Kidsdata.org provides the following measures of infant mortality:

• Infant mortality rate, as a three-year average
• Infant mortality rate by leading cause of death, as a three-year average
• Infant mortality rate by race/ethnicity, as a five-year average due to low numbers

To show comparable information at the local and state levels, kidsdata.org lists only the leading causes of death in children for the state of California. The leading causes of infant deaths in California are very similar to the leading causes locally and nationally. Kidsdata.org also provides data on deaths among older children.

Infant mortality is one of the most important indicators of the health of a nation, as it is associated with a variety of factors, including maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices (1). Major causes of infant mortality include: preterm births; congenital malformations or abnormalities (birth defects); Sudden Infant Death Syndrome (SIDS); maternal complications of pregnancy; and complications of the placenta, cord and membranes (2, 3). Early access to high-quality prenatal and well-baby preventive care can help identify and ameliorate some risk factors for infant mortality.

Although the U.S. infant mortality rate has declined since the 1980s, the rate is still higher than those in most other developed countries (1, 4). The infant mortality rate among African American/Black infants is particularly high—more than double the rate for white infants in recent years (5). Reducing infant mortality has been a national public health priority for decades. Healthy People 2020, an initiative of the U.S. Department of Health and Human Services that sets national public health goals, set an objective to reduce infant mortality from 6.7 deaths among children under age 1 per 1,000 live births in 2006 to 6.0 deaths per 1,000 live births in 2020 (6).

Find more information and research about infant mortality in kidsdata.org's Research & Links section.

Sources for this narrative:

1. MacDorman, M. F., & Mathews, T. J. (2008). Recent trends in infant mortality in the United States. NCHS Data Brief, 9. Hyattsville, MD: National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/data/databriefs/db09.htm.
2. MacDorman, M. F., & Mathews, T. J. (2009). Behind international rankings of infant mortality: How the United States compares with Europe. NCHS Data Brief, 23. Hyattsville, MD: National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/data/databriefs/db23.htm. 
3. Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC). (2011). Birth defects: Leading causes of infant death. Retrieved from: http://www.cdc.gov/Features/dsInfantDeaths/.
4. Federal Interagency Forum on Child and Family Statistics. (2011). Infant Mortality. Retrieved from: http://www.childstats.gov/americaschildren11/health2.asp.
5. MacDorman, M. F. & Mathews, T. J. (2011). Understanding racial and ethnic disparities in U.S. infant mortality rates. NCHS Data Brief, 74. Hyattsville, MD: National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/data/databriefs/db74.htm.
6. U.S. Department of Health and Human Services. (2011). Healthy People 2020: Maternal infant and child health: All infant deaths (within 1 year) MICH-1.3. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26

Some of the leading causes of infant mortality are preventable, or their risks can be addressed through public policy. While California policy currently promotes newborn screenings for potentially fatal birth defects (1), not all women understand the screening options, what the results mean, and/or how to follow up on the results. Public and institutional policy also can affect the risk and protective factors for Sudden Infant Death Syndrome (SIDS) and for prematurity, which can lead to infant death. Risks of prematurity can be reduced by ensuring that women are in good health before conception, avoiding smoking and substance use while pregnant, forgoing non-medically indicated preterm induction of labor or cesarean birth, and participating in comprehensive prenatal care programs (4, 5, 6).

According to research and subject experts, policy options that could influence infant mortality include:

• Increasing public education about newborn screenings and ensuring funding for those screenings, as screenings can prevent infant death, brain damage, and serious illness (1)
• Enhancing public education about how to reduce SIDS risk among a wide constellation of potential caregivers for infants; primary recommendations include avoiding sleeping on the stomach, overheating, overly soft and loose bedding, co-sleeping with an adult, and maternal smoking during pregnancy (2)
• Sustaining adequate funding for universal screening for substance use among pregnant women, and for treatment services specifically designed for pregnant women who use alcohol or illicit drugs (3, 4)
• Supporting public education and systems change to reduce the number of non-medically indicated induced preterm deliveries and cesareans (5, 6)
• Promoting expanded research, education and demonstration projects aimed at reducing the rates of preterm labor and delivery
• Supporting a comprehensive approach to women’s health, including integration of reproductive planning into women’s routine health care, as good health before conception can improve pregnancy outcomes; included in this approach should be a focus on increasing interpregnancy intervals (at least 12 months), recognizing that short intervals are associated with increased risk for preterm birth (7, 8)

For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section, or visit the Centers for Disease Control and Prevention and the March of Dimes. Also see policy implications on kidsdata.org for Prenatal Care, Low Birthweight and Preterm Births, and Health Care.

Sources for this narrative:

1. California Newborn Screening Program. (n.d). Retrieved from: http://www.cdph.ca.gov/programs/nbs/Pages/default.aspx
2. American Academy of Pediatrics. (2005). Policy statement: The changing concept of Sudden Infant Death Syndrome. Pediatrics, 115(5): 1245-1255. Retrieved from: http://pediatrics.aappublications.org/cgi/reprint/116/5/1245?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=SIDS+Risk+Reduction&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
3. Chasnoff, I. J., McGourty, R. F., Wells, A. M., & McCurties, S. (2008). Perinatal substance use screening in California. Chicago, IL: NTI Upstream. Retrieved from: http://www.adp.cahwnet.gov/Alcohol/pdf/PerinatalSubstanceUseSR.pdf
4. Brady, T. M., & Ashley, O. S. (2005). Women in substance abuse treatment: Results from the Alcohol and Drug Services Study (ADSS). US Department of Health and Human Services. Retrieved from: http://oas.samhsa.gov/WomenTX/WomenTX.htm#2.4
5. March of Dimes. (2010). Elimination of non-medically indicated (elective) deliveries before 39 weeks gestational age. California Maternal Quality Care Collaborative, California Department of Public Health. Retrieved from: http://www.cdph.ca.gov/programs/mcah/Documents/MCAH-EliminationOfNon-MedicallyIndicatedDeliveries.pdf
6. Fleischman, A. R. (2010). What happens when babies are born too early? March of Dimes Foundation, Testimony before the US House of Representatives: Prematurity and Infant Mortality. Retrieved from: http://www.modimes.org/advocacy/prevention_indepth.html
7. DeFranco, et al. (2007). A short interprenancy interval is a risk factor for preterm birth and its recurrence. American Journal of Obstetrics and Gynecology, 197(3). Retrieved from: http://www.ajog.org/article/S0002-9378%2807%2900818-6/abstract
8. Wise, P. (2008). Transforming preconceptional, prenatal, and interconceptional care into a comprehensive commitment to women's health. Women’s Health Issues, 18(6), Supplement, S13-S18. Retrieved from: http://www.whijournal.com/article/S1049-3867%2808%2900109-6/fulltext#sec4

California's infant mortality rate has declined from 5.9 per 1,000 live births in 1996-98 to 4.9 in 2008-10. Local infant mortality rates range widely, from 2.6 to 7.2 among counties with available data in 2008-10. Statewide, in 2008-10 and previous years, the leading causes of infant deaths were congenital defects and disorders related to preterm birth and low birthweight. Disparities persist in infant mortality rates by race/ethnicity, with California's Asian/Pacific Islander and white infants having lower infant mortality rates than other racial/ethnic groups with available data.

• Association of Maternal and Child Health Programs
• Child Trends: Infant, Child, and Teen Mortality
• ChildStats.gov, Federal Interagency Forum on Child and Family Statistics
• CityMatch
• Infant Mortality and Pregnancy Loss Knowledge Path, Maternal and Child Health Library at Georgetown University
• Maternal and Infant Health Research, Centers for Disease Control and Prevention
• Office of Minority Health and Health Disparities: Infant Mortality, Centers for Disease Control and Prevention
• Pediatrics Journal

• Air Pollution and Postneonatal Infant Mortality in the United States, 1999-2002, 01/2008, Environmental Health Perspectives, Woodruff, Darrow & Parker
• Behind International Rankings of Infant Mortality: How the United States Compares with Europe, 2009, National Center for Health Statistics, MacDorman & Mathews
• Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach, 2010, Ethnicity and Disease, Lu et al.
• Intensive Home Visiting Is Associated with Decreased Risk of Infant Death, 2007, Pediatrics, Donovan et al.
• Pediatric Palliative and Hospice Care in America, 04/2009, National Hospice and Palliative Care Organization, Friebert
• Perinatal Substance Use Screening in California, 2008, NTI Upstream, Chasnoff et al.
• Persistent Socioeconomic Disparities in Infant, Neonatal, and Postnatal Mortality Rates in the United States 1969-2001, 04/2007, Pediatrics, Singh & Kogan
• Policy Statement: The Changing Concept of Sudden Infant Death Syndrome, 2005, American Academy of Pediatrics
• Recent Trends in Infant Mortality in the United States, 10/2008, National Center for Health Statistics, MacDorman & Mathews
• Recommendations to Improve Preconception Health and Health Care --- United States, 04/21/2006, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Johnson et al.
• The Challenge of Fetal Mortality, 04/2009, National Center for Health Statistics, MacDorman & Kirmeyer
• What Happens When Babies are Born Too Early: Testimony on Prematurity and Infant Mortality, 05/12/2010, March of Dimes Foundation, Committee on Energy and Commerce & Subcommittee on Health, U.S. House of Representatives, Fleischman

• Kern County Report Card, 2013, Kern County Network for Children
• Tulare County Children’s Report Card 2010, 2011, Children's Services Network

add your report to kidsdata.org

Do you have a local or regional report relevant to a topic on kidsdata.org? If you’d like to add it to our research and links section, please send it to us at kidsdata@lpfch.org.