Infant Mortality

The Centers for Disease Control and Prevention defines infant mortality as the death of an infant before his or her first birthday. The infant mortality rate (IMR) is the number of infant deaths for every 1,000 live births. The IMR provides key information about both maternal and infant health and is an important marker of the overall health of a society. In 2017, the infant mortality rate in the United States was 5.7 deaths per 1,000 live births.1

Alabama's infant mortality rate of 7.0 infant deaths per 1,000 live births in 2018 is lower than the 7.4 infant deaths per 1,000 live births in 2017. This is the lowest infant mortality rate ever recorded in Alabama. It represents 405 infant deaths with 198 of those deaths to black infants, 196 of those deaths to white infants, and 11 other race 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.

Disparities in infant mortality by race continue to persist. The infant mortality rate of black infants remains twice that of white infants. The 2018 black infant mortality rate was 11.0 infant deaths per 1,000 live births compared to the white infant mortality rate of 5.1 infant deaths per 1,000 live births. Health outcomes are molded by the environment in which people are born, live, work, play, and age and not simply by health behaviors of the individual. These factors, which contribute to health outcomes, are formed by the historical, social, political and economic forces in the individual’s environment. Resources that enhance quality of life can have a significant influence on population health.2 Therefore, improving birth outcomes, reducing maternal, fetal, and infant deaths requires a multifaceted approach that addresses both societal and health systems factors.

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 associated factors. Leading causes of infant death that contribute to infant mortality in Alabama include low birthweight, preterm births before 37 weeks gestation, Sudden Infant Death Syndrome (SIDS) and bacteria sepsis of newborn. Associated factors include race, where one lives, environmental influences, and available resources known as social determinants 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 birthweight is defined as weighing less than 3 pounds and 5 ounces and these infants accounted for 192 of the infant deaths in 2018. 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.

Preterm birth is the birth of an infant born too soon, before 37 weeks of gestation have been completed.3 Prematurity and low birth weight are the second leading cause of infant mortality and accounted for 19 percent of the infant deaths in 2018. In 2018, 12.5 percent of all live births were preterm and 10.5 percent of all infant deaths were associated with low birth weight in Alabama. The best predictor of a preterm birth is a previous preterm birth. Important growth and development occurs throughout pregnancy, including in the final months and weeks. Premature babies have to spend time in a neonatal intensive care unit, may have health problems, and may experience long-term challenges including intellectual and developmental disabilities that may last a lifetime.4

An additional concern in Alabama is Sudden Unexpected Infant Death (SUID). These deaths occur among infants less than one year old and have no immediately obvious cause.5 The three commonly reported types of SUID include Sudden infant death syndrome (SIDS), unknown cause, and accidental suffocation and strangulation in bed. From 2017 to 2018, there was a 37 percent decrease in SUIDs. Seventy infant deaths were classified as SUID; this accounted for 17.3 percent of all infant deaths in Alabama. For more information on prevention and risk reduction see Ways to Reduce the Risk of SIDS and Other Sleep Related Causes. It is important to always use a crib or sleep space that is Consumer Product Safety Commission approved. See the CPSC Safe to Sleep Crib Education Center to learn more.

References

1Centers for Disease Control and Prevention (CDC). (2019, March 27). Reproductive Health: Infant Mortality. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

2Office of Disease Prevention and Health Promotion. (2019, December 5). 20202 Objectives: Social Determinants of Health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

3CDC. (2019, October 21). Reproductive Health: Preterm Birth. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm

4March of Dimes. (2019, October). Premature Babies. Retrieved from
https://www.marchofdimes.org/complications/premature-babies.aspx

5CDC. (19, September 13). Sudden Unexpected Infant Death and Sudden Infant Death syndrome: Data and Statistics. Retrieved from: https://www.cdc.gov/sids/data.htidsm