- Infant Mortality
- Hospital Use
- Low Birthweight and Preterm Births
- Prenatal Care
- Teen Births
- Why This Topic Is Important
Infant mortality is a key measure of a nation's health, reflecting socioeconomic conditions, maternal health, public health practices, and access to high-quality medical care, among other factors (1, 2). Major causes of infant mortality include birth defects, low birthweight and preterm birth, maternal pregnancy complications, and sudden infant death syndrome (3). Reducing infant mortality requires wide-ranging approaches that improve primary care prior to pregnancy, prenatal and well-baby preventive care, specialty care for infants born preterm and those with health conditions, breastfeeding support, and immunizations, along with empowered communities creating safe, healthy environments for all families (1).
Although the U.S. infant mortality rate has declined in recent decades, it remains higher than rates in most other developed countries (1, 2). The mortality rate among black infants is particularly high—more than double the rate for white and Asian groups, both nationally and in California (3, 4).Find more information and research on infant mortality in kidsdata.org's Research & Links section.
Sources for this narrative:
1. U.S. Department of Health and Human Services. (2013). Report of the Secretary's Advisory Committee on Infant Mortality: Recommendations for HHS action and framework for a national strategy. Retrieved from: https://www.hrsa.gov/advisorycommittees/mchbadvisory/InfantMortality/About/natlstrategyrecommendations.pdf
2. MacDorman, M. F., et al. (2014). International comparisons of infant mortality and related factors: United States and Europe, 2010. National Vital Statistics Reports, 63(5). Retrieved from: https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf
3. Centers for Disease Control and Prevention. (2019). Infant mortality. Retrieved from: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm
4. As cited on kidsdata.org, Infant mortality rate, by race/ethnicity. (2019). California Department of Public Health & National Center for Health Statistics.
- How Children Are Faring
California's infant mortality rate declined by 40% between 1994 and 2016, from 7 infant deaths per 1,000 births to 4.2 per 1,000. Infant mortality rates statewide have followed but remained lower than U.S. rates over this period.
At the county level, infant mortality rates vary widely, from 2.6 (San Francisco) to 8.1 (Mendocino) among counties with data in 2014-16. Statewide, in 2014-16 and in previous years, the leading causes of infant death were birth defects and disorders related to low birthweight and preterm birth.
Disparities persist in infant mortality rates by race/ethnicity. Statewide, among groups with data in 2012-16, African American/black and multiracial infants died at rates of at least 9 per 1,000 births, whereas Asian/Pacific Islander and white infants had mortality rates below 4 per 1,000.
- Policy Implications
Some of the leading causes of infant mortality—e.g., birth defects, preterm birth, and sudden infant death syndrome (SIDS)—are preventable and can be addressed through public policy. California requires newborn screenings for potentially fatal genetic diseases, as early identification and treatment can help avert long-term health consequences and even death (1). Public and institutional policy also can address risk and protective factors for SIDS and preterm births by ensuring that women are in good health before conception, avoid smoking and substance use while pregnant, and forgo elective deliveries before 39 weeks of pregnancy, as well as broader strategies that address social determinants of health (2, 3).
Policy and program options that could reduce infant mortality include:
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 U.S. Department of Health and Human Services Maternal and Child Health Bureau. Also see policy implications on kidsdata.org for Low Birthweight and Preterm Births and Prenatal Care.
- Supporting evidence-based, culturally-appropriate communication and social marketing strategies to educate families about ways to promote infant health, including family planning, breastfeeding, immunizations, smoking cessation, and safe sleep practices (2, 3)
- Ensuring that key recommendations to prevent SIDS and other sleep-related infant deaths—including back sleeping, firm sleep surfaces, separate sleep surfaces for caregivers and infants, and smoking avoidance during pregnancy—reach a wide constellation of potential caregivers for infants (2, 4)
- Sustaining funding for substance use screening among pregnant women and for treatment designed specifically for pregnant women who use alcohol or drugs (2)
- Promoting research, education, and systems change aimed at reducing preterm labor and elective deliveries before 39 weeks of pregnancy (2, 3, 5)
- Increasing efforts to ensure that all women and infants, including those with special health care needs, receive quality medical care that is safe, timely, effective, efficient, and patient centered (2)
- 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; this should include addressing mental/behavioral health and social support needs, as well as increasing the interval between pregnancies to at least 18 months (2, 6)
- Addressing underlying causes of infant mortality by focusing on social determinants of health; e.g., investing in under-resourced communities and efforts to ameliorate the effects of poverty on families during childbearing years (2)
- Supporting ongoing efforts to improve data systems for measuring health care access, quality, and outcomes for women and infants, as timely and accurate data are critical for informing policy and program decisions (2)
- Promoting collaboration across agencies and sectors at the local, state, and national levels to combine resources and expertise toward the common goal of reducing infant mortality (2)
Sources for this narrative:
1. California Department of Public Health. (2018). Newborn Screening Program. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DGDS/Pages/nbs
2. U.S. Department of Health and Human Services. (2013). Report of the Secretary's Advisory Committee on Infant Mortality: Recommendations for HHS action and framework for a national strategy. Retrieved from: https://www.hrsa.gov/advisorycommittees/mchbadvisory/InfantMortality/About/natlstrategyrecommendations.pdf
3. Richards, J., & DeFrancis Sun, B. (2013). Infant mortality toolkit. MCH Digital Library & National SUID/SIDS Resource Center. Retrieved from: https://www.mchlibrary.org/toolkits/infant-mortality.php
4. American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5), e20162938. Retrieved from: https://pediatrics.aappublications.org/content/138/5/e20162938
5. Centers for Disease Control and Prevention (2018). Preterm birth. Retrieved from: https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm
6. Floyd, R. L., et al. (2013). A national action plan for promoting preconception health and health care in the United States (2012-2014). Journal of Women's Health, 22(10), 797-802. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480361
- Websites with Related Information
- Association of Maternal and Child Health Programs (AMCHP)
- California Dept. of Public Health: Maternal, Child and Adolescent Health Division
- California Maternal Quality Care Collaborative
- California Perinatal Quality Care Collaborative
- Centers for Disease Control and Prevention: Before Pregnancy
- Centers for Disease Control and Prevention: Infant Mortality
- CityMatCH. University of Nebraska Medical Center.
- Infant Mortality and Pregnancy Loss: Professional Resource Guide. Maternal and Child Health Digital Library.
- National Institute for Children's Health Quality
- Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. Centers for Disease Control and Prevention.
- U.S. Dept. of Health and Human Services: Maternal and Child Health Bureau
- Key Reports and Research
- Birth Settings in America: Outcomes, Quality, Access, and Choice. (2020). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
- California American Indian/Alaska Native Maternal and Infant Health Status Report. (2019). California Department of Public Health, Maternal, Child and Adolescent Health Division.
- Child Mortality in the U.S. and 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis. (2018). Health Affairs. Thakrar, A. P., et al.
- Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint. (2019). Center for American Progress. Taylor, J., et al.
- Fighting at Birth: Eradicating the Black-White Infant Mortality Gap. (2018). Samuel DuBois Cook Center on Social Equity & Insight Center for Community Economic Development. Smith, I. Z., et al.
- Health Equity and Birth Outcomes. March of Dimes.
- How Can California Reduce Disparities in Maternal and Infant Health? (2020). California Dept. of Public Health, Maternal, Child and Adolescent Health Division.
- Infant and Youth Mortality Trends by Race/Ethnicity and Cause of Death in the United States. (2018). JAMA Pediatrics. Khan, S. Q., et al.
- Infant Mortality in the United States, 1915-2017: Large Social Inequalities Have Persisted for Over a Century. (2019). International Journal of Maternal and Child Health and AIDS. Singh, G. K., & Yu, S. M.
- Infant Mortality in the United States, 2019: Data from the Period Linked Birth/Infant Death File. (2021). National Vital Statistics Reports. Ely, D. M., & Driscoll, A. K.
- Maternal and Infant Predictors of Infant Mortality in California, 2007-2015. (2020). PLoS ONE. Ratnasiri, A. W. G., et al.
- Preventing Infant and Maternal Mortality: State Policy Options. (2019). National Conference of State Legislatures. Bellazaire, A., & Skinner, E.
- Racial and Ethnic Differences in Mortality Rate of Infants Born to Teen Mothers: United States, 2017-2018. (2020). NCHS Data Brief. Woodall, A. M., & Driscoll, A. K.
- Report of the Secretary’s Advisory Committee on Infant Mortality: Recommendations for HHS Action and Framework for a National Strategy. (2013). U.S. Dept. of Health and Human Services.
- State and Local Government Expenditures and Infant Mortality in the United States. (2020). Pediatrics. Goldstein, N. D., et al.
- What Do We Know About Infant Mortality in the U.S. and Comparable Countries? (2019). Peterson-KFF Health System Tracker. Kamal, R., et al.
- County/Regional Reports
- Annual Report on the Conditions of Children in Orange County. Orange County Children's Partnership.
- Community Health Improvement Plan for Los Angeles County. Los Angeles County Dept. of Public Health.
- Important Facts About Kern’s Children. Kern County Network for Children.
- Live Well San Diego Report Card on Children, Families, and Community. San Diego Children’s Initiative.
- Pathway to Progress: Indicators of Young Child Well-Being in Los Angeles County. First 5 LA.
- San Mateo County All Together Better. San Mateo County Health.
- Santa Clara County Public Health Department: Open Data Portal
- More Data Sources For Infant Mortality
- CDC WONDER. Centers for Disease Control and Prevention.
- Exploring Infant Health Outcomes Across Race and Ethnicity and by State. (2019). Center for American Progress. Novoa, C., & Brady, M.
- FastStats: Infant Health. National Center for Health Statistics.
- Health, United States, 2019 – Data Finder. National Center for Health Statistics.
- KIDS COUNT Data Center. Annie E. Casey Foundation.
- National Vital Statistics Reports. National Center for Health Statistics.
- PeriStats. March of Dimes Perinatal Data Center.
- Pregnancy Risk Assessment Monitoring System (PRAMS) Centers for Disease Control and Prevention.
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