Pennsylvania has a Poor National Standing for Infant Mortality

Written by: Linda S. Duchak, EdM, MCHES, Associate Director, Pennsylvania Public Health Training Center
Copy editor: Kurt Holliday, Communications Specialist, Pennsylvania Public Health Training Center  

In the U.S., for every 1,000 babies born, about 6 die before age 1. In Pennsylvania, for every 1,000 babies born, about 7 die before they reach age 1 (2010). Only 11 states in the U.S. had higher rate of infant mortality than Pennsylvania.

Infant mortality is defined as the death of an infant before his or her first birthday. The infant mortality rate (IMR) measures this occurrence per 1,000 live births. In addition to being a key marker of maternal and child health, the IMR has been called the most sensitive indicator of overall societal health.

In the United States, substantial progress has been made over the last 50 years in reducing the IMR. Yet with an IMR of 6.05 in 2011, the U.S. still has a relatively poor global standing. In 2010, the United States ranked 32nd among the 34 nations of the Organization for Economic Cooperation and Development in infant mortality with an overall IMR three times that of the countries with the lowest IMRs. The main reason that the U.S. IMR remains higher than that of European nations is because the U.S. has a high percentage of preterm births (12%).

Infant mortality is divided into two age periods: neonatal (birth–27 days) and post-neonatal (28–364 days). Approximately two-thirds of all infant deaths occur in the neonatal period and are caused by complications arising from low birth weight, birth defects, maternal health, preterm birth, complications of labor and delivery, and lack of access to appropriate care at the time of delivery. These problems can be linked to a complex group of conditions, including systematic inequality and lack of access to care.

Racial and geographic disparities remain persistent. Non-Hispanic black infants continue to die at nearly twice the rate of non-Hispanic white infants. Additionally, preterm-related causes of death among black infants occur at a rate three times greater than that of white infants. Geographically, Pennsylvania is included with a majority of southern states in the top quartile for infant mortality.

Further reduction of preventable infant deaths remains a challenge. Prevention of infant deaths should begin in the preconception period; opportunities are available to improve the health of mothers and thus avoid preventable infant deaths. The rates of preterm birth, including rates of late preterm birth (births between 34 and 36 weeks of gestation) and elective preterm delivery, need to be reduced. Opportunities exist to reduce the mortality rate among infants born preterm by addressing key risk factors such as maternal smoking, drinking, drug use, and chronic maternal health problems such as high blood pressure and diabetes. Many very low birth weight infants in the United States are not born in hospitals that have level III neonatal intensive-care units, which have been shown to significantly reduce mortality, indicating a need to increase access to high quality care.

Source: Morbidity and Mortality Weekly Report, August 9, 2013 / 62(31);625-628.