Infant mortality

Infant mortality is the death of a child before they reach their first birthday. The infant mortality rate of a population is calculated by identifying the number of infants who die per thousand live births within that population. Infant mortality rates are a major indicator of a country's economic status and the well-being of its people. About 45 percent of all cases of child mortality (deaths of those under age five) involve infants, and about 75 percent of those occur before an infant reaches one week old.

Major causes of infant mortality include birth trauma or injuries (including asphyxia or lack of oxygen), infections, congenital malformations, chromosomal abnormalities, sudden infant death syndrome (SIDS), complications from premature birth, low birth weight, maternal conditions, or barriers to adequate medical care. Developing countries typically have much higher infant mortality rates than developed nations, and many of the leading causes in such places are preventable. Factors such as a lack of access to hospitals and proper medical care, unsanitary delivery and living conditions, the prevalence of infectious diseases, and lack of education contribute to infant mortality.

Overview

Globally, the educational and socioeconomic status of a mother is strongly correlated with infant mortality rates, with the highest rates occurring among mothers with little education and low socioeconomic status. Experts have suggested that the infant mortality rate may be reduced by as much as 13 percent by providing paid maternity leave. Indeed, the United States' relatively high infant mortality rate among developed nations has often been linked to the fact that it is the only highly industrialized nation in the world that does not provide paid maternity leave as a matter of national policy. Ongoing efforts to improve infant mortality rates increasingly pay close attention to such external factors surrounding maternal well-being.

Infant mortality rates are also significantly correlated with breastfeeding rates, and studies continue to demonstrate that breastfeeding is one of the healthiest practices a new mother can engage in for her child's well-being. In developing countries, breastfeeding may mean the difference between life and death. The willingness of a mother to breastfeed has been shown to be a result of her age, parity status, educational level, culture, and knowledge about the health benefits of breastfeeding. Because breast milk contains many nutritious carbohydrates, proteins, fats, minerals, and vitamins, it boosts infant immune systems and offers protection against conditions such as respiratory infections, diarrhea, urinary tract infections, necrotizing enterocolitis, bacterial meningitis, SIDS, and lymphoma. The protection offered by vaccinations is also improved by breastfeeding.

International organizations such as UNICEF and the World Health Organization (WHO) have launched campaigns in areas where infant mortality rates are highest to teach mothers that breastfeeding alone is the healthiest option. Experts suggest that breastfeeding should start within the first hour after birth and continue for a minimum of six months. Only at the end of the first year of life should complementary foods be introduced into a child's diet.

Other factors involved in reducing infant mortality rates include specific actions that can be taken during pregnancy. These include taking folic acid; controlling diet and weight; engaging in moderate physical activity; abstaining from tobacco, alcohol, and drugs; taking prescribed medications properly; and avoiding situations where injuries are likely to occur. Studies on infant mortality also continue to suggest other factors, including important differences between highly developed and developing nations. For example, a study published in 2019 in the journal Demography found that in countries with low levels of development, increasing the spacing between pregnancies from one year to two effectively halved infant mortality rates. However, no such effect was observed in more developed countries.

International Statistics

Infant mortality has long been considered an important measure of a population's overall health and well-being, as many public health factors affect infant mortality. At the turn of the twenty-first century, the United Nations (UN) identified reducing overall child mortality as the fourth Millennium Development Goal (MDG) for global health, stating that it should be reduced by two-thirds from the 1990 rate by 2015. Efforts toward reduction have included improving vaccination rates of infants and children, increasing access to medicines and health facilities, providing clean water and proper sanitation, increasing female literacy, and limiting exposure to potential diseases and infections. The project saw some results, with the global neonatal mortality (death in the first month of life) rate declining from thirty-three deaths per thousand live births to nineteen, but success was scattered, and infant mortality proved more difficult to combat than mortality of older children. However, between 1990 and 2019, the number of infant deaths worldwide decreased from 5 million to 2.4 million. Additionally, the global death rate of children under five declined from 12.8 million in 2019 to a historic low of 4.9 million in 2022, with 2.3 million of those deaths occurring in children under one month.

The countries that experience the highest infant mortality rates are the poorest countries and those in political turmoil. Data from the US Central Intelligence Agency indicated in the mid-2020s that the countries with the highest infant mortality rates were Afghanistan (111 deaths per thousand live births), Somalia (84), the Central African Republic (81), Equatorial Guinea (77), and Sierra Leone (71). By contrast, the countries with the lowest infant mortality rates were all highly industrialized countries in Europe or Asia: Slovenia (1.5), Singapore (1.5), Iceland (1.6), Monaco (1.7), Norway (1.8), and Japan (1.9).

In the first decades of the twenty-first century, the global neonatal death rate dropped by 53 percent from 5.2 million in 1990 to 2.3 million in 2022. Africa had the highest infant death rate of any continent, with the highest rates occurring in Sub-Saharan Africa, where poverty is endemic. While its infant mortality rate is far lower than that of most developing countries, the United States has historically faced a higher rate than many other developed nations. In the United States, over 20,000 infants die each year, and the US infant mortality rate is between 2.6 and 5.8.

Despite general reductions in the infant mortality rate in developed countries, marginalized populations within individual countries continue to have higher-than-average mortality rates. In the United States, for example, there are significant differences in infant mortality rates among White and Black Americans. Data from the US Department of Health and Human Services Office of Minority Health suggests that among African Americans, infant mortality is over two times higher than in the non-Hispanic White population. Infant mortality from complications of low birth weight is 3.5 times more prevalent in African American families, and SIDS is about twice as prevalent.

The United States is not the only developed country with significant infant mortality disparities between demographic groups. In Canada, for instance, there are also substantial differences in the infant mortality rates of minorities compared to other populations. In Quebec, First Nations and Inuit mothers have been shown to be more likely to give birth prematurely, to give birth to infants with abnormally low or high birth weights, and to experience more stillbirths, perinatal, neonatal, and postnatal deaths.

Bibliography

Arnold, Carolyne W. Infant Mortality and Social Policy. Center for Research on Women, Wellesley College, 1990.

"Country Comparison: Infant Mortality Rate." The World Factbook, US Central Intelligence Agency, www.cia.gov/the-world-factbook/field/infant-mortality-rate/country-comparison. Accessed 1 Jan. 2025.

Elder, Todd E., et al. “The Changing Character of the Black-White Infant Mortality Gap, 1983-2004.” American Journal of Public Health, vol. 104, suppl. 1, 2014, pp. S105–11, doi:10.2105/AJPH.2013.301349. Accessed 1 Jan. 2025.

"Infant Mortality." Centers for Disease Control and Prevention, 16 Sept. 2024, www.cdc.gov/maternal-infant-health/infant-mortality/index.html. Accessed 1 Jan. 2025.

Jacdonmi, Itse, et al. "Breastfeeding, a Child Survival Strategy against Infant Mortality in Nigeria." Current Science, vol. 110, no. 7, 2016, pp. 1282–87.

Molitoris, Joseph, et al. "When and Where Birth Spacing Matters for Child Survival: An International Comparison Using the DHS." Demography, vol. 56, no. 4, 2019, pp. 1349–70, doi:10.1007/s13524-019-00798-y. Accessed 1 Jan. 2025.

"Newborns: Reducing Mortality." World Health Organization, 14 Mar. 2024, www.who.int/news-room/fact-sheets/detail/newborn-mortality. Accessed 1 Jan. 2025.