Infant Mortality

Infant mortality reflects the overall state of maternal health as well as the quality and accessibility of primary health care available to pregnant women and infants in a geographical region.  Alabama's infant mortality rate of 7.4 infant deaths per 1,000 live births in 2017 is lower than the 9.1 infant deaths per 1,000 live births in 2016.  This is the lowest infant mortality rate ever recorded in Alabama.  It represents 435 infant deaths with 207 of those deaths to black infants, 33 to Hispanic infants , and 196 of those deaths to white infants.  When compared to the 2017 national rate of 5.8 infant deaths per 1,000 live births, Alabama continues to have much work to conduct.

For reasons not fully understood, disparities in infant mortality by race continue to persist.  The infant mortality rate of black infants remains twice that of white infants.  The 2017 black infant mortality rate was 11.3 infant deaths per 1,000 live births compared to the white infant  mortality rate of 5.6 infant deaths per 1,000 live births.

Most often, there is no single factor that causes the death of an infant, and it is often the result of a number of contributing and asociated factors. Leading factors in Alabama that contribute to infant mortality include low birthweight, preterm births before 37 weeks gestation, and Sudden Infant Death Syndrome (SIDS).  Associated factors include race, where one lives, environmental influences, and available resources known as social dertiminants of health or health inequities.

Being born low birthweight , less than 5 pounds and 8 ounces, is a significant factor directly related to infant morbidity and mortality.  Babies born too soon or too small encounter significant risks of serious, costly, and devastating life-long health conditions.  Very low bithweight is defined as weighing less than 3 pounds and 5 ounces and these infants accounted for 196 of the infant deaths in 2017.  These very small and fragile babies are at risk of developing major, long-term physical and cognitive problems with consequences impacting families and state resources.  The definitive cause(s) of being born low birthweight remains unknown; however, the increasing magnitude of the problem has continued to gain attention.  Currently, the few measures that can reduce risk factors include prevention of unintended or mistimed pregancies, spacing births 24 months apart, receiving early and consistent prenatal care, identifying women at risk for a preterm birth, and being healthy before and between pregnancies.

Prematurity is the second leading cause of infant mortality and accounted for 62.3 percent of the infant deaths in 2017.  Prematurity is the birth of an infant at least three weeks before a baby's due date or 37 weeks of gestation.  In 2017, 12.0 percent of all live births were preterm and 13.3 percent of all infant deaths were associated with being born preterm in Alabama.  The best predictor of a preterrm birth is a previous preterm birth.  Approximately 5 percent or 350 infants were born to mothers who had experienced a previous preterm birth.  Important growth and development occurs throughour pregnancy, but especially in the final months and weeks.  Being born preterm carries serious medical, develpomental, and potential behavioral problems that can last a lifetime.  Addressing prematurity is complex and has no one single solution.  Infants who survive due to the advancements of modern medicine and technology may spend weeks or months hospitalized in a neonatal intensive care unit.  Not only is premature birth an emotional roller coaster for families, but being born preterm costs ten times more than being born full-term at 39 weeks or more gestation.

An additional concern in Alabama resulting in a high number of infant deaths includes Sudden Unexplained Infant Death (SUID).  These deaths occur among infants less than one year old and are diagnosed after a complete examination of the death scene, an autopsy, and a review of the infant's medical history.  Although the causes of death in many of these infants cannot be explained, most occur while the infant is sleeping in an unsafe sleeping environment (sleeping in a bed, on a sofa, or in a recliner with someone else, accidental suffocation or strangulation, and roll-over).  In 2017, 111 infants died from sleep associated causes; this accounted for 25.5 percent of all infant deaths in Alabama.  Prevention and risk reduction begins with always placing an infant in their own sleep area for very sleep time, placing them on their backs with no pillows, crib bumper pads, soft bedding, stuffed animals, toys, or blow up beds.  It is important to always use a crib or sleep space that is Consumer Product Safety Commision approved. See the CPSC Safe to Sleep Crib Education Center to learn more.

Health starts in homes, schools, workplaces,neighborhoods, and communities.  Health is also influenced by taking care of ourselves by eating a well-balanced diet and exercising, not smoking or using illicit drugs, getting immunizations and health screens.  In 2017, 9.6 percent of all live births were to mothers who admitted to smoking during pregnancy.  Infants born to mothers who smoke are three times more likely to die than infants born to non-smoking mothers.  Mothers using or dependent on opiates are on the rise in Alabama.  The effects of these substances on the unborn infant are creating serious challenges for providers as they treat newborns that experience the withdrawal effects associated with a condition known as neonatal abstinence syndrome. 

On a positive note, the percent of births to teen mothers has been consistently trending down since 2007 in Alabama.  The 2017 rate is the lowest ever recorded at 7.3 percent of all live births.  Over a ten-year period, the number of births to all teens has decreased from a high of 8,567 in 2008 to 4,285 in 2017.  The percent of births with maternal smoking is steadily decreasing with the rate of maternal smoking in women between the ages of 10 and 19 at 8.2 percent of all live births in 2017.

Educating and promoting the utilization of alpha-hydroxyprogesterone caproate (17P), a hormone treatment whicj is prescribed for women who have experienced a spontaneous previous preterm birth as a means to reduce her risk of having another preterm birth.

Encouraging and supporting mothers to breastfeed their infants.  Scientific research well documents the benifits for mom, infant, and the environment if breastfeeding is initiated and then continued through at least the first six months of life.

Strategies to Reduce Infant Mortality in Alabama

  • Increase the use of progesterone to women with a history of prior preterm birth.
  • Reduce tobacco use among women of childbearing age.
  • Encourage women to wait at least 18 months between giving birth and becoming pregnant again.
  • Expand the Well Woman Preventive visit to provide pre-conception and interconception care.
  • Continue safe sleep education effforts.
  • Continue collaborative efforts to address the opiod epidemic.
  • Expand the Fetal and Infant Mortality Review activities at the community level.

Initiatives

  • Identifying, studying and learning the factors that play a role in infant survival; implementing initiatives at the community level to improve infant health and vitality statewide.
  • Establishing a Maternal Mortality Review Committee to analyze the maternal deaths that occur within the state so as to improve maternal health outcomes.

For additional statistics on infant mortality in Alabama, visit the Center for Health Statistics Publications page.

To learn about the Alabama Infant Mortality Reduction Initiative and Infant Mortality summits, visit our Reduction Initiative page.





Page last updated: September 18, 2019