Infant mortality is often viewed as an important marker of the overall health of a society. It is characterized by either neonatal mortality, which refers to the death of an infant between birth and 27 days, or post-neonatal mortality, which refers to deaths between 28 to 364 days. According to the CDC, the majority (2 out of 3) of infant deaths occur in the neonatal period .
Several risk factors contribute to infant mortality. Complications from preterm birth, low birth weight, lack of necessary care during delivery, and maternal health conditions are major determinants of neonatal death . On the other hand, sudden infant death syndrome (SIDS) is the leading cause of death in post-neonatal period.
In the District, the infant mortality rate decreased from 13.1 per 1,000 live births in 2007 to 7.1 per 1,000 live births in 2016 , yet continues to exceed the DC Healthy People 2020 Target of 6.0 per 1,000 live births . Per guidance from the National Center for Health Statistics, when the number of infant deaths is small (less than 100), great care should be taken in the interpretation of the data. As a result, for most analyses of infant mortality, DC Health presents estimates based on combined years of data.
It is important to note that in the U.S, racism, not race or ethnicity, is a pervasive force that produces differences or inequities in health and socioeconomic status . Racism and other forms of structured oppression sap our potential to become the healthiest nation and these outcomes also impact infant health outcomes. In the District, the infant mortality rate was significantly higher for infants of non-Hispanic Black mothers (11.49 per 1,000 live births) compared to infants of Hispanic mothers (5.33 per 1,000 live births) and infants of non-Hispanic White mothers (2.55 per 1,000 live births) .
Recent studies have shown that Black women with high socioeconomic status (i.e., with a college education, high income, and access to private insurance-covered health care) still experience poorer birth outcomes than White women from low socioeconomic backgrounds (i.e., unemployed, with low educational attainment). The literature also identifies that maternal exposure and experiences to racism are a significant health risk because of the psycho-social response it produces (stress, anger, depression) [4, 5].
In 2018, the national neonatal mortality rates were highest for infants of women under age 20 and age 40 or older, while in the District infants of women age 20-24 experienced the highest mortality rate. The District followed the national trend where infants of women aged 30–34 had the lowest neonatal mortality rates . The average maternal age at the time of their first birth increased for all states between the years 2000-2014 from 24.9 years to 26.3 years respectively. The District experienced the largest average increase in maternal age (3.4 years) during this time with a resulting first birth maternal age average of 28.3 year.
In the District, infant mortality rates were highest among mothers who had a high school diploma (10.5 per 1,000 live births) and mothers who had less than a high school education (8.0 per 1,000 live births). The infant mortality rates in these two groups were significantly higher than the infant mortality rate among mothers who had more than a high school education (4.9 per 1,000 live births) .
Leading Causes of Infant Deaths
The 10 leading causes of infant death in 2015-2016 accounted for 65% of all infant deaths in the District. The first ranked leading cause of infant death during this time period was maternal complications of pregnancy, which accounted for 16.5% of infant deaths in DC. Nationally, maternal complications of pregnancy was the fourth ranked leading cause of infant death and accounted for 6.5% of infant deaths in the US .
Among all 152 infant deaths that occurred in the District in 2015-2016, the majority (72%, n=109) of deaths occurred among neonates (newborns aged less than 28 days), and resulted in a neonatal mortality rate of 5.6 per 1,000 live births. Nearly 60% (n=87) of infant deaths occurred during the first six days following birth, known as the early neonatal period, and 15% (n=22) of infant deaths occurred between 7-27 days after birth, known as the late neonatal period.
Assets & Resources
• Newborn Screening and Surveillance Programs – Birth Defects Registry
• Pilot quality improvement efforts around newborn discharge protocols
• Baby-Friendly Hospital Initiative
• Collaboration with Department of Employment Services to implement healthy relationships and parenting skills curricula with men
• Help Me Grow, a centralized referral program that links prenatal women and children 0-5 and their families to services to support healthy development
• Pilot place-based approaches to improve perinatal health: Early Childhood Innovation Network (ECIN), Smart from the Start Woodland Terrace Child & Family Development Program
• Additional resources listed in table 13 of Perinatal Health Report
Promising Practices & Policies:
• MICH-I Increase minimum wage to a living wage.
• MICH-II Increase centering pregnancy programs (services for pregnant women in intimate group settings).
• Centering Pregnancy is a multifaceted model of group maternity care that incorporates health assessment, education, and support.
Citations & Additional Data Resources
1. DC Health. Perinatal Health and Infant Mortality Report. 2018
2. CDC Reproductive Health. Infant Mortality. 2019
3. Chandra L. Ford, Derek M. Griffith, Marino A. Bruce, Keon L. Gilbert, , “Foreword: An APHA Perspective”, Racism: Science & Tools for the Public Health Professional. 2019
4. Joint Center for Political and Economic Studies Health Policy Institute. Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality. 2017
5. Duke University Samuel DuBois Cook Center on Social Equity and Insight Center for Community Economic Development. Fighting at Birth: Eradicating the Black-White Infant Mortality Gap. 2018
6. National Center of Health Statistics. Infant Mortality by Age at Death in the United States, 2016. 2018
Photo by Aditya Romansa on Unsplash