View source for Infant mortality

{{Short description|Death of children under the age of 1}}

[[File:Infant-mortality.svg|thumb|upright=1.65|World map of infant mortality rates in 2023]]

'''Infant mortality''' is the death of an [[infant]] before the infant's first birthday.<ref name="CDC-2022">{{Cite web |date=2022-09-08 |title=Infant Mortality {{!}} Maternal and Infant Health {{!}} Reproductive Health {{!}} CDC |url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm |access-date=2023-04-07 |website=www.cdc.gov |language=en-us}}</ref> The occurrence of infant mortality in a population can be described by the '''infant mortality rate''' ('''IMR'''), which is the number of deaths of infants under one year of age per 1,000 live births.<ref name="CDC-2022" /> Similarly, the ''[[child mortality]] rate'', also known as the ''under-five mortality rate,'' compares the death rate of children up to the age of five.<ref>{{Cite news |title=Under-Five Mortality |work=UNICEF |url=https://data.unicef.org/topic/child-survival/under-five-mortality/ |access-date=2017-03-07}}</ref>

In 2013, the leading cause of infant mortality in the United States was [[birth defect]]s.<ref>{{Cite journal |vauthors=Mathews TJ, MacDorman MF, Menacker F |date=January 2002 |title=Infant Mortality Statistics from the 1999 Period: Linked Birth/Infant Death Data Set |url=https://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_04.pdf |journal=National Vital Statistics Reports |volume=50 |issue=4 |pages=1–28 |doi=10.1037/e558952006-001 |pmid=11837053 |hdl-access=free |hdl=1903/24216}}</ref> Other leading causes of infant mortality include [[birth asphyxia]], [[pneumonia]], [[neonatal infection]], [[diarrhea]], [[malaria]], [[measles]], [[malnutrition]],<ref>{{Cite web |title=Infant Mortality & Newborn Health |url=https://www.womenandchildrenfirst.org.uk/infant-mortality-newborn-health |access-date=2017-04-25 |publisher=Women and Children First}}</ref> term birth complications such as abnormal presentation of the fetus, [[umbilical cord prolapse]], or [[prolonged labor]].<ref>{{Cite news |title=Labor and Delivery Complications -- the Basics |work=WebMD |url=http://www.webmd.com/baby/understanding-labor-delivery-complications-basics#3 |access-date=2017-03-16}}</ref> One of the most common preventable causes of infant mortality is smoking during pregnancy.<ref>{{Cite journal |vauthors=Hall ES, Venkatesh M, Greenberg JM |date=November 2016 |title=A population study of first and subsequent pregnancy smoking behaviors in Ohio |journal=Journal of Perinatology |volume=36 |issue=11 |pages=948–953 |doi=10.1038/jp.2016.119 |pmid=27467563 |s2cid=29303225 |doi-access=free}}</ref> Lack of prenatal care, alcohol consumption during pregnancy, and drug use also cause complications that may result in infant mortality.<ref name="cdc-2020">{{Cite web |last=CDC |date=2020-06-03 |title=Commit to Healthy Choices to Help Prevent Birth Defects {{!}} CDC |url=https://www.cdc.gov/ncbddd/birthdefects/prevention.html |access-date=2020-07-30 |website=Centers for Disease Control and Prevention |language=en-us}}</ref>{{Failed verification|reason=source gives advice on preventing birth defects generally, not specific to those that cause infant mortality|date=August 2020}} Many situational factors contribute to the infant mortality rate, such as the pregnant woman's level of education, environmental conditions, political infrastructure, and level of medical support.<ref>{{Cite journal |vauthors=Genowska A, Jamiołkowski J, Szafraniec K, Stepaniak U, Szpak A, Pająk A |date=July 2015 |title=Environmental and socio-economic determinants of infant mortality in Poland: an ecological study |journal=Environmental Health |volume=14 |issue=1 |article-number=61 |doi=10.1186/s12940-015-0048-1 |pmc=4508882 |pmid=26195213 |bibcode=2015EnvHe..14...61G |doi-access=free }}</ref> Improving [[sanitation]], access to clean drinking water, [[immunization]] against [[infectious diseases]], and other [[public health]] measures can help reduce rates of infant mortality.

In 1990, 8.8 million infants younger than one-year-old died globally<ref>{{Cite web |date=2020 |title=Infant Mortality |url=https://www.who.int/gho/child_health/mortality/neonatal_infant_text/en/ |archive-url=https://web.archive.org/web/20140324141053/http://www.who.int/gho/child_health/mortality/neonatal_infant_text/en/ |archive-date=March 24, 2014 |access-date=22 October 2020 |website=World Health Organization}}</ref> out of 12.6 million child deaths under the age of five.<ref name="Roser" /> More than 60% of the deaths of children under-five are seen as avoidable with low-cost measures such as continuous [[breastfeeding]], vaccinations, and improved nutrition.<ref>{{Cite web |title=WHO {{!}} Child mortality |url=https://www.who.int/pmnch/media/press_materials/fs/fs_mdg4_childmortality/en/ |archive-url=https://web.archive.org/web/20110314194542/http://www.who.int/pmnch/media/press_materials/fs/fs_mdg4_childmortality/en/ |archive-date=March 14, 2011 |access-date=2017-03-16 |website=www.who.int}}</ref> The global under-five mortality rate in 1950 was 22.5%, which dropped to 4.5% in 2015.<ref name="Roser">{{Cite journal |vauthors=Roser M |date=2013-05-10 |title=Child Mortality |url=https://ourworldindata.org/child-mortality |journal=Our World in Data}}</ref> Over the same period, the infant mortality rate declined from 65 deaths per 1,000 live births to 29 deaths per 1,000.<ref>{{Cite web |title=Mortality rate, infant (per 1,000 live births) {{!}} Data |url=https://data.worldbank.org/indicator/sp.dyn.imrt.in |access-date=2019-03-24 |website=data.worldbank.org}}</ref> Globally, 5.4 million children died before their fifth birthday in 2017;<ref>{{Cite web |title=Children: reducing mortality |url=https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality |access-date=2020-07-31 |website=www.who.int |language=en}}</ref> by 2021 that number had dropped to 5 million children.<ref>{{Cite web |date=January 2023 |title=Under-five mortality |url=https://data.unicef.org/topic/child-survival/under-five-mortality/ |website=[[UNICEF]]}}</ref>

The child mortality rate (not the infant mortality rate) was an indicator used to monitor progress towards the Fourth Goal of the [[Millennium Development Goals]] of the [[United Nations]] for the year 2015. A reduction in child mortality was established as a target in the [[Sustainable Development Goals]]—Goal Number 3: Ensure healthy lives and promote well-being for all at all ages.<ref>{{Cite web |title=Sustainable Development Knowledge Platform |url=https://sustainabledevelopment.un.org/sdg3 |access-date=23 April 2016 |publisher=UN-DESA}}</ref> {{As of|January 2022}}, an analysis of 200 countries found 133 already meeting the SDG target, with 13 others trending towards meeting the target by 2030.<ref>{{Cite web |date=January 20, 2022 |title=Global, regional and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030 |url=https://data.unicef.org/resources/global-regional-and-national-trends-in-under-5-mortality-between-1990-and-2019/ |website=[[UNICEF]]}}</ref> Throughout the world, the infant mortality rate (IMR) fluctuates drastically, and according to Biotechnology and Health Sciences, education and life expectancy in a country are the leading indicators of IMR.<ref name="alijanzadeh-2016">{{Cite journal |last1=Alijanzadeh |first1=Mehran |last2=Asefzadeh |first2=Saeed |last3=Moosaniaye Zare |first3=Seyed Ali |date=2016-02-05 |title=Correlation Between Human Development Index and Infant Mortality Rate Worldwide |journal=Biotechnology and Health Sciences |volume=3 |issue=1 |doi=10.17795/bhs-35330 |doi-broken-date=1 July 2025 |s2cid=73614487 |issn=2383-0271}}</ref> This study was conducted across 135 countries over the course of 11 years, with the continent of Africa having the highest infant mortality rate of any region studied, with 68 deaths per 1,000 live births.<ref name="alijanzadeh-2016" />

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==Classification==
Infant mortality rate (IMR) is the number of deaths per 1,000 live births of children under one year of age. The rate for a given region is the number of children dying under one year of age, divided by the number of live births during the year, multiplied by 1,000.<ref name="Andrews">{{Cite book |title=Encyclopedia of Infant and Early Childhood Development |vauthors=Andrews KM, Brouillette DB, Brouillette RT |publisher=Elsevier |year=2008 |isbn=978-0-12-370877-9 |pages=343–359 |chapter=Mortality, Infant |doi=10.1016/B978-012370877-9.00084-0}}</ref>

Forms of infant mortality:
* [[Perinatal mortality]] is late fetal death (22 weeks gestation to birth) or death of a newborn up to one week postpartum.<ref name="Andrews" />
* [[Neonatal mortality#Neonatal mortality|Neonatal mortality]] is death occurring within 28 days postpartum. Neonatal death is often attributed to inadequate access to basic medical care, during pregnancy and after delivery. This accounts for 40–60% of infant mortality in developing countries.<ref name="Norton">{{Cite journal |vauthors=Norton M |date=April 2005 |title=New evidence on birth spacing: promising findings for improving newborn, infant, child, and maternal health |url=https://zenodo.org/record/1259057 |journal=International Journal of Gynaecology and Obstetrics |volume=89 |issue=Suppl 1 |pages=S1-6 |doi=10.1016/j.ijgo.2004.12.012 |pmid=15820364 |s2cid=26219456 |doi-access=free}}</ref>
* [[Postneonatal mortality]] is the death of children aged 29 days to one year. The major contributors to postneonatal death are malnutrition, infectious disease, pregnancy complications, [[SIDS|sudden infant death syndrome]], and problems in the home environment.<ref name="CDC-2022" />

== Causes ==
Causes of infant mortality, or direct causes of death, differ from contributions to the IMR, as contributing factors raise the risk of death, but do not directly cause death.<ref>{{Cite web |title=What causes infant mortality? |url=https://www.nichd.nih.gov/health/topics/infant-mortality/topicinfo/causes |access-date=2017-03-07 |website=www.nichd.nih.gov}}</ref> Environmental and social barriers that prevent access to basic medical resources contribute to an increased infant mortality rate, 86% of infant deaths are caused by [[infections]], [[premature births]], complications during delivery, perinatal [[asphyxia]], and birth injuries. Many of these common causes are preventable with low-cost measures.<ref name="Andrews" /> While 99% of infant deaths occur in developing countries, the greatest percentage reduction in infant mortality occurs in countries that already have low rates of infant mortality.<ref name="Andrews" /><ref name="Bishai">{{Cite journal |vauthors=Bishai D, Opuni M, Poon A |date=March 2007 |title=Does the level of infant mortality affect the rate of decline? Time series data from 21 countries |journal=Economics and Human Biology |volume=5 |issue=1 |pages=74–81 |doi=10.1016/j.ehb.2006.10.003 |pmid=17141591}}</ref>  In the United States, a primary source of infant mortality risk is infant birth weight, with lower birth weights increasing the risk;<ref>{{Cite journal |vauthors=Saugstad LF |date=September 1981 |title=Weight of all births and infant mortality |journal=Journal of Epidemiology and Community Health |volume=35 |issue=3 |pages=185–191 |doi=10.1136/jech.35.3.185 |pmc=1052154 |pmid=7199074}}</ref> the causes of low birth weight include socioeconomic, psychological, behavioral, and environmental factors.<ref name="Osel2008">{{Cite SSRN |title=Being (Born) Black in America: Perceived Discrimination & African-American Infant Mortality |year=2008 |ssrn=2173553 |vauthors=Osel JD}}</ref>

=== Main causes ===
There are  three main leading causes of infant mortality: conditions related to [[preterm birth]], [[birth defect|congenital anomalies]], and [[SIDS]] (sudden infant death syndrome).<ref name="dollfus-1990">{{Cite journal |last1=Dollfus |first1=C. |last2=Patetta |first2=M. |last3=Siegel |first3=E. |last4=Cross |first4=A. W. |date=August 1990 |title=Infant mortality: a practical approach to the analysis of the leading causes of death and risk factors |journal=Pediatrics |volume=86 |issue=2 |pages=176–183 |doi=10.1542/peds.86.2.176 |issn=0031-4005 |pmid=2371093 |s2cid=42744378}}</ref> In North Carolina between 1980 and 1984, 37.5% of infant deaths were due to prematurity, congenital anomalies accounted for 17.4% and SIDS accounted for 12.9%.<ref name="dollfus-1990" />

==== Premature birth ====
{{Main|Preterm birth}}
Premature, or [[preterm birth]] (PTB), is defined as birth before a [[gestational age]] of 37 weeks, as opposed to full term birth at 40 weeks. This can be further sub-divided in various ways, one being: "mild preterm (32–36 weeks), very preterm (28–31 weeks) and extremely preterm (<28 weeks)".<ref name="Moutquin-2003">{{Cite journal |vauthors=Moutquin JM |date=April 2003 |title=Classification and heterogeneity of preterm birth |journal=BJOG |volume=110 |issue=Suppl 20 |pages=30–3 |doi=10.1046/j.1471-0528.2003.00021.x |pmid=12763108 |s2cid=33268768 |doi-access=free}}</ref>  A lower gestational age increases the risk of infant mortality.<ref name="harrison-2016">{{Cite journal |vauthors=Harrison MS, Goldenberg RL |date=April 2016 |title=Global burden of prematurity |journal=Seminars in Fetal & Neonatal Medicine |volume=21 |issue=2 |pages=74–9 |doi=10.1016/j.siny.2015.12.007 |pmid=26740166}}</ref>

Between 1990 and 2010 prematurity was the second leading cause of worldwide mortality for neonates and children under the age of five.<ref name="Blencowe" /> The overall PTB mortality rate in 2010 was 11.1% (15 million deaths) worldwide and was highest in low to middle-income countries in sub-Saharan Africa and south Asia (60% of all PTBs), compared with high-income countries in Europe or the United States.<ref name="Blencowe">{{Cite journal |display-authors=6 |vauthors=Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, Adler A, Vera Garcia C, Rohde S, Say L, Lawn JE |date=June 2012 |title=National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications |url=https://researchonline.lshtm.ac.uk/id/eprint/40396/1/1-s2.0-S0140673612608204-main.pdf__tid%3D6e9a5226-c455-11e5-8722-00000aacb362%26acdnat%3D1453830871_1bfa5cad3ce2895d33a963f1f360c67a |journal=Lancet |volume=379 |issue=9832 |pages=2162–72 |doi=10.1016/s0140-6736(12)60820-4 |pmid=22682464 |s2cid=253520}}</ref>{{Failed verification|date=July 2023}} Low-income countries also have limited resources to care for the needs of preterm infants, which increases the risk of infant mortality. The survival rate in these countries for infants born before 28 weeks of gestation is 10%, compared with a 90% survival rate in high-income countries.<ref>{{Cite book |last=March of Dimes Birth Defects Foundation. |title=Born too soon: the global action report on preterm birth |publisher=World Health Organization |year=2012 |isbn=978-92-4-150343-3 |oclc=1027675119}}</ref> In the United States, the period from 1980 to 2000 saw a decrease in the total number of infant mortality cases, despite a significant increase in premature births.<ref name="behrman-2007" />

Based on distinct clinical presentations, there are three main subgroups of preterm births: those that occur due to spontaneous premature labor, those that occur due to spontaneous membrane ([[amniotic sac]]) rupture, and those that are medically induced.<ref>{{Cite journal |last=Kramer |first=M. S. |date=October 1987 |title=Intrauterine growth and gestational duration determinants |journal=Pediatrics |volume=80 |issue=4 |pages=502–511 |doi=10.1542/peds.80.4.502 |issn=0031-4005 |pmid=3658568 |s2cid=21632987}}</ref> Both spontaneous factors are viewed to be a result of similar causes; hence, two main classifications remain: spontaneous and medically induced causes.<ref>{{Cite journal |last=Klebanoff |first=M. A. |year=1998 |title=Conceptualizing categories of preterm birth |journal=Prenatal and Neonatal Medicine |volume=3 |issue=1 |pages=13–15}}</ref> The risk of spontaneous PTB increases with "extremes of maternal age (both young and old), short inter-pregnancy intervals, multiple gestations, assisted reproductive technology, prior PTB, family history, substance abuse, cigarette use, low maternal socioeconomic status, late or no prenatal care, low maternal prepregnancy weight, [[bacterial vaginosis]], [[periodontal disease]], and poor pregnancy weight gain."<ref>{{Cite journal |vauthors=Rubens CE, Sadovsky Y, Muglia L, Gravett MG, Lackritz E, Gravett C |date=November 2014 |title=Prevention of preterm birth: harnessing science to address the global epidemic |journal=Science Translational Medicine |volume=6 |issue=262 |pages=262sr5 |doi=10.1126/scitranslmed.3009871 |pmid=25391484 |s2cid=8162848 |doi-access=free}}</ref> Medically induced preterm birth is often conducted when continuing pregnancy poses significant risks to the pregnant parent or fetus; the most common causes include [[preeclampsia]], diabetes, maternal medical conditions, [[fetal distress]], or developmental problems.<ref name="Moutquin-2003" /> Despite these risk factors, the underlying causes of premature infant death are often unknown, and approximately 65% of all cases are not associated with any known risk factor.<ref name="harrison-2016" />

Infant mortality caused by premature birth is mainly attributed to developmental immaturity, which impacts multiple organ systems in the infant's body.<ref name="behrman-2007-2">{{Cite book |last1=Behrman |first1=Richard E. |url=https://www.ncbi.nlm.nih.gov/books/NBK11385/ |title=Mortality and Acute Complications in Preterm Infants |last2=Butler |first2=Adrienne Stith |last3=Outcomes |first3=Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy |date=2007 |publisher=National Academies Press (US) |language=en}}</ref> The main body systems affected include the respiratory system, which may result in [[pulmonary hypoplasia]], [[Infant respiratory distress syndrome|respiratory distress syndrome]], [[bronchopulmonary dysplasia]] (a chronic lung disease), and [[apnea]].<ref name="behrman-2007-2" /> Other body systems that fully develop at a later gestational age include the [[Gastrointestinal tract|gastrointestinal system]], the skin, the [[immune system]], the [[cardiovascular system]], and the [[Blood|hematologic system]].<ref name="behrman-2007-2" /> Poor development of these systems increases the risk of infant mortality.{{cn|date=December 2023}}

Understanding the biological causes and predictors of PTB is important for identifying and preventing premature birth and infant mortality. While the exact mechanisms responsible for inducing premature birth are often unknown, many of the underlying risk factors are associated with inflammation. Approximately "80% of preterm births that occur at <1,000 g or at <28 to 30 weeks of gestation" have been associated with inflammation.{{citation needed|date=July 2023}} Biomarkers of inflammation, including [[C-reactive protein]], [[ferritin]], various [[interleukin]]s, [[chemokine]]s, [[cytokine]]s, [[defensin]]s, and [[bacteria]], have been shown to be associated with increased risks of infection or inflammation-related preterm birth. Biological fluids have been utilized to analyze these markers in hopes of understanding the pathology of preterm birth, but they are not always useful if not acquired at the appropriate gestational time-frame. For example, biomarkers such as [[fibronectin]] are accurate predictors of premature birth at over 24 weeks of gestation but have poor predictive values before then.<ref>{{Cite journal |vauthors=Goldenberg RL, Goepfert AR, Ramsey PS |date=May 2005 |title=Biochemical markers for the prediction of preterm birth |journal=American Journal of Obstetrics and Gynecology |volume=192 |issue=5 Suppl |pages=S36-46 |doi=10.1016/j.ajog.2005.02.015 |pmid=15891711}}</ref> Additionally, understanding the risks associated with different gestational ages is a helpful determiner of [[Gestational age-specific mortality]].<ref name="behrman-2007">{{Cite book |last1=Behrman |first1=Richard E. |url=https://www.ncbi.nlm.nih.gov/books/NBK11386/ |title=Prematurity at Birth: Determinants, Consequences, and Geographic Variation |last2=Butler |first2=Adrienne Stith |last3=Outcomes |first3=Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy |date=2007 |publisher=National Academies Press (US) |language=en}}</ref>

==== Sudden infant death syndrome (SIDS) ====
{{Main|Sudden infant death syndrome}}

Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant less than one year of age with no cause detected after a thorough investigation. SIDS is more common in Western countries.<ref name="Duncan_2018">{{Cite book |title=SIDS Sudden infant and early childhood death: The past, the present and the future |vauthors=Duncan JR, Byard RW, Duncan JR, Byard RW |publisher=University of Adelaide Press |year=2018 |isbn=978-1-925261-67-7 |veditors=Duncan JR, Byard RW |pages=15–50 |chapter=Sudden Infant Death Syndrome: An Overview |jstor=10.20851/j.ctv2n7f0v.6 |pmid=30035964 |jstor-access=free}}</ref> The [[United States Centers for Disease Control and Prevention]] report SIDS to be the leading cause of death in infants aged one month to one year of life.<ref name="cdc.gov">{{Cite web |date=2020-01-28 |title=Sudden Unexpected Infant Death and Sudden Infant Death Syndrome |url=https://www.cdc.gov/sids/index.htm |access-date=2020-07-30 |website=www.cdc.gov |language=en-us}}</ref> Even though researchers are not sure what causes SIDS, they have found that putting babies to sleep on their backs, instead of their stomachs, lowers the risk. Campaigns like [[Safe to Sleep|Back to Sleep]] have used this research to lower the SIDS death rate by 50%.<ref>{{Cite journal |vauthors=Willinger M, Hoffman HJ, Hartford RB |date=May 1994 |title=Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD |url=http://pediatrics.aappublications.org/content/93/5/814.long |journal=Pediatrics |volume=93 |issue=5 |pages=814–9 |doi=10.1542/peds.93.5.814 |pmid=8165085 |s2cid=245121375|url-access=subscription }}</ref> Though the exact cause is unknown, the "triple-risk model" presents three factors that together may contribute to SIDS: smoking while pregnant, the age of the infant, and stress from conditions such as prone sleeping, [[co-sleeping]], overheating, and covering of the face or head.<ref name="Duncan_2018" /> In the early 1990s, it was argued that immunizations could contribute to an increased risk of SIDS; however, more recent support the idea that vaccinations reduce the risk of SIDS.<ref>{{Cite journal |vauthors=Vennemann MM, Höffgen M, Bajanowski T, Hense HW, Mitchell EA |date=June 2007 |title=Do immunisations reduce the risk for SIDS? A meta-analysis |journal=Vaccine |volume=25 |issue=26 |pages=4875–9 |doi=10.1016/j.vaccine.2007.02.077 |pmid=17400342}}</ref>

In the United States, approximately 3,500 infant deaths are sleep-related, a category that includes SIDS.<ref name="moon-2016">{{Cite journal |vauthors=Moon RY |date=November 2016 |title=SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment |journal=Pediatrics |volume=138 |issue=5 |pages=e20162940 |doi=10.1542/peds.2016-2940 |pmid=27940805 |s2cid=5744617 |doi-access=free}}</ref> To reduce sleep-related infant deaths, the American Academy of Pediatrics recommends providing infants with safe-sleeping environments, breastfeeding, and immunizing according to the recommended [[Vaccination schedule|immunization schedule]]. They recommend against the use of a [[pacifier]] and recommend avoiding exposure to smoke, alcohol, and illicit drugs during and after pregnancy.<ref name="moon-2016" />

==== Congenital malformations ====
{{Main|Congenital malformation}}

Congenital malformations are present at birth and include conditions such as cleft lip and palate, Down Syndrome, and heart defects. Some congenital malformations may be more likely when the mother consumes alcohol, but they can also be caused by genetics or unknown factors.<ref>{{Cite web |title=Medical Definition of Congenital malformation |url=https://www.medicinenet.com/script/main/art.asp?articlekey=2820 |website=MedicineNet.com |access-date=2018-07-25 |archive-date=2020-04-01 |archive-url=https://web.archive.org/web/20200401120742/https://www.medicinenet.com/script/main/art.asp?articlekey=2820 }}</ref>
Congenital malformations have had a significant impact on infant mortality, but malnutrition and infectious diseases remain the main causes of death in less developed countries. For example, in the Caribbean and Latin America in the 1980s, congenital malformations only accounted for 5% of infant deaths, while malnutrition and infectious diseases accounted for 7% to 27% of infant deaths.<ref>{{Cite journal |vauthors=Rosano A, Botto LD, Botting B, Mastroiacovo P |date=September 2000 |title=Infant mortality and congenital anomalies from 1950 to 1994: an international perspective |journal=Journal of Epidemiology and Community Health |volume=54 |issue=9 |pages=660–6 |doi=10.1136/jech.54.9.660 |pmc=1731756 |pmid=10942444}}</ref> In more developed countries, such as the United States, there was a rise in infant deaths due to congenital malformations, mostly heart and central nervous system problems. In the 20th century, there was a decrease in the number of infant deaths from heart conditions, from 1979 to 1997, there was a 39% decline.<ref>{{Cite journal |vauthors=van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW |date=November 2011 |title=Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis |journal=Journal of the American College of Cardiology |volume=58 |issue=21 |pages=2241–7 |doi=10.1016/j.jacc.2011.08.025 |pmid=22078432 |doi-access=free}}</ref>

=== Medicine and biology ===
Causes of infant mortality and deaths that are related to medical conditions include: low birth weight, [[sudden infant death syndrome]], malnutrition, congenital malformations, infectious diseases, and low income for health care, including [[neglected tropical diseases]].

The American Academy of Pediatrics recommends that infants need multiple doses of vaccines such as [[DPT vaccine|diphtheria–tetanus–acellular pertussis vaccine]], [[Hib vaccine|''Haemophilus influenzae'' type b (Hib) vaccine]], [[Hepatitis B vaccine|hepatitis B (HepB) vaccine]], [[Polio vaccine|inactivated polio vaccine]] (IPV), and [[pneumococcal vaccine]] (PCV). Research conducted by the [[Institute of Medicine]]'s [[Immunization Safety Review Committee]] concluded that there is no relationship between these vaccines and the risk of SIDS in infants.<ref>{{Cite book |last1=Institute of Medicine (US) Immunization Safety Review Committee |url=http://www.nap.edu/catalog/10649 |doi-access=free |title=Immunization Safety Review: Vaccinations and Sudden Unexpected Death in Infancy |last2=Stratton |first2=K. |last3=Almario |first3=D. A. |last4=Wizemann |first4=T. M. |last5=McCormick |first5=M. C. |date=2003-10-28 |publisher=National Academies Press |isbn=978-0-309-08886-2 |location=Washington, D.C. |doi=10.17226/10649 |pmid=25057654 |url-status=live |archive-url=https://web.archive.org/web/20231211061018/https://nap.nationalacademies.org/read/10649/chapter/1#ii |archive-date= Dec 11, 2023 }}</ref>{{rp|77–78}}

==== Low birth weight ====
{{Main|Low birth weight}}
[[Low birth weight]] makes up 60–80% of the infant mortality rate in developing countries. ''[[The New England Journal of Medicine]]'' stated that "The lowest mortality rates occur among infants weighing {{convert|3000|to|3500|g|lbs|abbr=on}}. For infants born weighing {{Convert|2500|g|lbs|abbr=on}} or less, the mortality rate rapidly increases with decreasing weight, and most of the infants weighing {{convert|1000|g|lbs|abbr=on}} or less die. As compared with normal-birth-weight infants, those with low weight at birth are almost 40 times more likely to die in the neonatal period; for infants with very low weight at birth the relative risk of neonatal death is almost 200 times greater."<ref name="NEJM1985" />{{Outdated statistic|date=June 2025}} Infant mortality due to low birth weight is usually a direct cause stemming from other medical complications such as preterm birth, poor maternal nutritional status, a lack of [[prenatal care]], maternal sickness during pregnancy, and unhygienic home environments.<ref name="Andrews" /> Birth weight and the length of gestation are the two most important predictors of an infant's chances of survival and their overall health.<ref name="MacDorman 2009" />

According to the ''New England Journal of Medicine'', "in the past two decades, the infant mortality rate (deaths under one year of age per thousand live births) in the United States has declined sharply."<ref name="NEJM1985">{{cite journal |last1=McCormick |first1=Marie C. |title=The Contribution of Low Birth Weight to Infant Mortality and Childhood Morbidity |journal=New England Journal of Medicine |date=10 January 1985 |volume=312 |issue=2 |pages=82–90 |doi=10.1056/NEJM198501103120204 |pmid=3880598 }}</ref>{{Update inline|date=June 2025|reason=This statement was made in 1985.}} The rate of low birth weights among African Americans remains twice as high as the rate for white people. Low birth weight, the leading cause of infant deaths, is preventable by effective programs to help prevent low birth weight are a combination of health care, education, the environment,{{Clarify span|mental modification,|date=August 2023}} and public policy.<ref>{{Cite web |year=2000 |title=Infant Mortality, Low Birthweight and Racial Disparity |url=http://www.nationalhealthystart.org/site/assets/docs/Infant%20Mortality%20Low%20Birthweight.pdf |archive-url=https://web.archive.org/web/20191230004308/http://www.nationalhealthystart.org/site/assets/docs/Infant%20Mortality%20Low%20Birthweight.pdf |archive-date=2019-12-30 |website=National Healthy Start Association }}</ref> Preterm birth is the leading cause of newborn deaths worldwide.<ref>{{Cite web |title= Preterm birth |url=https://www.who.int/mediacentre/factsheets/fs363/en/index.html |access-date=2013-09-29 |website=WHO |date=November 2012 |archive-url= https://web.archive.org/web/20131002115944/https://www.who.int/mediacentre/factsheets/fs363/en/index.html |archive-date= Oct 2, 2013 }}</ref> Even though America has a higher survival rate for premature infants, the percentage of Americans who deliver prematurely is comparable to those in developing countries. Reasons for this include [[teenage pregnancy]], an increase in pregnancy after the age of 35, an increase in the use of [[in vitro fertilisation]] (which increases the risk of multiple births), obesity, and diabetes. Also, pregnant people who do not have access to health care are less likely to visit a doctor, therefore increasing their risk of delivering prematurely.<ref name="lag" />

====Malnutrition====
{{Main|Undernutrition in children}}
[[File:Hunger Map 2020 World Food Programme.svg|thumb|310px|Percentage of population suffering from hunger, [[World Food Programme]], 2020<br />
{{Legend|#29b8c7|< 2.5%}}
{{Legend|#16b484|2.5–5.0%}}
{{Legend|#fec960|5.0–14.9%}}
{{Legend|#f47846|15.0–24.9%}}
{{Legend|#f2203a|25.0–34.9%}}
{{Legend|#7f0928|> 35.0%}}
{{Legend|#b5aba4|No data}}]]
Malnutrition or undernutrition is defined as inadequate intake of nourishment, such as proteins and vitamins, which adversely affects the growth, energy, and development of people all over the world.<ref>{{Cite journal |vauthors=de Onís M, Monteiro C, Akré J, Glugston G |date=1993 |title=The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth |journal=Bulletin of the World Health Organization |volume=71 |issue=6 |pages=703–12 |pmc=2393544 |pmid=8313488 }}</ref> It is especially prevalent during pregnancy and in infants and children under 5 who live in developing countries within the poorer regions of Africa, Asia, and Latin America.<ref>{{Cite news |date=2012-09-26 |title=Top 9 countries fighting child malnutrition |first1=Kathryn |last1=Reid |work=World Vision |url=https://www.worldvision.org/hunger-news-stories/top-nine-countries-fighting-child-malnutrition |access-date=2018-07-27}}</ref> Children are especially vulnerable as they have yet to fully develop a strong [[immune system]] and are dependent on their parents to provide the necessary food and nutritional intake. It is estimated that about 3.5 million children die each year as a result of childhood or maternal malnutrition, with [[stunted growth]], low body weight, and low birth weight accounting for about 2.2 million associated deaths.<ref>{{Cite journal |display-authors=6 |vauthors=Martins VJ, Toledo Florêncio TM, Grillo LP, do Carmo P, Franco M, Martins PA, Clemente AP, Santos CD, de Fatima A, Vieira M, Sawaya AL |date=June 2011 |title=Long-lasting effects of undernutrition |journal=International Journal of Environmental Research and Public Health |volume=8 |issue=6 |pages=1817–46 |doi=10.3390/ijerph8061817 |pmc=3137999 |pmid=21776204 |doi-access=free}}</ref> Socioeconomic and environmental factors contribute to malnutrition, as do gender, location, and cultural practices surrounding [[breastfeeding]].<ref>{{Cite journal |vauthors=Mahgoud SE |date=2006 |title=Factors Affecting Prevalence of Malnutrition Among Children Under Three Years Of Age In Botswana |url=https://ubrisa.ub.bw/bitstream/handle/10311/219/Mahgoub_AJFAND_2006.pdf?sequence=1&isAllowed=y |journal=African Journal of Food, Agriculture, Nutrition and Development |volume=6}}</ref> It is difficult to assess the most pressing factor as they can intertwine and vary among regions.

Children suffering from malnutrition can become underweight, and experience stunting or [[wasting]]. In Africa, the number of stunted children has risen, while Asia has the most children under 5 suffering from wasting.<ref>{{Cite web |date=2015 |title=Levels and trends in child malnutrition |url=https://www.unicef.org/media/files/JME_2015_edition_Sept_2015.pdf |archive-url=https://web.archive.org/web/20210525180258/https://www.unicef.org/media/files/JME_2015_edition_Sept_2015.pdf |archive-date=2021-05-25 |access-date=2018-07-27 |website=UNICEF – WHO – World Bank Group joint child malnutrition estimates}}{{Moved resource|date=July 2023}}</ref> Inadequate nutrients adversely affect physical and cognitive development, increasing susceptibility to severe health problems. Micronutrient deficiency has been linked to [[Iron-deficiency anemia|anemia]], fatigue, [[Vitamin A deficiency#Signs and symptoms|blindness]], [[Iodine deficiency#Goiter|goiter]], poor brain development, and death.<ref>{{Cite journal |vauthors=Torpy JM, Lynm C, Glass RM |date=August 2004 |title=JAMA patient page. Malnutrition in children |journal=JAMA |volume=292 |issue=5 |page=648 |doi=10.1001/jama.292.5.648 |pmid=15292091 |doi-access=free}}</ref> Malnutrition also decreases the immune system's ability to fight infections, resulting in higher rates of death from diseases such as malaria, respiratory disease, and diarrhea.<ref>{{Cite journal |vauthors=Tette EM, Sifah EK, Nartey ET |date=November 2015 |title=Factors affecting malnutrition in children and the uptake of interventions to prevent the condition |journal=BMC Pediatrics |volume=15 |issue=1 |article-number=189 |doi=10.1186/s12887-015-0496-3 |pmc=4653928 |pmid=26586172 |doi-access=free }}</ref>

[[Folic acid]] during pregnancy is one way to combat iron deficiency. A few [[public health]] measures used to lower levels of iron deficiency anemia include added iodine to salt or drinking water and including vitamin A and multivitamin supplements in the diet.<ref name="Andrews" /> A deficiency of this vitamin causes certain types of [[anemia]] (low red blood cell count).<ref>{{Cite web |title=Folic Acid |url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000723 |archive-url=https://web.archive.org/web/20100714151130/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000723 |archive-date=14 July 2010 |website=PubMed Health |publisher=]National Center for Biotechnology Information, U.S. National Library of Medicine}}</ref>

====Infectious diseases====
Babies born in low- to middle-income countries in sub-Saharan Africa and southern Asia are at the highest risk of neonatal death. Bacterial infections of the bloodstream, lungs, and the brain's covering ([[meningitis]]) are responsible for 25% of neonatal deaths worldwide. Newborns can acquire infections during birth from bacteria present in the birth canal, the person may not be aware of the infection, or they may have an untreated [[pelvic inflammatory disease]] or a [[sexually transmitted disease]]. These bacteria can also move up the vaginal canal into the amniotic sac surrounding the baby causing in utero transmission. Maternal blood-borne infection is another route of bacterial infection. Neonatal infection is more likely with the [[premature rupture of the membranes]] (PROM) of the amniotic sac.<ref>{{Cite journal |vauthors=Chan GJ, Lee AC, Baqui AH, Tan J, Black RE |date=August 2013 |title=Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis |journal=PLOS Medicine |volume=10 |issue=8 |article-number=e1001502 |doi=10.1371/journal.pmed.1001502 |pmc=3747995 |pmid=23976885 |doi-access=free }}</ref>

Seven out of ten childhood deaths are due to infectious diseases like [[acute respiratory infection]], [[diarrhea]], [[measles]], and [[malaria]]. Acute respiratory infections such as [[pneumonia]], [[bronchitis]], and [[bronchiolitis]] account for 30% of childhood deaths; 95% of pneumonia cases occur in the developing world. Diarrhea is the second-largest cause of childhood mortality in the world, while malaria causes 11% of childhood deaths. Measles is the fifth-largest cause of childhood mortality.<ref name="Andrews" /><ref name="Nussbaum">{{Cite book |title=Creating Capabilities |vauthors=Nussbaum M |publisher=The Belknap Press of Harvard University Press |year=2011 |isbn=978-0-674-05054-9}}</ref>

===Environmental===
The infant mortality rate is one measure of a nation's health and social conditions. Its causes are a composite of a number rates that each have their own separate relationships with each other and with various other social factors. As such, IMR can often be seen as an indicator to measure the level of socioeconomic disparity within a country.<ref name="MacDorman 2009">{{Cite journal |vauthors=MacDorman MF, Mathews TJ |year=2009 |title=The challenge of infant mortality: have we reached a plateau? |doi-access=free |journal=Public Health Reports |volume=124 |issue=5 |pages=670–81 |doi=10.1177/003335490912400509 |pmc=2728659 |pmid=19753945}}</ref><ref name="Gortmaker 1997">{{Cite journal |vauthors=Gortmaker SL, Wise PH |year=1997 |title=The first injustice: socioeconomic disparities, health services technology, and infant mortality |journal=Annual Review of Sociology |volume=23 |pages=147–70 |doi=10.1146/annurev.soc.23.1.147 |pmid=12348279}}</ref>

Organic [[water pollution]] is a better indicator of infant mortality than health expenditures per capita. Water contaminated by animal waste houses various [[pathogens]] including a host of [[parasitic]] and [[microbial]] infections.<ref name="Jorgenson">{{Cite journal |vauthors=Jorgenson AK |year=2004 |title=Global inequality, water pollution, and infant mortality |journal=The Social Science Journal |volume=41 |issue=2 |pages=279–288 |doi=10.1016/j.soscij.2004.01.008 |s2cid=154147986}}</ref> Areas of low [[socioeconomic status]] are more prone to inadequate plumbing infrastructure and poorly maintained facilities.<ref name="Andrews" /> Climate and geography often play a role in sanitation conditions. For example, the inaccessibility of clean water exacerbates poor sanitation conditions.<ref name="Jorgenson" />

The burning of inefficient fuels doubles the rate of acute respiratory tract infections in children under 5 years old.<ref name="Andrews" /> People who live in areas where [[particulate matter]] air pollution is higher tend to have more health problems regardless of age. The short and long-term effects of [[air pollution]] are associated with an increased mortality rate, including infant mortality. Air pollution is consistently associated with postnatal mortality due to respiratory effects and sudden infant death syndrome (SIDS). Specifically, air pollution is highly associated with SIDS in the United States during the post-neonatal stage.<ref>{{Cite journal |vauthors=Woodruff TJ, Darrow LA, Parker JD |date=January 2008 |title=Air pollution and postneonatal infant mortality in the United States, 1999-2002 |journal=Environmental Health Perspectives |volume=116 |issue=1 |pages=110–5 |doi=10.1289/ehp.10370 |pmc=2199284 |pmid=18197308|bibcode=2008EnvHP.116..110W }}</ref> High infant mortality is exacerbated because newborns are a vulnerable subgroup that is affected by air pollution.<ref>{{Cite journal |vauthors=Glinianaia SV, Rankin J, Bell R, Pless-Mulloli T, Howel D |date=October 2004 |title=Does particulate air pollution contribute to infant death? A systematic review |journal=Environmental Health Perspectives |volume=112 |issue=14 |pages=1365–71 |doi=10.1289/ehp.6857 |pmc=1247561 |pmid=15471726|bibcode=2004EnvHP.112.1365G }}</ref> Newborns who were born into these environments are no exception, and pregnant women exposed to greater air pollution on a daily basis should be closely watched by their doctors, including after the baby is born. Babies who live in areas with less air pollution have a greater chance of living until their first birthday, meaning babies who live in environments with more air pollution are at greater risk for infant mortality. Areas that have higher air pollution also have a greater chance of having a higher population density, higher crime rates, and lower income levels, all of which can lead to higher infant mortality rates.<ref>{{Cite web |title=Infant Mortality: Reducing Infant Deaths. |url=http://www.nichd.nih.gov/news/resources/advances/2005/infant.cfm |archive-url=https://web.archive.org/web/20111012190945/http://www.nichd.nih.gov/news/resources/advances/2005/infant.cfm |archive-date=12 October 2011 |publisher=[[Eunice Kennedy Shriver National Institute of Child Health and Human Development]]}}</ref>

A key pollutant in infant mortality rates is [[carbon monoxide]]. Carbon monoxide is a colorless, odorless gas that can kill, and is especially dangerous to infants because of their immature respiratory systems.<ref>{{Cite journal |vauthors=Benjamin DK |date=Winter 2006 |title=Air Pollution and Infant Mortality |url=http://perc.org/articles/air-pollution-and-infant-mortality |journal=Property and Environmental Research Center Report |volume=24 |issue=4}}</ref>
Another major pollutant that can have detrimental effects on a fetus is second-hand smoke.

{{Blockquote|source=''American Journal of Public Health''|text=[I]n 2006, more than 42,000 Americans died of secondhand smoke-attributable diseases, including more than 41,000 adults and nearly 900 infants. Fully 36% of the infants who died of low birth weight caused by exposure to maternal smoking in utero were black, as were 28% of those dying of respiratory distress syndrome, 25% dying of other respiratory conditions, and 24% dying of sudden infant death syndrome.}}

{{Blockquote|source=''The American Journal of Epidemiology''|text=Compared with nonsmoking women having their first birth, women who smoked less than one pack of cigarettes per day had a 25% greater risk of mortality, and those who smoked one or more packs per day had a 56% greater risk. Among women having their second or higher birth, smokers experienced 30% greater mortality than nonsmokers.}}

Modern research in the United States into racial disparities in infant mortality suggests a link between [[institutionalized racism]] and high rates of African American infant mortality. In synthesis{{Synthesis inline|date=July 2023}} of this research, it has been observed that "African American infant mortality remains elevated due to the social arrangements that exist between groups and the lifelong experiences responding to the resultant power dynamics of these arrangements."<ref name="Osel2008" />

It is important to note that infant mortality rates do not decline among African Americans if their socio-economic status improves. Parker Dominguez at the University of Southern California<ref>{{Cite web |title=Tyan Parker Dominguez {{!}} USC Social Work |url=https://dworakpeck.usc.edu/academics/faculty-directory/tyan-parker-dominguez |access-date=2024-03-16 |website=dworakpeck.usc.edu |language=en}}</ref> has made some headway in determining the reasons behind this, claiming black women in the US are more prone to psychological stress than women of other races. Stress is a leading factor in the start of labor, and therefore, high levels of stress during pregnancy could lead to premature births that have the potential to be fatal for the infant.<ref>{{Cite news |date=2014-03-03 |title=Why do black infants die so much more often than white infants? |work=Southern California Public Radio |url=http://www.scpr.org/news/2014/03/03/42483/why-do-black-infants-die-so-much-more-often-than-w/ |access-date=2017-02-07}}</ref>

====Early childhood trauma====
[[Early childhood trauma]] includes physical, sexual, and psychological abuse of a child from birth to five years old. [[Childhood trauma|Trauma]] in early childhood has an extreme impact over the course of a lifetime and is a significant contributor to infant mortality. Developing organs are fragile, when an infant is shaken, beaten, strangled, or raped, the impact is exponentially more destructive than when the same abuse occurs to a fully developed body.{{Fact or opinion|date=July 2023}} Studies estimate that 1–2 per 100,000 U.S. children are fatally injured annually, and it is reasonable to assume that these statistics underrepresent actual mortality.<ref name="child welfare">{{Cite book |last=Child Welfare Information Gateway |url=https://www.childwelfare.gov/pubpdfs/fatality.pdf |title=Child Abuse and Neglect Fatalities 2018: Statistics and Interventions |date=2020 |publisher=Children's Bureau, U.S. Department of Health and Human Services |location=Washington, DC |access-date=22 October 2020 |archive-date=16 October 2020 |archive-url=https://web.archive.org/web/20201016192931/https://www.childwelfare.gov/pubPDFs/fatality.pdf }}</ref><ref>{{Cite journal |vauthors=Palusci VJ, Covington TM |date=January 2014 |title=Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System |journal=Child Abuse & Neglect |volume=38 |issue=1 |pages=25–36 |doi=10.1016/j.chiabu.2013.08.014 |pmid=24094272}}</ref> Almost three-quarters (70.6%) of child fatalities in [[Fiscal year|FFY]] 2018 involved children younger than 3 years, and children younger than 1 year accounted for half (49.4%) of all fatalities.<ref name="child welfare" /> In particular, correctly identifying deaths due to neglect is problematic, and children with sudden, unexpected deaths or deaths from apparently unintentional causes often have preventable risk factors that are substantially similar to those in families with maltreatment.{{citation needed|date=August 2023}}

There is a direct relationship between the age at which maltreatment or injury occurs and the risk of death. The younger an infant is, the more dangerous the maltreatment.<ref>{{Cite journal |vauthors=Imamura JH, Troster EJ, Oliveira CA |date=September 2012 |title=What types of unintentional injuries kill our children? Do infants die of the same types of injuries? A systematic review |journal=Clinics |volume=67 |issue=9 |pages=1107–16 |doi=10.6061/clinics/2012(09)20 |pmc=3438254 |pmid=23018311}}</ref>{{Failed verification|date=July 2023|reason=Improper synthesis?}}

Family configuration,<ref>{{Cite journal |vauthors=Smith-Greenaway E, Trinitapoli J |date=April 2014 |title=Polygynous contexts, family structure, and infant mortality in sub-saharan Africa |journal=Demography |volume=51 |issue=2 |pages=341–66 |doi=10.1007/s13524-013-0262-9 |pmc=3974908 |pmid=24402794}}</ref><ref>{{Cite web |title=Child Maltreatment: Risk and Protective Factors |url=https://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html |archive-url=https://web.archive.org/web/20100306061203/https://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html |archive-date=6 March 2010 |website=Centers for Disease Control and Prevention}}</ref> child gender, social isolation, lack of support, maternal youth, marital status, [[poverty]], parental [[Adverse Childhood Experiences Study|adverse childhood experiences]], and parenting practices<ref>{{Cite journal |vauthors=Leventhal JM, Garber RB, Brady CA |date=March 1989 |title=Identification during the postpartum period of infants who are at high risk of child maltreatment |journal=The Journal of Pediatrics |volume=114 |issue=3 |pages=481–7 |doi=10.1016/S0022-3476(89)80580-3 |pmid=2921696}}</ref> are all thought to contribute to increased risk.<ref name="child welfare" />

====Socio-economic factors====
[[File:Infant mortality rates are higher in more unequal countries.jpg|thumb|Infant mortality rates are higher in countries with higher [[economic inequality]].]]
[[Social class]] is a major factor in infant mortality, both historically and today. Between 1912 and 1915, the Children's Bureau in the United States examined data across eight cities and nearly 23,000 live births. They discovered that lower [[income]]s tended to [[correlation|correlate]] with higher infant mortality. In cases where the father had no income, the rate of infant mortality was 357% higher than that for the highest income earners ($1,250+).<ref name="ReferenceA" />{{rp|5}} Differences between [[race (classification of humans)|races]] were also apparent. African-American mothers experience infant mortality at a rate 44% higher than average;<ref name="ReferenceA">{{Cite journal |vauthors=Haines MR |year=2011 |title=Inequality and infant and childhood mortality in the United States in the twentieth century |url=http://www.nber.org/papers/w16133.pdf |journal=Explorations in Economic History |volume=48 |issue=3 |pages=418–28 |doi=10.1016/j.eeh.2011.05.009 |s2cid=154583453 |ssrn=1630138}}</ref> however, research indicates that socio-economic factors do not totally account for the racial disparities in infant mortality.<ref name="Osel2008" />

[[File:Countries by GDP (nominal) per capita in 2019.svg|thumb|left|270x270px|Countries by 2019 [[List of countries by GDP (nominal) per capita|GDP (nominal) per capita]]{{efn|Data from the [[United Nations]] is used.}}]]

While infant mortality is normally negatively correlated with GDP, there may be some beneficial short-term effects from a recession. A 2009 study in ''[[The Economist]]'' showed that economic slowdowns reduce air pollution, which results in a lower infant mortality rate. In the late 1970s and early 1980s, the recession's impact on air quality was estimated to have saved around 1,300 US babies.<ref>{{Cite news |date=2009-06-01 |title=A recession breathes life |newspaper=The Economist |url=http://www.economist.com/research/articlesBySubject/displaystory.cfm?subjectid=7933604&story_id=13764868 |archive-url=https://web.archive.org/web/20090725034036/http://www.economist.com/research/articlesBySubject/displaystory.cfm?subjectid=7933604&story_id=13764868 |archive-date=2009-07-25}}</ref> It is only during deep recessions that infant mortality increases. According to Norbert Schady and Marc-François Smitz, recessions when [[per capita GDP]] drops by 15% or more increase IMR.<ref>{{Cite web |last1=Schady |first1=Norbert |last2=Smitz |first2=Marc |date=August 2009 |title=Aggregate Economic Shocks and Infant Mortality: New Evidence for Middle-Income Countries |url=http://siteresources.worldbank.org/INTAFRICA/Resources/SchadySmitz_080509.pdf |website=The World Bank}}</ref>

Social class dictates which medical services are available to an individual. Disparities due to [[socioeconomic]] factors have been highlighted by advances in medical [[technology]]. Developed countries, most notably the United States, have seen a divergence in IMR between those living in poverty who cannot afford medically advanced resources, and those who can.<ref name="Gortmaker 1997" />

Developing nations with democratic governments tend to be more responsive to public opinion, [[social movements]], and [[special interest groups]] on issues like infant mortality. In contrast, non-democratic governments are more interested in corporate issues than in health issues. Democratic status affects the dependency a nation has on its economic state via exports, investments from multinational corporations, and international lending institutions.<ref name="Shandra">{{Cite journal |vauthors=Shandra JM, Nobles J, London B, Williamson JB |date=July 2004 |title=Dependency, democracy, and infant mortality: a quantitative, cross-national analysis of less developed countries |url=http://www.escholarship.org/uc/item/1wm303dg |journal=Social Science & Medicine |volume=59 |issue=2 |pages=321–333 |doi=10.1016/j.socscimed.2003.10.022 |pmid=15110423 |s2cid=616916}}</ref>

Levels of socioeconomic development and global integration are inversely related to a nation's infant mortality rate, meaning that as they increase, IMR decreases.<ref name="Andrews" /><ref name="Fuse">{{Cite journal |vauthors=Fuse K, Crenshaw EM |date=January 2006 |title=Gender imbalance in infant mortality: a cross-national study of social structure and female infanticide |journal=Social Science & Medicine |volume=62 |issue=2 |pages=360–74 |doi=10.1016/j.socscimed.2005.06.006 |pmid=16046041}}</ref> A nation's internal impact is highly influenced by its position in the global economy, which has adverse effects on the survival of children in developing countries.<ref name="Jorgenson" /> Countries can experience disproportionate effects from [[trade]] and stratification within the global system,<ref>{{Cite journal |vauthors=Moore S, Teixeira AC, Shiell A |date=July 2006 |title=The health of nations in a global context: trade, global stratification, and infant mortality rates |url=https://www.researchgate.net/publication/7316172 |journal=Social Science & Medicine |volume=63 |issue=1 |pages=165–78 |doi=10.1016/j.socscimed.2005.12.009 |pmid=16457924}}</ref> which contributes to the global [[division of labor]], and distorts the [[domestic economy|domestic economies]] of developing nations. The dependency of developing nations can reduce the rate of economic growth, increase income inequality inter- and intra-nationally, and adversely affect the wellbeing of a nation's population. Collective cooperation between  countries plays a role in development policies in the poorer countries of the world.<ref name="Shandra" />{{Explain|date=July 2023|reason=Jargon heavy paragraph is hard to follow for the non-economist.}}

These economic factors present challenges to governments' public [[health policy|health policies]].<ref name="Jorgenson" /> If the nation's ability to raise its own revenues is compromised, governments will lose funding for their health service programs, including those that aim to decrease infant mortality rates.<ref name="Shandra" /> Less developed countries face higher levels of vulnerability to the possible negative effects of globalization and trade in relation to more developed countries.<ref name="Jorgenson" />

Even with a strong economy and economic growth (measured by a country's [[gross national product]]), the advances of medical technologies may not be felt by everyone, increasing social disparities.<ref name="Gortmaker 1997" /> In England, from 2014 to 2017, a rise in infant mortality was disproportionately experienced by the poorest regions, where the previously declining trend was reversed and an additional 24 infant deaths per 100,000 live births occurred annually.<ref>{{Cite journal |display-authors=6 |vauthors=Taylor-Robinson D, Lai ET, Wickham S, Rose T, Norman P, Bambra C, Whitehead M, Barr B |date=October 2019 |title=Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000-2017: time trend analysis |journal=BMJ Open |volume=9 |issue=10 |article-number=e029424 |doi=10.1136/bmjopen-2019-029424 |pmc=6954495 |pmid=31578197}}</ref>

====War====
Infant mortality rates correlate with [[war]], political unrest, and [[government corruption]].<ref name="Andrews" /> In most cases, war-affected areas will experience a significant increase in infant mortality rates. Having a war take place when planning pregnancy is not only stressful on the mother and fetus but also has several detrimental effects.<ref>{{Cite journal |last=Abouharb |first=M. Rodwan |date=2023-03-16 |title=War and infant mortality rates |journal=[[PLOS Medicine]] |volume=22 |issue=2 |pages=135–157 |doi=10.1080/14754835.2022.2122786 |issn=1475-4835 |doi-access=free }}</ref><ref>{{Cite journal |last1=Jawad |first1=Mohammed |last2=Hone |first2=Thomas |last3=Vamos |first3=Eszter P. |last4=Cetorelli |first4=Valeria |last5=Millett |first5=Christopher |date=2021-09-28 |title=Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000–2019 |journal=PLOS Medicine |language=en |volume=18 |issue=9 |article-number=e1003810 |doi=10.1371/journal.pmed.1003810 |doi-access=free |issn=1549-1676 |pmc=8478221 |pmid=34582455}}</ref>

Many other significant factors influence infant mortality rates in war-torn areas. Health care systems in developing countries in the midst of war often collapse, and obtaining basic medical supplies and care becomes increasingly difficult. During the [[Yugoslav Wars]] in the 1990s, Bosnia experienced a 60% decrease in child immunizations. Preventable diseases can quickly become epidemics during war.<ref name="Krug_2002">{{Cite book |url=https://www.who.int/violence_injury_prevention/violence/world_report/en/ |title=World Report on Violence and Health |vauthors=Krug E |publisher=Geneva WHO |year=2002 |location=Geneva}}</ref>

Many developing countries rely on foreign aid for basic nutrition, and transport of aid becomes significantly more difficult in times of war. In most situations, the average weight of a population will drop substantially.<ref>{{Cite journal |vauthors=Toole MJ, Galson S, Brady W |date=May 1993 |title=Are war and public health compatible? |url=https://zenodo.org/record/1258317 |journal=Lancet |volume=341 |issue=8854 |pages=1193–6 |doi=10.1016/0140-6736(93)91013-C |pmid=8098086 |s2cid=7743798}}</ref> Expectant mothers are affected even more by a lack of access to food and water. During the Yugoslav Wars in Bosnia, the number of premature babies born increased and the average birth weight decreased.<ref name="Krug_2002" />

There have been several instances in recent years of systematic rape as a weapon of war. People who become pregnant as a result of war rape face even more significant challenges in bearing a healthy child. Studies suggest that people who experience sexual violence before or during pregnancy are more likely to experience infant death.<ref>{{Cite journal |vauthors=Asling-Monemi K, Peña R, Ellsberg MC, Persson LA |year=2003 |title=Violence against women increases the risk of infant and child mortality: a case-referent study in Nicaragua |journal=Bulletin of the World Health Organization |volume=81 |issue=1 |pages=10–6 |pmc=2572309 |pmid=12640470}}</ref><ref>{{Cite journal |vauthors=Emenike E, Lawoko S, Dalal K |date=March 2008 |title=Intimate partner violence and reproductive health of women in Kenya |journal=International Nursing Review |volume=55 |issue=1 |pages=97–102 |doi=10.1111/j.1466-7657.2007.00580.x |pmid=18275542}}</ref><ref>{{Cite journal |vauthors=Jejeebhoy SJ |date=September 1998 |title=Associations between wife-beating and fetal and infant death: impressions from a survey in rural India |journal=Studies in Family Planning |volume=29 |issue=3 |pages=300–8 |doi=10.2307/172276 |jstor=172276 |pmid=9789323}}</ref> Causes of infant mortality after abuse during pregnancy range from physical side effects of the initial trauma to psychological effects that lead to poor adjustment to society.<ref>{{Cite journal |vauthors=Fisher SK |date=October 1996 |title=Occupation of the Womb: Forced Impregnation as Genocide |url=https://scholarship.law.duke.edu/dlj/vol46/iss1/4 |journal=Duke Law Journal |volume=46 |issue=1 |pages=91–133 |doi=10.2307/1372967 |jstor=1372967}}</ref> Many people who became pregnant by rape in Bosnia were isolated from their hometowns, making life after childbirth exponentially more difficult.<ref>{{Cite journal |last=Theidon |first=Kimberly |date=1 December 2015 |title=Hidden in Plain Sight |url=https://www.journals.uchicago.edu/doi/10.1086/683301 |journal=Current Anthropology |volume=56 |issue=S12 |pages=S191–S200 |doi=10.1086/683301 |issn=0011-3204|url-access=subscription }}</ref>
=== Culture ===
High rates of infant mortality occur in developing countries where financial and material resources are scarce, and where there is a high tolerance for infant deaths. There are a number of developing countries where certain cultural situations, such as favoring male babies over female babies, are the norm.<ref name="Andrews" /> In developing countries such as Brazil, infant mortality rates are commonly not recorded due to not registering for death certificates.<ref name="Nations">{{Cite journal |vauthors=Nations MK, Amaral ML |year=1991 |title=Flesh, Blood, Souls, and Households: Cultural Validity in Mortality Inquiry |journal=Medical Anthropology Quarterly |volume=5 |issue=3 |pages=204–220 |doi=10.1525/maq.1991.5.3.02a00020}}</ref> Another cultural reason for infant mortality, such as what is happening in Ghana, is that "besides the obvious, like rutted roads, there are prejudices against wives or newborns leaving the house."<ref>{{Cite web |date=October 29, 2012 |title=Ghana: A grant meant to curb infant mortality focuses on getting mothers to the hospital |url=https://www.nytimes.com/2012/10/30/health/gates-foundation-backs-hospital-transportation-for-expectant-mothers.html |url-access=subscription |website=The New York Times |vauthors=McNeil D}}</ref> This makes it even more difficult for pregnant women and newborns to get the needed treatment that is available to them.

In the United States cultural influences and lifestyle habits can account for some infant deaths. Examples include [[teenage pregnancy]], [[obesity]], [[diabetes]], and [[smoking]]. All are possible causes of premature births, which constitute the second-highest cause of infant mortality.<ref name="lag">{{Cite web |date=May 2, 2012 |title=U.S. Lags in Global Measure of Premature Births |url=https://www.nytimes.com/2012/05/03/health/us-lags-in-global-measure-of-preterm-births.html |url-access=subscription |website=The New York Times |vauthors=McNeil D |url-status=live |archive-url= https://web.archive.org/web/20230410044313/https://www.nytimes.com/2012/05/03/health/us-lags-in-global-measure-of-preterm-births.html |archive-date= Apr 10, 2023 }}</ref> According to the Journal of the American Medical Association, "the post neonatal mortality risk (28 to 364 days) was highest among continental Puerto Ricans" compared to non-Hispanic babies. Ethnic differences are accompanied by a higher prevalence of behavioral risk factors and sociodemographic challenges that each ethnic group faces.<ref name="MacDorman 2009" />

====Male sex favoritism====
Historically, males have had higher infant mortality rates than females, with the difference being dependent on environmental, social, and economic conditions. More specifically, males are biologically more vulnerable to infections and conditions associated with prematurity and development. Before 1970, the reasons for male infant mortality were infections and chronic degenerative diseases. However, since 1970, male sex favoritism in certain cultures has led to a decrease in the infant mortality gap between males and females. Also, medical advances have resulted in a greater effect on the survival rate of male infants than female infants, due to the initial high infant mortality rate of males.<ref name="Dreven">{{Cite journal |vauthors=Drevenstedt GL, Crimmins EM, Vasunilashorn S, Finch CE |date=April 2008 |title=The rise and fall of excess male infant mortality |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=105 |issue=13 |pages=5016–21 |bibcode=2008PNAS..105.5016D |doi=10.1073/pnas.0800221105 |pmc=2278210 |pmid=18362357 |doi-access=free }}</ref>

Genetic components result in newborn females being at a biological advantage when it comes to surviving their first birthday, versus newborn males, who have lower chances of surviving infancy. As infant mortality rates decreased globally, the gender ratios changed from males being at a biological disadvantage to females facing a societal disadvantage.<ref name="Dreven" /> Some developing nations have social and cultural patterns that favor boys over girls for their future earning potential. A country's ethnic composition, [[Monoethnicity|homogeneous]] or [[Polyethnicity|heterogeneous]], has been suggested by Fuse and Crenshaw to partly explain social attitudes and practices. According to their [[ecological study]], heterogeneous levels may be protective against male-biased sex discrimination in terms of infant mortality.<ref name="Fuse" />

====Birth spacing====
[[File:Total Fertility Rate Map by Country.svg|thumb|right|upright=1.35|Map of countries by fertility rate, according to the [[Population Reference Bureau]]]]
Birth spacing is the time between births. Births spaced at least three years apart are associated with the lowest rate of mortality. The longer the interval between births, the lower the risk of having complications at birth, or of infant, childhood, or [[maternal mortality]].<ref name="Norton" /><ref name="Rutstein">{{Cite journal |vauthors=Rutstein SO |date=April 2005 |title=Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys |journal=International Journal of Gynaecology and Obstetrics |volume=89 |issue=Suppl 1 |pages=S7-24 |doi=10.1016/j.ijgo.2004.11.012 |pmid=15820369 |s2cid=37743580}}</ref> Conception less than six months after a birth, abortion, or miscarriage is associated with higher rates of preterm births and low birth weight, and also increases the chances of [[Chronic condition|chronic]] and general undernutrition. In 55 developing countries 57% of reported pregnancies had birth spaces of less than three years, and 26% of less than two years. While only 20% of new parents report wanting another birth within two years, only 40% are taking steps like [[family planning]] to achieve this.<ref name="Norton" />

Unplanned pregnancies and birth intervals of less than twenty-four months are known to correlate with low birth weights and delivery complications. Also, mothers who are already small in stature tend to deliver smaller than average babies, perpetuating a cycle of being [[underweight]].<ref name="Andrews" /><ref name="Norton" /><ref name="Rutstein" />

==Prevention and outcomes==
To reduce infant mortality rates across the world, health practitioners, governments, and non-governmental organizations have worked to create institutions, programs, and policies to generate better health outcomes. Current efforts focus on the development of human resources, strengthening health information systems, health service delivery, etc. Improvements in such areas aim to increase regional health systems and aid efforts to reduce mortality rates.

===Policy===
Reductions in infant mortality are possible at any stage of a country's development.<ref name="Bishai" /> Rate reductions are evidence that a country is advancing in human knowledge, social [[institutions]], and [[physical capital]]. Governments can reduce mortality rates by addressing the combined need for education (such as [[universal primary education]]), nutrition, and access to basic maternal and infant health services. Focused policies has the potential to aid those most at risk for infant and childhood mortality, including rural, poor, and migrant populations.<ref>{{Cite journal |vauthors=Farahani M, Subramanian SV, Canning D |date=June 2009 |title=The effect of changes in health sector resources on infant mortality in the short-run and the long-run: a longitudinal econometric analysis |journal=Social Science & Medicine |volume=68 |issue=11 |pages=1918–25 |doi=10.1016/j.socscimed.2009.03.023 |pmid=19362762}}</ref>

Reducing the chances of babies being born at low birth weights and contracting pneumonia can be accomplished by improving air quality.{{citation needed|date=July 2023}} Improving [[hygiene]] can prevent infant mortality. Home-based technology to [[Water chlorination|chlorinate]], filter, and use [[solar disinfection]] for organic water pollution could reduce cases of diarrhea in children by up to 48%.<ref name="Andrews" /><ref name="Nussbaum" /><ref name="Jorgenson" /> Improvements in food supplies and [[sanitation]] have been shown to work for the most vulnerable populations in the US, including among African Americans.<ref name="Gortmaker 1997" />

Promoting [[Behaviour change (public health)|behavioral changes]], such as [[hand washing]] with soap, can significantly reduce the rate of infant mortality from respiratory and diarrheal diseases.<ref>{{Cite journal |vauthors=Curtis V, Cairncross S |date=May 2003 |title=Effect of washing hands with soap on diarrhoea risk in the community: a systematic review |journal=The Lancet. Infectious Diseases |volume=3 |issue=5 |pages=275–81 |doi=10.1016/S1473-3099(03)00606-6 |pmid=12726975}}</ref> According to UNICEF, hand washing with soap before eating and after using the [[toilet]] can save  children's lives by reducing deaths from diarrhea and acute respiratory infections.<ref>{{Cite web |title=The State of the World's Children 2008. Child Survival. UNICEF |url=https://www.unicef.org/media/84861/file/SOWC-2008.pdf |url-status=live |archive-url=https://web.archive.org/web/20230528174903/https://www.unicef.org/media/84861/file/SOWC-2008.pdf |archive-date=2023-05-28 |access-date=2023-08-15}}</ref>

Focusing on preventing preterm and low birth weight deliveries throughout all populations can help eliminate cases of infant mortality and decrease health care disparities within communities. In the United States, these two goals have decreased regional infant mortality rates, but there has yet to be further progress on a national level.<ref name="MacDorman 2009" />

Increasing human resources such as [[physicians]], [[nurses]], and other health professionals will increase the number of skilled attendants and the number of people able to give out immunizations against diseases such as measles. Increasing the number of skilled professionals is correlated with lower maternal, infant, and childhood mortality. With the addition of one physician per 10,000 people, there is a potential for 7.08 fewer infant deaths per 10,000.<ref>{{Cite journal |vauthors=Russo LX, Scott A, Sivey P, Dias J |date=2019-05-31 |title=Primary care physicians and infant mortality: Evidence from Brazil |journal=PLOS ONE |volume=14 |issue=5 |article-number=e0217614 |bibcode=2019PLoSO..1417614R |doi=10.1371/journal.pone.0217614 |pmc=6544253 |pmid=31150468 |doi-access=free}}</ref>

In certain parts of the US, specific programs aim to reduce levels of infant mortality. One such program is the "Best Babies Zone" (BBZ), based at the [[University of California, Berkeley]]. The BBZ uses the [[life course approach]] to address the structural causes of poor birth outcomes and [[toxic stress]] in three US neighborhoods. By employing community-generated solutions, the Best Babies Zone's ultimate goal is to achieve health equity in communities that are disproportionately impacted by infant mortality.<ref>{{Cite web |title=Best Babies Zone - ACPHD |url=http://www.acphd.org/building-blocks/projects/bbz.aspx#:~:text=Best%20Babies%20Zone%20is%20a,to%20live%2015%20fewer%20years. |access-date=2020-08-03 |website=www.acphd.org}}</ref>

=== Prenatal care and maternal health ===
Certain steps can help to reduce the chance of complications during pregnancy. Attending regular [[prenatal care]] check-ups will help improve the baby's chances of being delivered in safer conditions and surviving.<ref>{{Cite journal |vauthors=Otundo Richard M |date=2019 |title=WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience in Kenya |journal=SSRN Working Paper Series |doi=10.2139/ssrn.3449460 |issn=1556-5068 |s2cid=219379303|doi-access=free }}</ref> Additionally, taking supplementation, including [[Folate|folic acid]], can help reduce the chances of birth defects, a leading cause of infant mortality.<ref name="cdc-2020" /> Many countries have instituted mandatory folic acid supplementation in their food supply, which has significantly reduced the occurrence of a birth defect known as [[spina bifida]] in newborns.<ref>{{Cite journal |display-authors=6 |vauthors=Atta CA, Fiest KM, Frolkis AD, Jette N, Pringsheim T, St Germaine-Smith C, Rajapakse T, Kaplan GG, Metcalfe A |date=January 2016 |title=Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis |journal=American Journal of Public Health |volume=106 |issue=1 |pages=e24-34 |doi=10.2105/AJPH.2015.302902 |pmc=4695937 |pmid=26562127}}</ref> Similarly, the fortification of salt with iodine, called [[salt iodization]], has helped reduce negative birth outcomes associated with low iodine levels during pregnancy.<ref name="ramakrishnan-2012">{{Cite journal |vauthors=Ramakrishnan U, Grant F, Goldenberg T, Zongrone A, Martorell R |date=July 2012 |title=Effect of women's nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review |journal=Paediatric and Perinatal Epidemiology |volume=26 |issue=Suppl 1 |pages=285–301 |doi=10.1111/j.1365-3016.2012.01281.x |pmid=22742616 |doi-access=free}}</ref>

Abstinence from alcohol can also decrease the chances of harm to the fetus as drinking any amount of alcohol during pregnancy may lead to [[fetal alcohol spectrum disorder]]s (FASD) or other alcohol related birth defects.<ref>{{Cite journal |vauthors=Flak AL, Su S, Bertrand J, Denny CH, Kesmodel US, Cogswell ME |date=January 2014 |title=The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis |journal=Alcoholism: Clinical and Experimental Research |volume=38 |issue=1 |pages=214–26 |doi=10.1111/acer.12214 |pmid=23905882|doi-access=free }}</ref> Tobacco use during pregnancy has also been shown to significantly increase the risk of a preterm or low birth weight birth, both of which are leading causes of infant mortality.<ref>{{Cite journal |display-authors=6 |vauthors=Banderali G, Martelli A, Landi M, Moretti F, Betti F, Radaelli G, Lassandro C, Verduci E |date=October 2015 |title=Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review |journal=Journal of Translational Medicine |volume=13 |article-number=327 |doi=10.1186/s12967-015-0690-y |pmc=4608184 |pmid=26472248 |doi-access=free }}</ref> Pregnant women should consult with their doctors to best manage any [[Pre-existing condition|pre-existing health conditions]] to avoid complications to both their health as well as the fetus's. Obese people are at an increased risk of developing complications during pregnancy, including [[gestational diabetes]] or pre-eclampsia. Additionally, they are more likely to experience a pre-term birth or have a child with birth defects.<ref>{{Cite journal |vauthors=Marchi J, Berg M, Dencker A, Olander EK, Begley C |date=August 2015 |title=Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews |url=http://openaccess.city.ac.uk/12304/1/Risks%20associated%20with%20obesity%20in%20pregnancy%20%28final%20accepted%20version%29.pdf |journal=Obesity Reviews |volume=16 |issue=8 |pages=621–38 |doi=10.1111/obr.12288 |pmid=26016557 |s2cid=206228471 |hdl-access=free |hdl=2262/75578}}</ref><ref name="ramakrishnan-2012" />

=== Nutrition ===
Appropriate nutrition for newborns and infants can help keep them healthy, and can help avoid health complications during early childhood. The [[American Academy of Pediatrics]] recommends exclusively [[breastfeeding]] infants for the first 6 months of life, and continuing breastfeeding as other sources of food are introduced through the next 6 months of life (up to 1 year of age).<ref>{{Cite journal |last1=Eidelman |first1=Arthur I. |last2=Schanler |first2=Richard J. |last3=Johnston |first3=Margreete |last4=Landers |first4=Susan |last5=Noble |first5=Larry |last6=Szucs |first6=Kinga |last7=Viehmann |first7=Laura |date=March 2012 |title=Breastfeeding and the use of human milk |journal=Pediatrics |volume=129 |issue=3 |pages=e827–e841 |doi=10.1542/peds.2011-3552 |pmid=22371471 |doi-access=free}}</ref> Infants under 6 months of age who are exclusively breastfed have a lower risk of mortality compared to infants who are breastfed part of the time or not at all.<ref>{{Cite journal |vauthors=Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, Bahl R |date=December 2015 |title=Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis |journal=Acta Paediatrica |volume=104 |issue=467 |pages=3–13 |doi=10.1111/apa.13147 |pmid=26249674 |s2cid=23206368 |hdl-access=free |hdl=1956/11852}}</ref> For this reason, breast feeding is favored over formula feeding by healthcare professionals.

=== Vaccinations ===
The [[Centers for Disease Control and Prevention]] (CDC) defines infants as those 1 month of age to 1 year of age.<ref>{{Cite web |date=4 February 2021 |title=Center of Disease Control and Development: Child Development |url=https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/infants.html |website=CDC.gov}}</ref> For these infants, the CDC recommends the following vaccinations: [[hepatitis B]] (HepB), [[rotavirus]] (RV), [[Haemophilus influenzae|haemophilus influenzae type B]] (HIB), [[Pneumococcal conjugate vaccine|pneumococcal conjugate]] (PCV13), [[Polio|inactivated poliovirus]] (IPV < 18 yrs), [[influenza]], [[Chickenpox|varicella]], [[measles]], [[mumps]], [[rubella]] (MMR), and [[diphtheria]], [[tetanus]], [[Whooping cough|acellular pertussis]] (DTapP < 7yrs).<ref name="cdcgov">{{Cite web |title=CDC Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020 |url=https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf |website=CDC.gov}}</ref> Each of these vaccinations are given at particular age ranges depending on the vaccination and are required to be done in a series of 1 to 3 doses over time depending on the vaccination.<ref name="cdcgov" />

The efficacy of these vaccinations can be seen immediately following their introduction to society.<ref name="who-2008">{{Cite web |title=WHO {{!}} Vaccination greatly reduces disease, disability, death and inequity worldwide |url=https://www.who.int/bulletin/volumes/86/2/07-040089/en/ |archive-url=https://web.archive.org/web/20080227011328/http://www.who.int/bulletin/volumes/86/2/07-040089/en/ |archive-date=February 27, 2008 |access-date=2020-07-30 |website=WHO}}</ref> Following the advent of the [[Pneumococcal conjugate vaccine|pneumococcal conjugate vaccine]] (PCV13) in the United States in the year 2000, the [[World Health Organization]] (WHO) reports studies done in 2004 had shown a 57% decline in invasive{{efn|Invasive meaning cultured from a normally sterile site}} penicillin resistant strains of the disease and a 59% reduction in [[multi drug resistant]] strains.<ref name="who-2008" /> This reduction was even greater for children under 2 years of age with studies finding an 81% reduction in those same strains.<ref name="who-2008" />

As mentioned in a previous section,{{efn|Causes: [[#Sudden infant death syndrome (SIDS)|SIDS]]}} [[SIDS|sudden infant death syndrome]] (SIDS) is the leading cause of infant mortality between 1 month and 1 year of age.<ref name="cdc.gov" /> Immunizations, when given in accordance to proper guidelines, have shown to reduce the risk of SIDS by 50%.<ref name="moon-2016" /><ref>{{Cite book |title=Immunization safety review measles-mumps-rubella vaccine and autism |vauthors=Stratton KR |date=2001 |publisher=National Academy Press |isbn=0-309-07447-9 |oclc=928430099}}</ref> For this reason, the [[American Academy of Pediatrics]] (AAP) and the [[Centers for Disease Control and Prevention|Center for Disease Control]] (CDC) both recommend immunizations in accordance to their guidelines.<ref name="moon-2016" /><ref>{{Cite web |title=Immunizations |url=http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Pages/Immunizations-home.aspx |access-date=2020-07-30 |website=AAP.org |language=en-US}}</ref>

===Socio-economic factors===
It has been well documented that increased education among mothers, communities, and local health workers results in better [[family planning]], improvement in children's health, and lower rates of children's deaths. High-risk areas, such as Sub-Saharan Africa, have demonstrated that an increase in women's educational attainment leads to a reduction in infant mortality by about 35%.<ref>{{Cite journal |vauthors=Shapiro D, Tenikue M |date=2017-09-13 |title=Women's education, infant and child mortality, and fertility decline in rural and urban sub-Saharan Africa |journal=Demographic Research |volume=37 |pages=669–708 |doi=10.4054/demres.2017.37.21 |issn=1435-9871 |doi-access=free}}</ref> Similarly, coordinated efforts to train community health workers in diagnosis, treatment, malnutrition prevention, reporting and referral services has reduced infant mortality in children under 5 by as much as 38%.<ref>{{Cite journal |display-authors=6 |vauthors=Mugeni C, Levine AC, Munyaneza RM, Mulindahabi E, Cockrell HC, Glavis-Bloom J, Nutt CT, Wagner CM, Gaju E, Rukundo A, Habimana JP, Karema C, Ngabo F, Binagwaho A |date=August 2014 |title=Nationwide implementation of integrated community case management of childhood illness in Rwanda |journal=Global Health: Science and Practice |volume=2 |issue=3 |pages=328–41 |doi=10.9745/GHSP-D-14-00080 |pmc=4168626 |pmid=25276592}}</ref> Public health campaigns centered around the [[First 1000 days]] of life have been successful in providing cost-effective supplemental nutrition programs, as well as assisting young mothers in sanitation, hygiene and breastfeeding.<ref>{{Cite journal |vauthors=Flood D, Chary A, Colom A, Rohloff P |date=June 2018 |title=Adolescent Rights and the "First 1,000 days" Global Nutrition Movement: A View from Guatemala |journal=Health and Human Rights |volume=20 |issue=1 |pages=295–301 |pmc=6039738 |pmid=30008571}}</ref> Increased intake of nutrients and better [[sanitation]] habits have a positive impact on health, especially for developing children. Educational attainment and public health campaigns provide the knowledge and means to practice better habits and lead to lower infant mortality rates.{{citation needed|date=July 2023}}

A decrease in [[GDP]] results in increased rates of infant mortality.<ref>{{Cite journal |vauthors=Baird S, Friedman J, Schady N |date=2011 |title=Aggregate Income Shocks and Infant Mortality in the Developing World |url=http://www.gwu.edu/~iiep/assets/docs/papers/Baird_IIEPWP2010-7.pdf |journal=The Review of Economics and Statistics |volume=93 |issue=3 |pages=847–856 |doi=10.1162/REST_a_00084 |jstor=23016081 |s2cid=57566653 |hdl=10986/4916}}</ref> A reduction in household income reduces the amount being spent on food and healthcare, affecting the quality of life, and reduces access to medical services that ensure full development and survival. Likewise, increased household income translates to more access to nutrients and healthcare, reducing the risks associated with malnutrition and infant mortality.<ref name="haddad-2003">{{Cite journal |vauthors=Haddad L, Alderman H, Appleton S, Song L, Yohannes Y |date=2003-06-01 |title=Reducing Child Malnutrition: How Far Does Income Growth Take Us? |journal=The World Bank Economic Review |volume=17 |issue=1 |pages=107–131 |doi=10.1093/wber/lhg012 |issn=0258-6770 |hdl-access=free |hdl=10419/81795}}</ref> Moreover, increased aggregate household incomes will produce better health facilities, water and [[Sewage treatment|sewer infrastructures]] for the entire community.<ref name="haddad-2003" />

==Differences in measurement==

[[File:Infant Mortality Rate by Region 1950-2050.png|thumb|upright=1.65|Infant mortality rate by region]]
[[File:Life Expectancy at Birth by Region 1950-2050.png|thumb|upright=1.65|[[Life expectancy]] at birth by region]]
The infant mortality rate correlates very strongly with the likelihood of [[state failure]], and is among the best predictors thereof.<ref>{{Cite journal |name-list-style=vanc |vauthors=King G, Zeng L |year=2011 |title=Improving Forecasts of State Failure |journal=World Politics |volume=53 |issue=4 |pages=623–58 |doi=10.1353/wp.2001.0018 |jstor=25054167 |s2cid=18089096 |ssrn=1082922}}</ref> IMR is therefore also a useful indicator of a country's level of health ([[Human development (economics)|development]]), and is a component of the [[physical quality of life index]].

The method of calculating IMR often varies widely between countries, as it is based on how they define a live birth and how many premature infants are born in the country. Depending on a nation's live birth criterion, vital registration system, and reporting practices, reporting may be inconsistent or understated.<ref>{{Cite journal |vauthors=Anthopolos R, Becker CM |year=2010 |title=Global Infant Mortality: Correcting for Undercounting |journal=World Development |volume=38 |issue=4 |pages=467–81 |doi=10.1016/j.worlddev.2009.11.013}}</ref> The reported IMR provides one statistic which reflects the standard of living in each nation. Changes in the infant mortality rate "reflect enduring social and technical capacities that become attached to a population".<ref name="Bishai" /> The [[World Health Organization]] (WHO) defines a live birth as any infant born demonstrating independent signs of life, including breathing, heartbeat, umbilical cord pulsation or definite movement of voluntary muscles.<ref>{{Cite web |title=Neonatal mortality rate (per 1000 live births) |url=https://www.who.int/whosis/indicators/2007MortNeoBoth/en/ |archive-url=https://web.archive.org/web/20111221191114/http://www.who.int/whosis/indicators/2007MortNeoBoth/en/ |archive-date=December 21, 2011 |access-date=2013-08-26}}. WHO. 2011</ref> This definition is used in Austria,<ref>{{Cite web |last=Allmer |first=Gertrude |title=Bundesgesetz über den Hebammenberuf (Federal law on the midwifery profession) |url=http://www.pflegerecht.at/Druck/Versionen-Berufsrecht/Druckversion-HebG.pdf |archive-url=https://web.archive.org/web/20131002191821/http://www.pflegerecht.at/Druck/Versionen-Berufsrecht/Druckversion-HebG.pdf |archive-date=2013-10-02}}</ref> and is also used in Germany, but with one slight modification: muscle movement is not considered to be a sign of life.<ref>{{Cite web |title=PStV – Einzelnorm |url=http://www.gesetze-im-internet.de/pstv/__31.html |access-date=2013-09-29 |website=Gesetze-im-internet.de}}</ref> Many countries, including certain European states (e.g. France) and Japan, only count cases where an infant breathes at birth as a live birth, which makes their reported IMR numbers somewhat lower and increases their rates of [[perinatal mortality]].<ref>{{Cite magazine |date=2006-09-24 |title=Behind the Baby Count |url=http://health.usnews.com/usnews/health/articles/060924/2healy.htm |magazine=U.S. News & World Report |archive-url=https://web.archive.org/web/20070824012048/http://health.usnews.com/usnews/health/articles/060924/2healy.htm |archive-date=August 24, 2007 |access-date=2014-03-24 |vauthors=Healy B}}</ref> In other countries, the Czech Republic and Bulgaria, for instance, requirements for live birth are even higher.<ref>{{Cite web |title=Demographic Statistics: Definitions and Methods of Collection in 31 European Countries (by European Communities, 2003) |url=http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-CC-03-005/EN/KS-CC-03-005-EN.PDF |archive-url=https://web.archive.org/web/20131213060234/http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-CC-03-005/EN/KS-CC-03-005-EN.PDF |archive-date=2013-12-13 |access-date=2013-09-29}}</ref>

Although many countries have [[Vital registration|vital registration systems]] and specific reporting practices, there are often inaccuracies in the statistics, particularly in rural communities in developing countries. In those communities, some other alternative methods for calculating infant mortality rate are used, for example, popular death reporting and household survey. Studies have shown that when comparing three information sources{{emdash}}official registries, household surveys, and popular reporters{{emdash}}the popular death reporters are the most accurate; popular death reporters include midwives, gravediggers, coffin builders, priests, and others, essentially people who knew the most about the child's death. In developing nations, access to vital registries, and other government-run systems which record births and deaths, is difficult for poor families for several reasons. These struggles force families to take drastic measures, like having unofficial death ceremonies for their deceased infants. As a result, government statistics will inaccurately reflect a nation's infant mortality rate. Popular death reporters have first-hand information, and, provided this information can be collected and collated, can provide reliable, accurate death counts for a nation, as well as meaningful causes of deaths that can be measured and studied.<ref name="Nations" />

[[UNICEF]] uses a statistical methodology to account for reporting differences among countries:
{{Blockquote|UNICEF compiles infant mortality country estimates derived from all sources and methods of estimation obtained either from standard reports, direct estimation from micro data sets, or from UNICEF's yearly exercise. In order to sort out differences between estimates produced from different sources, with different methods, UNICEF developed, in coordination with WHO, the WB and UNSD, an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. Since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official IMR estimates used at the country level. However, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time.<ref>{{Cite web |title=Millennium Indicators |url=http://mdgs.un.org/unsd/mdg/Metadata.aspx?IndicatorId=0&SeriesId=562 |access-date=2013-09-29 |website=United Nations |archive-date=2011-05-03 |archive-url=https://web.archive.org/web/20110503203831/http://mdgs.un.org/unsd/mdg/Metadata.aspx?IndicatorId=0&SeriesId=562 }}</ref>}}

Another challenge in comparing infant mortality rates is the practice of counting frail or premature infants who die before the normal due date as [[miscarriage]]s, or counting those who die during or immediately after childbirth as [[stillbirth]]s. Therefore, the quality of a country's documentation of [[perinatal mortality]] can greatly affect the accuracy of its infant mortality statistics. This point is reinforced by the demographer [[Ansley J. Coale|Ansley Coale]], who finds the high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth dubious. As this pattern is consistent with the high male to female sex ratios recorded at birth in those countries it suggests two things: that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths; and that those countries do not follow WHO recommendations for the reporting of live births versus infant deaths.<ref>{{Cite journal |vauthors=Coale AJ, Banister J |date=August 1994 |title=Five decades of missing females in China |url=https://zenodo.org/record/1235093 |journal=Demography |volume=31 |issue=3 |pages=459–79 |doi=10.2307/2061752 |jstor=2061752 |pmid=7828766 |s2cid=24724998 |doi-access=free}}</ref>

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining, the reported IMRs often increase for a time. This is mainly because improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area, and not been reported to the government, might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.{{citation needed|date=July 2023}}

The country-to-country variation in child mortality rates is huge, and growing wider despite progress in decreasing the overall IMR. Among the world's roughly 200 nations, only Somalia showed no decrease in the under-5 mortality rate over the past two decades. In 2011 the global rate of under-5 deaths was 51 deaths per 1,000 births. Singapore had the lowest rate at 2.6, while Sierra Leone had the highest at 185 child deaths per 1,000 births. In the U.S., the rate was 8 under-5 deaths per 1,000 births.<ref>{{Cite news |date=2011-02-28 |title=Child mortality falls more than 40 percent in the past two decades |newspaper=The Washington Post |url=https://www.washingtonpost.com/national/health-science/child-mortality-falls-more-than-40-percent-in-the-past-two-decades/2012/09/12/8a5bbc68-fd14-11e1-8adc-499661afe377_story.html |vauthors=Brown D}}</ref>

Infant mortality rate (IMR) is not only a statistic but also a reflection of socioeconomic development, as such it effectively represents the presence of medical services in a country. IMR is an effective resource for health departments making decisions on medical resource allocation, and also formulates global health strategies and helps evaluate their success. The use of IMR helps solve the inadequacies of other [[Vital statistics (government records)|vital statistic]] systems for global health as most neglect infant mortality rates among the poor. There remains a certain amount of unrecorded infant death in rural area as they either do not have the concept of reporting early infant death, or they do not know about the importance of the IMR.<ref name="Nations" />

===Europe and US===
{|class="wikitable floatright" style="width: 40%; text-align:left"
|+Requirements for reporting a live birth, United States and selected European countries, 2004<ref>{{Cite report |url=https://www.europeristat.com/images/doc/EPHR/european-perinatal-health-report.pdf |title=European Perinatal Health Report |last=Euro-Peristat Network |date=2004 |page=40 |access-date=March 8, 2019}}</ref><ref>{{Cite report |url=https://www.cdc.gov/nchs/data/hus/hus08.pdf |title=Health United States, 2008 with special feature on the health of young adults. |last=US Department of Health and Human Services |date=2009 |page=193 |access-date=March 8, 2019}}</ref>
! Reporting requirement
!Country
|-
| style="width: 50%;" | All live births || style="text-align:left;"| Austria, Denmark, England and Wales, Finland, Germany, Hungary, Italy, Northern Ireland, Portugal, Scotland, Slovak Republic, Spain, Sweden, United States
|-
| style="width: 50%;" | Live births at 12 weeks of gestation or more|| style="text-align:left;"| Norway
|-
| style="width: 50%;" | Live births at 500 grams birthweight or more, and less than 500 grams if the infant survives for 24 hours|| style="text-align:left;"| Czech Republic
|-
| style="width: 50%;" | Live births at 22 weeks of gestation or more, or 500 grams birthweight or more|| style="text-align:left;"| France
|-
| style="width: 50%;" | All live births for civil registration, births at 500 grams birthweight or more for the national perinatal register|| style="text-align:left;"| Ireland
|-
| style="width: 50%;" | Live births at 22 weeks of gestation or more, 500 grams birthweight or more if gestational age is unknown|| style="text-align:left;"| Netherlands
|-
| style="width: 50%;" | Live births at 500 or more grams birthweight|| style="text-align:left;"| Poland
|-
|}
The inclusion or exclusion of high-risk neonates from the  reported IMRs can cause problems in making comparisons. Many countries, including the United States, Sweden and Germany, count any birth exhibiting any sign of life as alive, no matter the [[gestational age|month of gestation]] or neonatal size. All of the countries named in the table adopted the WHO definitions in the late 1980s or early 1990s,<ref>{{Cite journal |vauthors=Duc G |year=1995 |title=The crucial role of definition in perinatal epidemiology |journal=Sozial- und Präventivmedizin |volume=40 |issue=6 |pages=357–60 |doi=10.1007/BF01325417 |pmid=8578873 |s2cid=35350473}}</ref> and they are used throughout the European Union.<ref>{{Cite web |title=Definition of data collected in the European Union, see item 8 |url=http://ec.europa.eu/health/ph_projects/2001/monitoring/fp_monitoring_2001_a1_frep_01_en.pdf |website=Europa (web portal)}}</ref> However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the high rates of premature babies in the United States compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births under 500&nbsp;g and/or 22 weeks of gestation.<ref>{{Cite web |date=2009-11-04 |title=Preemies Raise U.S. Infant Mortality Rate |url=http://www.webmd.com/baby/news/20091103/preemies-raise-us-infant-mortality-rate |access-date=2009-11-04 |website=WebMD |vauthors=Hendrick B}}</ref><ref>{{Cite news |date=2009-11-03 |title=Premature births worsen US infant death rate |agency=Associated Press |url=http://www.denverpost.com/food/ci_13707079 |vauthors=Stobbe M}}</ref><ref name="pmid21058532">{{Cite journal |vauthors=MacDorman MF, Mathews TJ |year=2010 |title=Behind international rankings of infant mortality: how the United States compares with Europe |journal=International Journal of Health Services |volume=40 |issue=4 |pages=577–88 |doi=10.2190/HS.40.4.a |pmid=21058532 |s2cid=3190009 |hdl-access=free |hdl=2027/uc1.31210022969875}}</ref> However, differences in reporting are unlikely to be the primary explanation for the high rate of infant mortality in the United States compared to countries at a similar level of economic development. Rather, the report concluded that the primary reason for the higher infant mortality rate in the US compared to Europe was the much higher number of preterm births.<ref name="pmid21058532" />

Until the 1990s, Russia and the Soviet Union did not count, either as a live birth or as an infant death, extremely premature infants that were born alive but failed to survive for at least seven days (infants born weighing less than 1,000&nbsp;g, of less than 28 weeks gestational age, or less than 35&nbsp;cm in length, who that breathed, had a heartbeat, or exhibited voluntary muscle movement).<ref>{{Cite journal |vauthors=Anderson BA, Silver BD |year=1986 |title=Infant Mortality in the Soviet Union: Regional Differences and Measurement Issues |journal=Population and Development Review |volume=12 |issue=4 |pages=705–38 |doi=10.2307/1973432 |jstor=1973432}}</ref> Although such extremely premature infants typically accounted for only about 0.5% of all live-born children, their exclusion led to an estimated 22%–25% lower reported IMR.{{efn|In 1990, the Baltic states moved to the WHO standard definition; in 1993 Russia also moved to this definition.}} In some cases, too, {{Speculation inline|date=July 2023|text=perhaps because}} hospitals or regional health departments were held accountable for lowering the IMR in their [[Catchment area (human geography)|catchment area]], infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.<ref>{{Cite journal |vauthors=Blum, Alain |year=1987 |title=Une nouvelle table de mortalité pour l'URSS (1984-1985) |journal=Population (French Edition) |volume=42 |issue=6 |pages=843–862 |doi=10.2307/1532733 |jstor=1532733}}</ref><ref>{{Cite book |title=Demographic Trends and Patterns in the Soviet Union before 1991 |vauthors=Ksenofontova NY |publisher=Routledge |year=1994 |isbn=978-0-415-10194-3 |veditors=Lutz W, Scherbov S, Volkov A |location=London |pages=359–378 |chapter=Trends in infant mortality in the USSR}}</ref>

===Brazil===
{{One source|section|talk=|date=July 2023}}
In certain rural developing areas, such as northeastern Brazil, infant births are often not recorded, resulting in the discrepancies between the infant mortality rate (IMR) and the actual number of infant deaths. Access to vital registry systems for infant births and deaths is an extremely difficult and expensive task for poor parents living in rural areas. Government and bureaucracies tend to show an insensitivity to these parents and produce broad disclaimers in the IMR reports that the information has not been properly reported, resulting in discrepancies. Little has been done to address the underlying structural problems with the vital registry systems regarding the lack of reporting in rural areas, which has created a gap between the official and popular meanings of child death.<ref name="Nations" />

It is also argued that the bureaucratic separation of vital death recording from cultural death rituals is to blame for the inaccuracy of the infant mortality rate (IMR). Vital death registries often fail to recognize the cultural implications and importance of infant deaths. These systems can be an accurate representation of a region's socio-economic situation, if the statistics are valid, which is unfortunately not always the case. An alternate method of collecting and processing statistics on infant and child mortality is via "popular death reporters" who are culturally linked to infants and may be able to provide more accurate statistics.<ref name="Nations" /> According to [[Ethnography|ethnographic]] data, "popular death reporters" refers to people who had inside knowledge of ''anjinhos'', including the grave-digger, gatekeeper, midwife, popular healers etc.—all key participants in mortuary rituals.<ref name="Nations" /> Combining the methods of household surveys, vital registries, and asking "popular death reporters" can increase the validity of child mortality rates. However there remain barriers that affect the validity of statistics of infant mortality, including political economic decisions: numbers are exaggerated when international funds are being doled out; and underestimated during reelection.<ref name="Nations" />{{Failed verification|date=July 2023}}

The bureaucratic separation of vital death reporting and cultural death rituals stems, in part, from [[structural violence]].<ref>{{Cite journal |vauthors=Farmer PE, Nizeye B, Stulac S, Keshavjee S |date=October 2006 |title=Structural violence and clinical medicine |journal=PLOS Medicine |volume=3 |issue=10 |article-number=e449 |doi=10.1371/journal.pmed.0030449 |pmc=1621099 |pmid=17076568 |doi-access=free }}</ref> Individuals living in rural areas of Brazil need funds for lodging and travel in order to report births to a Brazilian Assistance League office, this deters registration as often these individuals are of lower income and cannot afford such expenses,<ref name="Nations" /> similar barriers exist when choosing to report infant mortality. Financial constraints such as reliance on [[food supplement]]ations may also lead to skewed infant mortality data.<ref name="Nations" />

In developing countries such as Brazil the deaths of impoverished infants are regularly not recorded into the countries vital registration system, which skews statistics. Culturally validity and contextual soundness can be used to ground the meaning of mortality from a statistical standpoint.{{clarify|date=July 2023}} In northeast Brazil they have accomplished this standpoint while conducting an ethnographic study combined with an alternative method to survey infant mortality. These types of techniques can develop quality data that will lead to a better portrayal of the IMR of a region.<ref name="Nations" />

Political economic reasons have been seen to skew the infant mortality data in the past when governor Ceara devised his presidency campaign on reducing the infant mortality rate during his term in office. By using this new way of surveying, these instances can be minimized and removed, overall creating accurate and sound data.<ref name="Nations" />{{relevance inline|date=July 2023}}

==Epidemiology==
{{See also|List of countries by infant mortality rate}}
{| class="wikitable" style="float:right; margin: 0.5em 0 0.5em 1em;"
|+ World historical and predicted infant mortality rates per 1,000 births (1950–2050) <br /><small>UN, medium variant, 2008 rev.</small><ref>{{Cite web |title=UNdata: Infant mortality rate (per 1,000 births) |url=http://data.un.org/Data.aspx?d=PopDiv&f=variableID%3A77}}</ref>
|-
!Years!!Rate!!Years!!Rate
|-
|1950–1955|| style="text-align:center;" |152||2000–2005|| style="text-align:center;" |52
|-
||1955–1960|| style="text-align:center;" |136||2005–2010|| style="text-align:center;" |47
|-
||1960–1965|| style="text-align:center;" |116||2010–2015|| style="text-align:center;" |43
|-
||1965–1970|| style="text-align:center;" |100||2015–2020|| style="text-align:center;" |40
|-
||1970–1975|| style="text-align:center;" |91||2020–2025|| style="text-align:center;" |37
|-
||1975–1980|| style="text-align:center;" |83||2025–2030|| style="text-align:center;" |34
|-
||1980–1985|| style="text-align:center;" |74||2030–2035|| style="text-align:center;" |31
|-
||1985–1990|| style="text-align:center;" |65||2035–2040|| style="text-align:center;" |28
|-
||1990–1995|| style="text-align:center;" |61||2040–2045|| style="text-align:center;" |25
|-
||1995–2000|| style="text-align:center;" |57||2045–2050|| style="text-align:center;" |23
|}
Global IMR, as well as the IMR for both [[less developed countries]] (LDCs) and [[developed countries|more developed countries]] (MDCs), declined significantly between 1960 and 2001. According to the [[Save the Children State of the World's Mothers report|State of the World's Mothers report]] by [[Save the Children]], the world IMR declined from 126 in 1960 to 57 in 2001.<ref>{{Cite web |date=2019-01-14 |title=UNICEF, State of the World's Children 2003 infant mortality table |url=http://www.unicef.org/sowc03/tables/table1.html |archive-url=https://web.archive.org/web/20190114153240/https://www.unicef.org/sowc03/tables/table1.html |archive-date=2019-01-14 |access-date=2013-09-29 |website=Unicef.org}}</ref> The global neonatal mortality rate, NMR, decreased from 36.6 in 1990 to 18.0 in 2017.<ref>{{Cite journal |vauthors=Hug L, Alexander M, You D, Alkema L |date=June 2019 |title=National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis |journal=The Lancet. Global Health |volume=7 |issue=6 |pages=e710–e720 |doi=10.1016/s2214-109x(19)30163-9 |pmc=6527519 |pmid=31097275}}</ref>

However, IMR was, and remains, higher in LDCs. In 2001, the IMR for 91 LDCs was about 10 times as large as it was for 8 MDCs. On average, for LDCs, the IMR is 17 times higher than that of MDCs.{{Clarify|reason=Was it 10 times as large or 17 times higher?|date=July 2023}} Also, while both LDCs and MDCs made significant reductions in IMR, the reduction rate has been lower in less developed countries than among the more developed countries. Among many low- and middle-income countries, there is also substantial variation in infant mortality rate at a subnational level.<ref>{{Cite journal |vauthors=Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, etal |date=October 2019 |title=Mapping 123 million neonatal, infant and child deaths between 2000 and 2017 |journal=Nature |volume=574 |issue=7778 |pages=353–358 |bibcode=2019Natur.574..353B |doi=10.1038/s41586-019-1545-0 |pmc=6800389 |pmid=31619795}}</ref>

As the lowest rate, in Monaco, is 1.80, and the highest IMR, in Afghanistan, is 121.63, a factor of about 67 separates them.

{| class="wikitable"
|+  Top and bottom five countries by this measure (2013 estimates)<ref>{{Cite web |title=Infant Mortality Rate |url=https://www.cia.gov/library/publications/the-world-factbook/fields/2091.html |archive-url=https://web.archive.org/web/20121119041333/https://www.cia.gov/library/publications/the-world-factbook/fields/2091.html |archive-date=November 19, 2012 |access-date=December 18, 2012 |website=CIA – The World Factbook}}</ref>
|-
! Rank || Country || Infant mortality rate <br /> (deaths/1,000 live births)
|-
| 1 || [[Afghanistan]] || 121.63
|-
| 2 || [[Niger]] || 109.98
|-
| 3 || [[Mali]] || 109.08
|-
| 4 || [[Somalia]] || 103.72
|-
| 5 || [[Central African Republic]] || 97.17
|-
| 218 || [[Sweden]] || 2.74
|-
| 219 || [[Singapore]] || 2.65
|-
| 220 || [[Bermuda]] || 2.47
|-
| 221 || [[Japan]] || 2.21
|-
| 222 || [[Monaco]] || 1.80
|}

===United Kingdom===
A study published in the [[British Medical Journal]] in 2019 found that the rate of infant mortality in England had increased with an additional 24 infant deaths per 100,000 live births per year. There was no significant change from the pre-existing trend in the most affluent areas, thus the rise disproportionately affected the poorest areas of the country, and was attributed largely to rising [[child poverty]], as a result of sustained reductions in the welfare benefits available to families with children.<ref>{{Cite news |date=4 October 2019 |title='Unprecedented' rise in infant mortality in England linked to poverty |publisher=The Journal.ie |url=https://www.thejournal.ie/infant-mortality-poverty-england-4835780-Oct2019/ |access-date=1 December 2019}}</ref>

===United States===

[[File:NewsPaperArticleChildMortality-TheWorld-SaturdayEvening-1906-07-14.jpg|thumb|1906 headline imploring parents to attend to the cleanliness of their infants, and to expose them to the "clean air" outdoors]]
According to the [[CIA World Factbook]], which ranks 227 entities—including sovereign nations, dependent territories, and other recognized regions—the United States ranks 173rd in infant mortality, with a rate of 5.1 deaths per 1,000 live births as of 2024.<ref>{{Cite web |title=Infant mortality rate Comparison - The World Factbook |url=https://www.cia.gov/the-world-factbook/field/infant-mortality-rate/country-comparison/ |website=cia.gov |access-date=20 June 2025 |language=en}}</ref> Significant racial and socio-economic differences in the United States affect the IMR, in contrast with other developed countries with more homogeneous populations. In particular, IMR varies greatly by race in the US. The average IMR for the country as a whole is therefore not a fair representation of the wide variations that exist between segments of the population.<ref>{{Cite news |date=September 29, 2014 |title=Our infant mortality rate is a national embarrassment |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/ |vauthors=Ingraham C}}</ref> Many theories have been explored as to why these racial differences exist, with socio economic factors usually coming out as a reasonable explanation. However, more studies have been conducted around this matter, and the largest advancement is around the idea of stress and how it affects pregnancy.{{citation needed|date=July 2023}}

In the 1850s, the infant mortality rate in the United States was estimated at 216.8 per 1,000 white babies  and 340.0 per 1,000 African American babies,{{citation needed|date=July 2023}} but rates have significantly declined in modern times. This declining rate has been mainly due to modern improvements in basic health care and technology, as well as medical advances.<ref>{{Cite book |title=Economics: Principles in Action |vauthors=O'Sullivan A, Sheffrin SM |date=2003 |publisher=Pearson Prentice Hall |isbn=978-0-13-063085-8 |author-link=Arthur O'Sullivan (economist) |author-link2=Steven M. Sheffrin}}</ref> In the last century, the infant mortality rate has decreased by 93%.<ref name="MacDorman 2009" /> Overall, the rates per 1,000 births have decreased drastically from 20 deaths in 1970 to 6.9 deaths in 2003. In 2003, the leading causes of infant mortality in the United States were congenital anomalies, disorders related to immaturity, AIDS, and maternal complications.{{citation needed|date=July 2023}} [[Smoking during pregnancy]] declined to 10.2% with 12.4% of these births being [[low birth weight]]s, compared with 7.7% of births being low birth weights for non-smokers. Overall, babies born with low birth weight increased to 8.1% between 2003 and 2004.<ref>{{Cite web |date=Jan 13, 2006 |title=Preventing Infant Mortality |url=https://www.hhs.gov/news/factsheet/infant.html |archive-url=https://web.archive.org/web/20120418035538/http://www.hhs.gov/news/factsheet/infant.html |archive-date=2012-04-18 |website=U.S. Department of Health & Human Services}}</ref> According to the ''New York Times'', "the main reason for the high rate is preterm delivery, and there was a 10% increase in such births from 2000 to 2006." Between 2007 and 2011, however, the preterm birth rate has decreased every year. In 2011, 11.73% of babies were born before the 37th week of gestation, down from a high of 12.80% in 2006.<ref>{{Cite journal |vauthors=Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Mathews TJ |date=June 2013 |title=Births: final data for 2011 |url=https://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_01.pdf |journal=National Vital Statistics Reports |volume=62 |issue=1 |pages=1–69, 72 |pmid=24974591}}</ref>

Economic expenditures on [[labor and delivery]] and neonatal care are relatively high in the United States. A conventional birth averages US$9,775 with a C-section costing US$15,041.<ref>{{Cite web |date=June 30, 2013 |title=American Way of Birth, Costliest in the World |url=https://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html |website=The New York Times |vauthors=Rosenthal E}}</ref>{{Failed verification|date=July 2023}} Preterm births in the US have been estimated to cost $51,600 per child, with a total yearly cost of $26.2 billion.<ref>{{Cite book |title=Preterm Birth: Causes, Consequences, and Prevention |date=2007 |publisher=National Academies Press (US) |veditors=Behrman RE, Butler AS |location=Washington (DC) |chapter=Chapter 12: Societal Costs of Preterm Birth |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK11358/ |archive-url=https://web.archive.org/web/20230606231804/https://www.ncbi.nlm.nih.gov/books/NBK11358/ |archive-date=2023-06-06}}</ref> Despite this spending, several reports state that infant mortality rate in the United States is significantly higher than in other developed nations.<ref name="Osel2008" /><ref>{{Cite journal |display-authors=6 |vauthors=Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, Lawn JE, Mathers CD |date=August 2011 |title=Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities |journal=PLOS Medicine |volume=8 |issue=8 |article-number=e1001080 |doi=10.1371/journal.pmed.1001080 |pmc=3168874 |pmid=21918640 |doi-access=free }}</ref><ref>{{Cite journal |vauthors=Starfield B |date=July 2000 |title=Is US health really the best in the world? |url=http://silver.neep.wisc.edu/~lakes/iatrogenic.pdf |journal=JAMA |volume=284 |issue=4 |pages=483–5 |doi=10.1001/jama.284.4.483 |pmid=10904513}}</ref> Estimates vary; the CIA's ''[[The World Factbook|World Factbook]]'' ranks the US 55th internationally in 2014, with a rate of 6.17, while the UN figures from 2005 to 2010 place the US 34th.{{Full citation needed|date=July 2023}}

Differences in measurement could play a substantial role in the disparity between the US and other nations. A [[Fetal viability|non-viable birth]] in the US could be registered as a [[stillbirth]] in similarly developed nations like Japan, Sweden, Norway, Ireland, the Netherlands, and France, thereby reducing their IMR.<ref name="pmid21058532" /> [[Neonatal intensive care unit|Neonatal intensive care]] is also more likely to be applied in the US to marginally viable infants, although such interventions have been found to increase both costs and disability. A study following the implementation of the [[Born-Alive Infants Protection Act|Born Alive Infant Protection Act of 2002]] found universal resuscitation of infants born between 20 and 23 weeks increased the neonatal spending burden by $313.3 million while simultaneously decreasing [[quality-adjusted life year]]s by 329.3.<ref>{{Cite journal |vauthors=Partridge JC, Sendowski MD, Martinez AM, Caughey AB |date=January 2012 |title=Resuscitation of likely nonviable infants: a cost-utility analysis after the Born-Alive Infant Protection Act |journal=American Journal of Obstetrics and Gynecology |volume=206 |issue=1 |pages=49.e1–49.e10 |doi=10.1016/j.ajog.2011.09.026 |pmid=22051817}}</ref>

[[File:Infant Mortality Rates in the US by Race and Hispanic Ethinicity of the Mother.png|thumb|upright=1.3|Data indicating the IMR disparity between infants non-Hispanic black postpartum parent's and infants of white or Hispanic postpartum parents in the United States from 2000 to 2010<ref name="QuickStats" />]]
The vast majority of research conducted in the late twentieth and early twenty-first century indicates that African-American infants are more than twice as likely to die in their first year of life than white infants. Although a decline occurred from 13.63 deaths in 2005 to 11.46 deaths per 1,000 live births in 2010, non-Hispanic black parents continued to report a rate 2.2 times as high as that for non-Hispanic white parents.<ref name="QuickStats">{{Cite journal |date=January 10, 2014 |title=QuickStats: Infant Mortality Rates,* by Race and Hispanic Ethnicity of Mother — United States, 2000, 2005, and 2010 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6301a9.htm |journal=Weekly |volume=63 |issue=1 |page=25}}</ref>

Contemporary research findings have demonstrated that nationwide racial disparities in infant mortality are linked to the experiences of the postpartum parent and that these disparities cannot be totally accounted for by socio-economic, behavioral or genetic factors.<ref name="Osel2008" /> The [[Hispanic paradox]], an effect observed in other health indicators, appears in the infant mortality rate, as well. Hispanic postpartum parents see an IMR comparable to non-Hispanic white postpartum parents, even with lower educational attainment and economic status.<ref>{{Cite news |last=Chung |first=Juliet |date=29 Aug 2006 |title=Hispanic Paradox: Income may be lower but health better than most |work=The Seattle Times |url=http://seattletimes.com/html/nationworld/2003233307_hispanichealth29.html |archive-url=https://web.archive.org/web/20131105041813/http://seattletimes.com/html/nationworld/2003233307_hispanichealth29.html |archive-date=2013-11-05}}</ref>  According to Mustillo's [[Coronary Artery Risk Development in Young Adults Study|CARDIA]] (Coronary Artery Risk Development in Young Adults) study, "self reported experiences of racial discrimination were associated with pre-term and low-birthweight deliveries, and such experiences may contribute to black-white disparities in prenatal outcomes."<ref>{{Cite journal |vauthors=Mustillo S, Krieger N, Gunderson EP, Sidney S, McCreath H, Kiefe CI |date=December 2004 |title=Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA Study |journal=American Journal of Public Health |volume=94 |issue=12 |pages=2125–31 |doi=10.2105/AJPH.94.12.2125 |pmc=1448602 |pmid=15569964}}</ref> A study in North Carolina, for example, concluded that "white women who did not complete high school have a lower infant mortality rate than black college graduates."<ref>{{Cite journal |vauthors=Dole N, Savitz DA, Siega-Riz AM, Hertz-Picciotto I, McMahon MJ, Buekens P |date=August 2004 |title=Psychosocial factors and preterm birth among African American and White women in central North Carolina |journal=American Journal of Public Health |volume=94 |issue=8 |pages=1358–65 |doi=10.2105/AJPH.94.8.1358 |pmc=1448456 |pmid=15284044}}</ref> Likewise, dozens of population-based studies indicate that "the subjective, or perceived experience of racial discrimination is strongly associated with an increased risk of infant death and with poor health prospects for future generations of African Americans."<ref name="Osel2008" />

==== African American ====
{{Advert|section|date=May 2025}}
While earlier parts of this article have addressed racial differences in the infant death rate, a closer look into the effects of racial differences within the country is necessary to view discrepancies. Non-Hispanic Black women have the highest infant mortality rate with a rate of 11.3, while the IMR among white women is 5.1.<ref>{{Cite news |title=Infant Mortality Rate (Deaths per 1,000 Live Births) by Race/Ethnicity |publisher=Henry J. Kaiser Family Foundation |url=https://www.kff.org/other/state-indicator/infant-mortality-rate-by-race-ethnicity/?currentTimeframe=0&selectedDistributions=non-hispanic-white--non-hispanic-black--hispanic&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D |access-date=2017-03-07}}</ref>

While the popular argument is that due to the trend of black women being of a lower socio-economic status there is in an increased likelihood of a child suffering, and while this does correlate, the theory is not congruent with the data on Latino IMR in the United States. Latino people are almost as likely to experience poverty as blacks in the U.S., however, the infant mortality rate of Latinos is much closer to white women than it is to black women. The poverty rate for blacks is 24.1% and for Latinos it is 21.4%; if there is a direct correlation, then the IMR of these two groups should be rather similar, however, blacks have an IMR double that of Latinos.<ref>{{Cite web |title=U.S. Poverty Statistics |url=http://federalsafetynet.com/us-poverty-statistics.html |access-date=2017-03-07 |website=Federal Safety Net |archive-date=2017-03-08 |archive-url=https://web.archive.org/web/20170308044424/http://federalsafetynet.com/us-poverty-statistics.html }}</ref> Also, for black women who move out of poverty, or never experienced it in the first place, their IMR is not much lower than their counterparts experiencing higher levels of poverty.

Tyan Parker Dominguez at the University of Southern California offers a theory to explain the disproportionally high IMR among black women in the United States. She says African American women experience stress at much higher rates than any other group in the country. Stress produces particular hormones that can induce labor and contribute to other pregnancy problems. Considering [[premature birth]] is one of the leading causes of death of infants under the age of one, early labor is a legitimate concern. The idea of stress as a factor in IMR spans socio-economic status as Parker Dominguez says that for lower-class women stress comes from an unstable family life and chronic worry over poverty, while for middle-class women, battling racism, real or perceived, can be an extreme stressor.<ref name="southern-california-public-radio-2014" />

Others believe black women are predisposed to a higher IMR, meaning ancestrally speaking, all women from African descent should experience an elevated rate. This theory is quickly disproven by looking at foreign-born  African immigrants, these women come from a completely different social context and are not prone to the higher IMR experienced by American-born black women.<ref name="southern-california-public-radio-2014">{{Cite news |date=2014-03-03 |title=Why do black infants die so much more often than white infants? |work=Southern California Public Radio |url=http://www.scpr.org/news/2014/03/03/42483/why-do-black-infants-die-so-much-more-often-than-w/ |access-date=2017-03-16}}</ref>
Arline Geronimus, a professor at the University of Michigan School of Public Health calls the phenomenon "[[Weathering hypothesis|weathering]]". She claims constantly dealing with disadvantages and racial prejudice causes black women's birth outcomes to deteriorate with age. Therefore, younger black women may experience stress with pregnancy due to social and economic factors, but older women experience stress at a compounding rate and therefore have pregnancy complications aside from economic factors.<ref>{{Cite news |title=Why Black Women, Infants Lag In Birth Outcomes |work=National Public Radio |url=https://www.npr.org/2011/07/08/137652226/-the-race-gap |access-date=2017-03-07 |vauthors=Geronimus A}}</ref>

Mary O. Hearst, a professor in the Department of Public Health at Saint Catherine University, researched the effects of [[Racial segregation|segregation]] on the African American community to see if it contributed to the high IMR in black children.<ref>{{Cite journal |vauthors=Hearst MO, Oakes JM, Johnson PJ |date=December 2008 |title=The effect of racial residential segregation on black infant mortality |journal=American Journal of Epidemiology |volume=168 |issue=11 |pages=1247–54 |doi=10.1093/aje/kwn291 |pmid=18974059 |doi-access=free}}</ref> Hearst claims that residential segregation contributes to the high rates because of the political, economic, and health implications it poses on black mothers regardless of their socioeconomic status. Racism, economic disparities, and sexism in segregated communities are all examples of the daily stressors that pregnant black women face, and are risk factors for conditions that can affect their pregnancies such as [[pre-eclampsia]] and [[hypertension]].{{citation needed|date=July 2023}}

Studies have also shown that high IMR is due to the inadequate care that pregnant African Americans receive compared to other women in the country.<ref>{{Cite news |date=April 11, 2018 |title=Why America's Black Mothers and Babies Are in a Life-or-Death Crisis |work=The New York Times |url=https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html |url-access=subscription |access-date=May 13, 2018 |vauthors=Villarosa L}}</ref> In another study, it was shown that Black patients were more likely to receive [[ibuprofen]] after surgery instead of [[oxycodone]].<ref>{{Cite journal |vauthors=Sabin JA, Greenwald AG |date=May 2012 |title=The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma |journal=American Journal of Public Health |volume=102 |issue=5 |pages=988–995 |doi=10.2105/AJPH.2011.300621 |pmc=3483921 |pmid=22420817}}</ref> This unequal treatment stems from the idea that there are racial medical differences and is also rooted in racial biases and controlled images of black women. Because of this unequal treatment, research on maternal and prenatal care received by African American women and their infants,<ref name="Chalhoub">{{Cite book |url=https://www.americanprogress.org/issues/women/reports/2018/05/10/450577/health-care-system-racial-disparities-maternal-mortality/ |title=The Health Care System and Racial Disparities in Maternal Mortality |vauthors=Chalhoub T, Rimar K |date=2018 |publisher=Center for American Progress |location=Washington, DC |access-date=22 October 2020}}</ref> finds that black women do not receive the same urgency in medical care; they are also not taken as seriously regarding pain they feel or complications they think they are having, as exemplified by the complications tennis-star [[Serena Williams]] faced during her delivery.<ref>{{Cite news |date=January 11, 2018 |title=For Serena Williams, Childbirth Was a Harrowing Ordeal. She's Not Alone. |work=The New York Times |url=https://www.nytimes.com/2018/01/11/sports/tennis/serena-williams-baby-vogue.html |access-date=May 13, 2018 |vauthors=Salam M}}</ref>

Several peer-reviewed articles have documented a difference in the levels of care a black patient receives regardless of whether they have insurance. For white women IMR drops after age 20, and remains the same until she is in her 40s; for black women IMR does not decrease when accounting for higher education, nor change based on age, suggesting that there is a racial element.<ref>{{Cite web |title=Urban or rural, black lives in NC are being cut short almost before they begin. |url=https://www.newsobserver.com/news/politics-government/article239388203.html |access-date=11 April 2021 |website=newsobserver.com |vauthors=Bonnor L}}</ref> There is another element that must be considered: the effect of the intersection of race and gender. [[Misogynoir]] is a commonly cited and overlooked issue.<ref>{{Cite web |date=18 April 2019 |title=Racism and sexism against Black women may contribute to high rates of Black infant mortality |url=https://www.childtrends.org/blog/racism-sexism-against-black-women-may-contribute-high-rates-black-infant-mortality |website=Child Trends}}</ref> Black feminists have often been cited as the backbone of numerous Civil Rights events, but they feel overlooked when it comes to meaningful change that positively changes the lives of Black women specifically.<ref>{{Cite web |date=19 June 2020 |title=The Black Lives Matter movement does not exist without black women |url=https://commonwealthtimes.org/2020/06/19/the-black-lives-matter-movement-does-not-exist-without-black-women/ |website=The Commonwealth Times |vauthors=Shammet T}}</ref> During the June 2020 [[Black Lives Matter]] protests, many black feminists criticized the movement for excluding them.<ref>{{Cite web |date=5 August 2020 |title=Hidden in plain sight? Black female activists feel left out of BLM movement. {{!}} Milwaukee Neighborhood News Service |url=https://milwaukeenns.org/2020/08/05/hidden-in-plain-sight-black-female-activists-feel-left-out-of-blm-movement/ |website=milwaukeenns.org}}</ref> When examined through this lens, the increased rates of IMR of African American women becomes a matter of equity and an issue of social justice.

Strides have been made, however, to combat this epidemic. In Los Angeles County, health officials have partnered with non-profits around the city to help black women after the delivery of their child. One non-profit that has made a large impact on many lives is [[Great Beginnings For Black Babies]] in Inglewood. The non-profit centers around helping women deal with stress by forming support networks, keeping an open dialogue around race and family life, and also finding these women a secure place in the workforce.<ref>{{Cite web |title=Great Beginnings for Black Babies |url=http://www.gbbb-la.org/ |access-date=2017-03-07 |website=Great Beginnings for Black Babies}}</ref>

Some research argues that to end the high infant mortality rate of black children, the country needs to fix the social and societal issues that plague African Americans,<ref>{{Cite web |date=March 2018 |title=Fighting at Birth: Eradicating the Black-White Infant Mortality Gap |url=https://socialequity.duke.edu/sites/socialequity.duke.edu/files/site-images/EradicatingBlackInfantMortality-March2018%20FINAL.pdf |archive-url=https://web.archive.org/web/20180925071653/https://socialequity.duke.edu/sites/socialequity.duke.edu/files/site-images/EradicatingBlackInfantMortality-March2018%20FINAL.pdf |archive-date=2018-09-25 |access-date=2018-05-13 |website=Duke University's Samuel DuBois Cook Center on Social Equity and Insight Center for Community Economic Development |vauthors=Smith IZ, Bentley-Edwards KL, El-Amin S, Darity W}}</ref> such as institutional racism, mass incarceration, poverty, and health care disparities that are present amongst the African American population. Following this theory, if institutional inequalities are addressed and repaired by the United States Government, this will reduce daily stressors for African Americans, and African American women in particular, and lessen the risk of complications in pregnancy and infant mortality. Others argue that increasing [[Diversity (politics)|diversity]] in the health care industry can help reduce the IMR as more representation can tackle deep-rooted racial biases and stereotypes that exist towards African American women.<ref>{{Cite book |url=https://archive.org/details/blackmaninwhitec0000twee |title=Black Man in a White Coat: A Doctor's Reflections on Race and Medicine |vauthors=Tweedy D |publisher=Picador |year=2015 |isbn=978-1-250-04463-1 |location=New York |url-access=registration}}</ref> Another attempt to reduce high IMR among black children is the use of [[doula]]s throughout pregnancy.<ref name="Chalhoub" />

== History ==
In the early 1900s, countries around the world started to notice that there was a need for better child health care services; first in Europe, and then with the United States creating a campaign to decrease the infant mortality rate. With this program, they were able to lower the IMR from 100 deaths to 10 deaths per every 1,000 births.<ref>{{Cite journal |vauthors=Brosco JP |date=February 1999 |title=The early history of the infant mortality rate in America: "A reflection upon the past and a prophecy of the future" |url=http://pediatrics.aappublications.org/content/103/2/478 |journal=Pediatrics |volume=103 |issue=2 |pages=478–85 |doi=10.1542/peds.103.2.478 |pmid=9925845|url-access=subscription }}</ref> When infant mortality began being noticed as a national problem it was viewed a social problem, and [[middle class]] American women with an educational background started to create a movement to provide housing for families of a lower [[social class]]. Through this movement they were able to establish public health care and government agencies, which in turn made more sanitary and healthier environments for infants. Medical professionals helped further the cause for infant health by creating the field of [[pediatrics]], which is devoted to the medical care of children.<ref>{{Cite journal |vauthors=Hargraves M, Thomas RW |date=November 1993 |title=Infant mortality: its history and social construction |journal=American Journal of Preventive Medicine |volume=9 |issue=6 Suppl |pages=17–26 |doi=10.1016/S0749-3797(18)30661-5 |pmid=8123283}}</ref>

===United States===
In the 20th century decreases in infant mortality around the world were linked to several common trends, including social programs, improved sanitation, improved access to healthcare, and improved education, as well as scientific advancements like the discovery of [[penicillin]] and the development of safer [[blood transfusion]]s.<ref>{{Cite report |url=https://www.cdc.gov/nchs/data/vsus/vsus_1950_1.pdf |title=Vital Statistics of the United States |date=1954 |publisher=United States Printing Office |location=Washington, D.C. |volume=1 |vauthors=Dunn HL}}</ref> By improving sanitation, especially access to safe drinking water, the United States dramatically decreased infant mortality, which had been a growing concern in the United States since the 1850s.<ref>{{Cite book |title=Save the babies: American public health reform and the prevention of infant mortality, 1850-1929 |vauthors=Meckel RA |date=1998 |publisher=University of Michigan Press |isbn=978-0-472-08556-9 |location=Ann Arbor |oclc=39269607}}</ref> During this time the United States also endeavored to increase education and awareness regarding infant mortality. [[Pasteurization]] of milk also helped the United States combat infant mortality in the early 1900s, as it helped curb disease in infants.<ref>{{Cite report |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm |title=Achievements in Public Health, 1900 - 1999: Healthier Mothers and Babies |date=1999 |publisher=Centers for Disease Control and Prevention |issue=38 |volume=48 |pages=849–858 |work=Morbidity and Mortality Weekly Report (MMWR)}}</ref> These factors, on top of a general increase in the standard of living in urban areas, helped the United States make dramatic improvements to their rates of infant mortality in the early 20th century.

Although the overall infant mortality rate was sharply dropping during this time, within the United States infant mortality varied greatly among racial and socio-economic groups. Between 1915 and 1933 the change in infant mortality per 1,000 births was, for the white population, 98.6 down to 52.8 per 1,000, and for the black population, 181.2 to 94.4 per 1,000 - studies imply that this has a direct correlation with relative economic conditions between these populations.<ref>{{Cite journal |name-list-style=vanc |vauthors=Woodbury RM |date=November 1936 |title=Infant Mortality in the United States |journal=The Annals of the American Academy of Political and Social Science |volume=188 |pages=94–106 |doi=10.1177/000271623618800110 |jstor=1020363 |s2cid=144927978}}</ref> Additionally, infant mortality in [[Southern United States|southern states]] was consistently 2% higher than other regions in the US across a 20-year period starting in 1985. Southern states also tend to perform worse on predictors for higher infant mortality, such as per capita income and poverty rate.<ref>{{Cite journal |vauthors=Menifield CE, Dawson J |year=2008 |title=Infant mortality in southern states: a bureaucratic nightmare |journal=Journal of Health and Human Services Administration |volume=31 |issue=3 |pages=385–402 |doi=10.1177/107937390803100302 |jstor=41288095 |pmid=19209565}}</ref>

In the latter half of the 20th century, a focus on greater access to medical care for women spurred declines in infant mortality in the United States. The implementation of [[Medicaid]], granting wider access to healthcare, contributed to a dramatic decrease in infant mortality, as did greater access to legal abortion and family-planning care, such the [[Intrauterine device|IUD]] and the birth control pill.<ref>{{Cite book |title=Determinants of Health: An Economic Perspective |vauthors=Jacobowitz S, Grossman M |publisher=Columbia University Press |year=2017 |isbn=978-0-231-54451-1 |veditors=Grossman M |location=New York |pages=305–330 |chapter=Variations in Infant Mortality Rates among Counties of the United States: The Roles of Public Policies and Programs |doi=10.7312/gros17812 |jstor=10.7312/gros17812}}</ref>

By 1984, the United States' decreasing infant mortality slowed. Funding for the federally subsidized Medicaid and Maternal and Infant Care programs was reduced, and availability of prenatal care decreased for low-income parents.<ref>{{Cite journal |vauthors=Miller CA |date=July 1985 |title=Infant mortality in the U.S |journal=Scientific American |volume=253 |issue=1 |pages=31–7 |bibcode=1985SciAm.253a..31M |doi=10.1038/scientificamerican0785-31 |jstor=24967721 |pmid=4001915}}</ref>

=== China ===
The growth of medical resources in the People's Republic of China's during the latter half of the 20th century partly explains its dramatic improvement regarding infant mortality during this time.<ref>{{cite web |url=https://theodora.com/stats/china/china_infant_mortality_rate_total_time_series.html |title=China: Infant Mortality Rate Total 2004-2024 Time Series deaths/1,000 live births, shows the dramatic decline of the infant mortality rate within a 21 year span |work=Countries of the World time series |access-date=2025-08-10 |archive-url=https://web.archive.org/web/20250710165800/https://theodora.com/stats/china/china_infant_mortality_rate_total_time_series.html |
archive-date=2025-07-10}}</ref> The [[Rural Cooperative Medical System]], which was founded in the 1950s, granted healthcare access to previously underserved rural populations, and is estimated to have covered 90% of China's rural population throughout the 1960s. The Cooperative Medical System achieved an infant mortality rate of 25.09 per 1,000; while it was later defunded, leaving many rural populations to rely on an expensive fee-for-service system, the rate continued to decline.<ref>{{Cite journal |vauthors=Liu X, Cao H |date=1992 |title=China's Cooperative Medical System: its historical transformations and the trend of development |journal=Journal of Public Health Policy |volume=13 |issue=4 |pages=501–11 |doi=10.2307/3342538 |jstor=3342538 |pmid=1287043 |s2cid=1977035}}</ref> As the Cooperative Medical System was replaced, the change caused a socio-economic gap in accessibility to medical care in China, however this was not reflected in its declining infant mortality rate; prenatal care was increasingly used, and delivery assistance remained accessible.<ref>{{Cite journal |vauthors=Song S, Burgard SA |date=September 2011 |title=Dynamics of inequality: mother's education and infant mortality in China, 1970-2001 |journal=Journal of Health and Social Behavior |volume=52 |issue=3 |pages=349–64 |doi=10.1177/0022146511410886 |jstor=23033284 |pmid=21896686 |s2cid=25288570}}</ref>

China's [[one-child policy]], adopted in the 1980s, negatively impacted its infant mortality. Women carrying unapproved pregnancies faced state consequences and [[social stigma]] and were thus less likely to use prenatal care. Additionally, economic realities and long-held cultural factors incentivized male offspring, leading some families who already had sons to avoid prenatal care or professional delivery services, and causing China to have unusually high female infant mortality rates during this time.<ref>{{Cite journal |name-list-style=vanc |vauthors=Lai D |date=2005 |title=Sex Ratio at Birth and Infant Mortality Rate in China: An Empirical Study |journal=Social Indicators Research |volume=70 |issue=3 |pages=313–326 |doi=10.1007/s11205-004-1542-y |jstor=27522168 |s2cid=143548315}}</ref>

== See also ==
* [[Maternal mortality]]
* [[Child mortality]]
* [[Adult mortality]]
* [[Miscarriage]]
* [[Stillbirth]]
* [[List of countries by infant mortality rate]]
* [[List of countries by maternal mortality ratio]]
** [[History of public health in the United Kingdom]]
Related statistical categories:
* ''[[Perinatal mortality]]'' only includes deaths between the fetal viability (22 weeks gestation) and the end of the 7th day after delivery.
* ''Neonatal mortality'' only includes deaths in the first 28 days of life.
* ''Postneonatal mortality'' only includes deaths after 28 days of life but before one year.
* ''[[Child mortality]]'' includes deaths before the age of 5.

== Notes ==
{{notelist}}

== References ==
{{reflist|1=30em}}

== Further reading==
* Abouharb, M. Rodwan, and Anessa L. Kimball. "A new dataset on infant mortality rates, 1816—2002." ''Journal of Peace Research'' 44.6 (2007): 743-754. [https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=d8823cfaa5bc23d24191b4fe04fe89fc82069fb8 online]

* Armstrong, David. "The invention of infant mortality." ''Sociology of Health & Illness'' 8.3 (1986): 211-232. [https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/j.1467-9566.1986.tb00298.x online]

* Chen, Alice, Emily Oster, and Heidi Williams. "Why is infant mortality higher in the United States than in Europe?." ''American Economic Journal: Economic Policy'' 8.2 (2016): 89-124. [https://pmc.ncbi.nlm.nih.gov/articles/PMC4856058/pdf/nihms-717273.pdf online]

* Conley, Dalton, and Kristen W. Springer. "Welfare state and infant mortality." ''American Journal of Sociology'' 107.3 (2001): 768-807.  [https://wagner.nyu.edu/files/faculty/publications/welfare_state_imr.pdf online]

* Galley, Chris. ''Infant Mortality in England, 1538-2000 '' (Local Population Studies Society. 2023), pp. 8-10.  [http://www.localpopulationstudies.org.uk/the-journal/galley-infant-mortality/ online]

* MacDorman, Marian F., et al. "International comparisons of infant mortality and related factors: United States and Europe, 2010." (2014). [https://stacks.cdc.gov/view/cdc/25388/cdc_25388_DS1.pdf online]

* Nathanson, Constance A. ''Disease prevention and social change, the state, society, and public health in the United States, France, Great Britain and Canada'' (Russell Sage Foundation, 2007) . pp.49–79.

* Reidpath, Daniel D., and Pascale Allotey. "Infant mortality rate as an indicator of population health." ''Journal of Epidemiology & Community Health'' 57.5 (2003): 344-346. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732453/pdf/v057p00344.pdf online]
* Singh, Gopal K., and Stella M. Yu. "Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010." ''American Journal of Public Health'' 85.7 (1995): 957-964. [https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.85.7.957 online]

== External links ==
{{Commons}}
* [https://childmortality.org/ Child and infant mortality estimates for all countries - website by UNICEF]

{{Death}}
{{Pediatric conditions originating in the perinatal period}}
{{Public health}}
{{Authority control}}

[[Category:Infant mortality| ]]
[[Category:Population]]
[[Category:Public health]]