Alabama Infant Mortality Rate for 2020 ties lowest rate in more than five decades

The 2020 infant mortality rate of 7.0 deaths per 1,000 live births ties for the lowest rate in more than five decades, and the 3-year infant mortality rate (2018-2020) of 7.2 is the lowest on record. Even so, Alabama's infant mortality rate has continued to be higher than the U.S. rate, which was provisionally 5.5 in 2020.

A total of 404 Alabama infants died before reaching 1 year of age in 2020; 449 died in 2019; 405 infants died in 2018; and 435 infants died in 2017. While the 2020 rate is a 10 percent decrease from 2019, this decline is not statistically significant. The 2019 rate was 7.7, the 2018 rate was 7.0, and the 2017 rate was 7.4.

Nine Alabama counties (Bibb, Cherokee, Chilton, Choctaw, Franklin, Hale, Marengo, Wilcox and Winston) had no infant deaths in 2020, compared to seven counties in 2019.

Longstanding disparities between birth outcomes for Black and White infants persist but narrowed in 2020. Of the 404 total infant deaths, 48.5 percent (196) were attributed to the White race group, while 49.3 percent (199) belonged to the Black race group. The infant mortality rate for Black infants decreased from 12.0 in 2019 to 10.9 in 2020, and the infant mortality rate for White infants decreased from 5.6 to 5.2.

The three leading causes of infant death in 2020 remained the same as in 2019, but in a different order. The first leading cause (disorders related to short gestation and low birth weight, now elsewhere classified) and the second leading cause (congenital malformations, deformations and chromosomal abnormalities) were reversed. Deaths from the third leading cause, sudden infant death syndrome, increased from 24 in 2019 to 43 in 2020.

Regarding Alabama births and pregnancies in 2020:

• The number of live births decreased from 58,615 in 2019 to 57,643 in 2020. This is the lowest number of births in Alabama since the 1920s. Live births to White mothers (37,492) were the lowest seen in the state since the mid-1970s. The number of births to Hispanic mothers of all races (5,148) was the largest number of births seen in the past decade.
• Births with no prenatal care slightly increased from 2.5 percent of live births (1,478) in 2019 to 2.6 percent of live births (1,486) in 2020; 53.1 percent of births with no prenatal care were to White mothers, 55.7 percent were to mothers aged 20-29, and 74.3 percent were paid by Medicaid.
• The number of preterm births increased from 7,309 in 2019 to 7,440 in 2020, which is statistically significant.
• Although not statistically significant, the number of low weight births increased from 6,153 in 2019 to 6,228 in 2020.
• Smoking during pregnancy continues to decline among teen and adult mothers.
• The number of fetal deaths decreased from 525 in 2019 to 491 in 2020.

State Health Officer Dr. Scott Harris said, "The death of any infant is tragic. Alabama must continue our commitment to prevent infant deaths by promoting evidence-based initiatives to address this persistent need.”

Center for Health Statistics Director Nicole Rushing said, “We are encouraged by the decline in infant deaths seen this past year and are motivated to make sure that infant deaths in the state continue this descent.”

(Article previously published in the April 2022 issue of Alabama's Health.)