disadvantage. 

The death of a baby is certainly one of the most painful experiences that can happen to parents and families. In addition to the personal heartbreak, the unexpected loss of an infant may result in extreme grief and persistent sadness among parents and family members.

It is widely recognized that the level of infant deaths reflects a nation’s wellbeing and the effectiveness of its health services for babies, pregnant women and young mothers. The poor standing of the United States relative to other wealthy nations is more than a disgrace; it is a clear warning that much more needs to be done to ensure the survival of America’s infants.

While the United States has made notable gains in reducing its rate of infant mortality over the recent past, ensuring that more babies survive their first year of life at levels comparable to other developed countries is surely a desirable, affordable and achievable goal for America. 

Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division and author of numerous publications on population issues, including his recent book, “Births, Deaths, Migrations and Other Important Population Matters.”