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Infant Mortality (see data for this topic)

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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, 3). Leading causes of infant mortality include birth defects, low birthweight or preterm birth, sudden infant death syndrome, unintentional injuries, and maternal pregnancy complications (1). Although the U.S. infant mortality rate has declined in recent decades, its progress has been slower and its rate remains higher than similar wealthy countries (2, 4). The U.S. also has significant disparities in infant mortality by demographic group, with the highest rates experienced by African American/black, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander populations, as well as those in rural areas, those with low incomes or education levels, and women under age 20 or over age 40 (1, 3, 5). The mortality rate among infants born to African American/black mothers is particularly high—more than twice the rate for infants born to white mothers, both nationally and in California (1, 6). Differences by race/ethnicity remain even after controlling for income and education, suggesting that systemic racism and discrimination play a critical role in disparate outcomes (3).

Reducing infant mortality requires wide-ranging approaches, from improving health care access, quality, coverage, and affordability, to addressing socioeconomic and behavioral risk factors (2, 5). For example, efforts to improve behavioral and social determinants may include public education campaigns (e.g., focused on infant safe sleep practices and smoking cessation for women) as well as larger strategies to address poverty, structural racism, inequities in access to quality education and health care, and food and housing insecurity (2, 5).
Find more information on infant mortality in kidsdata.org's Research & Links section.

Sources for this narrative:

1.  Ely, D. M., & Driscoll, A. K. (2022). Infant mortality in the United States, 2020: Data from the period linked birth/infant death file. National Vital Statistics Reports, 71(5). Retrieved from: https://stacks.cdc.gov/view/cdc/120700

2.  National Academies of Sciences, Engineering, and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25636/birth-settings-in-america-outcomes-quality-access-and-choice

3.  Hill, L., et al. (2022). Racial disparities in maternal and infant health: Current status and efforts to address them. Kaiser Family Foundation. Retrieved from: https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them

4.  Gunja, M. Z., et al. (2023). U.S. health care from a global perspective, 2022: Accelerating spending, worsening outcomes. Commonwealth Fund. Retrieved from: https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022

5.  Ratnasiri, A. W. G., et al. (2020). Maternal and infant predictors of infant mortality in California, 2007–2015. PloS One, 15(8), e0236877. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236877

6.  As cited on kidsdata.org, Infant mortality, by mother's race/ethnicity. (2023). CDC WONDER Online Database.
Policy Implications
Some of the leading causes of infant mortality—e.g., birth defects, preterm birth, and sudden infant death syndrome—are preventable and can be addressed through public health policy. California requires screening of newborns for potentially fatal genetic diseases, as early identification and treatment can help prevent death and long-term negative health consequences (1). Public health initiatives also can promote good maternal health before and during pregnancy, expand access to high-quality health care, and provide education to improve infant care practices and reduce risky behaviors (2, 3).

Increasingly, strategies to reduce infant mortality focus on social determinants of health, such as economic stability, housing and food environments, access to education and health care, social and community supports, and discriminatory practices and systems (4, 5, 6). While low income and educational attainment have long been associated with infant mortality, socioeconomic status alone does not account for differences by race and ethnicity (4, 7). For decades, infants born to African American/black mothers have died at higher rates than infants in other groups, statewide and nationally (4, 5, 7).

Although numerous federal and state policies and programs are in place to support maternal and infant health, including California's Momnibus Act, additional efforts and investments are needed to reduce infant deaths and inequities by race/ethnicity and socioeconomic status (2, 4, 6, 7).

Policy and practice options that could reduce infant mortality and demographic disparities include:
  • Ensuring adequate funding for social safety net programs, and investing in under-resourced communities so that all women have equitable opportunities and access to services (2, 4, 5, 8)
  • Increasing diversity and reducing bias among health care and social service providers, and supporting programs that specifically promote black women's health (4, 5, 8)
  • Reducing exposure to environmental pollutants and other hazards—which are linked to pregnancy complications—along with racial disparities in such exposure (5, 8, 9)
  • Expanding efforts to ensure that all women and their infants have access to comprehensive insurance coverage and affordable, high-quality, culturally-sensitive primary care, prenatal and childbirth services, well-baby preventive care, and specialty care for infants born preterm or with special health care needs (3, 4, 5, 8)
  • Ensuring adequate funding and capacity for screenings and interventions for pregnant women with treatable risk factors for preterm birth, such as smoking, substance use, or mental health issues (2, 4, 9)
  • Supporting a holistic approach to women's health, including integration of reproductive planning into women's routine health care; this should include addressing mental and behavioral health needs, as well as maintaining healthy intervals between pregnancies (9)
  • Expanding evidence-based social support programs for new and expectant mothers, including home-visiting services; such programs should aim to serve vulnerable groups, including African American/black, low-income, and rural communities (5, 8)
  • Supporting evidence-based, culturally-appropriate public awareness campaigns to educate families about ways to promote infant health; topics should include family planning, smoking cessation, healthy maternal weight, safe sleep practices, breastfeeding, and immunizations (2, 10)
  • Ensuring that key recommendations to prevent SIDS and other sleep-related infant deaths—such as back sleeping, firm sleep surfaces, separate sleep surfaces for caregivers and infants, and avoidance of tobacco, alcohol, and drugs—reach a wide constellation of potential caregivers for infants (2, 10)
  • Promoting systems change and public education aimed at reducing preterm labor and elective Caesarean deliveries (2, 3)
  • Strengthening cross-sector collaboration among health providers, systems, and agencies at the local, state, and national levels to advance data collection and research and to combine resources and expertise (3, 5, 9)
For more information, see kidsdata.org’s Research & Links section or visit the Centers for Disease Control and Prevention and California Department of Public Health’s Maternal, Child, and Adolescent Health Division. Also see Policy Implications on kidsdata.org for Low Birthweight and Preterm Births and Prenatal Care.

Sources for this narrative:

1.  California Department of Public Health. (2023). California Newborn Screening Program. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DGDS/Pages/nbs

2.  Ratnasiri, A. W. G., et al. (2020). Maternal and infant predictors of infant mortality in California, 2007–2015. PloS One, 15(8), e0236877. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236877

3.  National Academies of Sciences, Engineering, and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25636/birth-settings-in-america-outcomes-quality-access-and-choice

4.  Hill, L., et al. (2022). Racial disparities in maternal and infant health: Current status and efforts to address them. Kaiser Family Foundation. Retrieved from: https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them

5.  Dagher, R. K., & Linares, D. E. (2022). A critical review on the complex interplay between social determinants of health and maternal and infant mortality. Children, 9(3), 394. Retrieved from: https://www.mdpi.com/2227-9067/9/3/394

6.  California Department of Public Health. (2020). How can California reduce disparities in maternal and infant health? Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Communications/FactSheetPHE_2020.pdf

7.  Kennedy-Moulton, K., et al. (2022). Maternal and infant health inequality: New evidence from linked administrative data. National Bureau of Economic Research. Retrieved from: https://www.nber.org/papers/w30693

8.  Gibbs, H., et al. (2022). A strong start in life: How public health policies affect the well-being of pregnancies and families. Center for American Progress. Retrieved from: https://www.americanprogress.org/article/a-strong-start-in-life-how-public-health-policies-affect-the-well-being-of-pregnancies-and-families

9.  The White House. (2022). White House blueprint for addressing the maternal health crisis. Retrieved from: https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf

10.  Moon, R. Y., et al. (2022). Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics, 150(1): e2022057990. Retrieved from: https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022
How Children Are Faring
In 2022, 1,675 California infants died before their first birthday—fewer than half the number of infant deaths in 1995. Over this period, the state’s infant mortality rate fell by more than 35%, from 6.3 infant deaths per 1,000 births to 4 deaths per 1,000 births. Overall infant mortality trends statewide generally parallel those of the nation but have remained consistently lower than U.S. rates across years with comparable figures.

At the local level, infant mortality rates often vary widely by year and by region. Among counties with data for 2022, figures ranged from fewer than 3 deaths per 1,000 births (Placer, San Francisco, San Mateo) to more than 6 per 1,000 (Madera, Monterey, Shasta).

Statewide and nationally, the leading causes of infant mortality in 2020 were birth defects (0.9 deaths per 1,000 California births) and disorders related to low birthweight or preterm birth (0.6 deaths per 1,000 California births).

U.S. infants born to African American/black, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander mothers are much more likely to die before age 1 than their counterparts born to Asian, Hispanic/Latino, and white mothers. In California, the infant mortality rate for African American/black mothers (9 infant deaths per 1,000 births) was more than double the rate for Hispanic/Latino mothers (3.9 per 1,000) and nearly three times the rate for white mothers (3.1 per 1,000) in 2020.