Work targets lagging U.S. infant mortality rate: Nation’s rate has improved, but trails many similar countries
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* Charlotte Tucker

In the United States, for every 1,000 babies born, about six die before they reach age 1. On its face, 0.6 percent is a low number — particularly when compared to countries such as Afghanistan, with its 11 percent infant mortality, or South Sudan, at 7 percent.

But U.S. infant mortality ranks worse than about 30 other nations worldwide and puts the country in the company of less-wealthy, less-industrialized nations such as Cuba and Hungary.

Though the rate of U.S. infant deaths has improved in recent years, dropping 12 percent from 2005 to 2011, public health professionals who work in maternal and child health say there is still a ways to go.

“For us, this is a starting point,” said Brent Ewig, MHS, director for public policy and government affairs at the Association of Maternal and Child Health Programs. “We’ve seen a pretty dramatic improvement…but we can do much better.”

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/43/8/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/43/8/1.1/F1)

A newborn baby is held after being delivered via cesarean section. The U.S. infant mortality rate is improving, but still lags behind more than two dozen industrialized countries.

Photo by Mujdat Uzel, courtesy iStockphoto

According to the Centers for Disease Control and Prevention, the top four causes of infant mortality are low birthweight, congenital malformation, sudden infant death syndrome and maternal complications. Those problems can be linked to a complex group of conditions, including systemic inequality and lack of access to affordable care, researchers say. Programs at the national, state and local level are working to combat the causes, and early indications are that they are starting to work.

In Oklahoma, for example, the state initiated a program aimed at reducing infant mortality about four years ago, said Barbara O’Brien, MS, RN, program director in the Office of Perinatal Quality Improvement at the University of Oklahoma Health Sciences Center.

One of the state’s primary goals was to cut the number of women who were having elective preterm births. Though, traditionally, physicians have considered pregnancies lasting just 37 weeks to be full term, research has shown that babies born at 37 and 38 weeks are not as mature as those born at 39 and 40 weeks, O’Brien told *The Nation’s Health*.

“Babies at 37 and 38 weeks might look like they’re mature from the outside, but their insides might not be ready,” she said, citing underdeveloped lungs and brains as the most common problems. Babies born too early can have problems breathing and regulating their temperatures, among many issues, and may be more likely to die.

But some mothers were choosing to have their babies at 37 or 38 weeks for convenience or other reasons, not realizing the danger that decision posed, O’Brien said. Barring medical necessity, research shows that births should not be induced early.

“Our message is to wait — if you’re scheduling births — until 39 weeks,” she said. “Ultimately, it’s best to let labor begin on its own.”

Oklahoma partnered with the March of Dimes, which provided funding and educational materials for the Every Week Counts campaign.

The campaign is three-pronged: It works with hospitals to encourage them to put scheduling checks in place so that a woman must have a medical reason to be induced before 39 weeks, it reaches out to patients to educate them on the risks and it uses billboards and public service announcements to create awareness about the risks involved in early elective deliveries.

The program is already showing results. Between the first quarter of 2011 and the second quarter of 2013, early scheduled deliveries were reduced by 81 percent, O’Brien said. Participating hospitals in Oklahoma previously had about eight babies born each day as early elective deliveries, and now that figure is about one baby per day.

O’Brien said the state’s infant mortality rate is also down in recent years, but it is still too early to tell if the reduction in early-term births is to thank. She said partnerships with state officials, Medicaid and hospitals and statewide agreement about the necessity of reversing the problem has been key.

“We’re trying to be collaborative and work together,” she said. “That’s been a big reason we’ve been able to make this work.”

Another major focus of efforts to reduce infant mortality is examining disparities by race and ethnicity. According to a 2013 report in CDC’s *Morbidity and Mortality Weekly Report,* in 2009, black women had the highest infant mortality rate, at 12.4 per 1,000 live births. The rate for white women was just 5.33 per 1,000. Rates for American Indian and Alaska Natives were 48 percent higher than whites, at 8.47 deaths per 1,000 births. Hispanic women and Asian and Pacific Islanders had infant mortality rates that were slightly better than whites, at 5.29 and 4.4 per 1,000, respectively.

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/43/8/1.1/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/43/8/1.1/F2)

In the U.S., black women have the highest infant mortality rate, at 12.4 per 1,000 live births as of 2009, though rates have been improving. Improved education and access to care are being used to lower high overall infant mortality rates in the U.S.

Photo by Ruslan Dashinsky, courtesy iStockphoto

“The data has been incredibly stark,” Ewig, an APHA member, told *The Nation’s Health*. “(Until recently) there were things we could do to bring the rates down, but it didn’t close the gap.”

One such effort is the A Healthy Baby Begins with You program, which launched in 2007 and aims to raise awareness about infant mortality in the black community, said J. Nadine Gracia, MD, MSCE, deputy assistant secretary for minority health in the Department of Health and Human Services and director of the HHS Office of Minority Health.

Gracia noted that minority women are less likely to receive preventive services to stay healthy, less likely to receive quality care when they get sick, and face poorer health outcomes than the general population. The Healthy Baby Begins with You program has trained more than 1,800 students at schools of higher education to educate their peers about preconception health and prenatal care.

“We’re raising awareness and empowering college students to be ambassadors of health,” she told *The Nation’s Health*.

The Affordable Care Act also holds a great deal of promise for lowering the infant mortality rate, Gracia said. The health reform law will give 18.6 million uninsured women options for coverage next year, and all private insurance offered through the health insurance marketplaces will be required to provide maternity and newborn care. Women will also save because plans will not be able to charge them more just because they are women, Gracia said.

The health reform law also supports access to breast pumps and encourages breastfeeding as well as screenings for chronic conditions such as high blood pressure and diabetes. Gracia also pointed to the National Prevention Strategy and its potential to lessen the effects of health disparities linked to the social determinants of health.

Finally, the Prevention and Public Health Fund — the landmark fund created by the health reform law to reduce disease and improve wellness — will also be key to bringing down infant mortality, Gracia said. The fund provides help with smoking cessation, which is important because smoking is linked to low birthweight and sudden infant death syndrome.

For more information, visit [www.hhs.gov](http://www.hhs.gov).

*   Copyright The Nation’s Health, American Public Health Association