Infant mortality refers to deaths of young children, typically those
less than one year of age. It is measured by the infant mortality rate
(IMR), which is the number of deaths of children under one year of age
per 1000 live births. The under-five mortality rate is also an
important statistic, considering the infant mortality rate focuses
only on children under one year of age.
Premature birth is the biggest contributor to the IMR. Other
leading causes of infant mortality are birth asphyxia, pneumonia, term
birth complications such as abnormal presentation of the foetus
umbilical cord prolapse, or prolonged labor, neonatal infection,
diarrhea, malaria, measles and malnutrition. One of the most common
preventable causes of infant mortality is smoking during pregnancy.
Many factors contribute to infant mortality, such as the mother's
level of education, environmental conditions, and political and
medical infrastructure. Improving sanitation, access to clean
drinking water, immunization against infectious diseases, and other
public health measures can help reduce high rates of infant mortality.
Child mortality is the death of a child before the child's fifth
birthday, measured as the under-5 child mortality rate (U5MR).
National statistics sometimes group these two mortality rates
together. Globally, 9.2 million children die each year before their
fifth birthday; more than 60% of these deaths are seen as being
avoidable with low-cost measures such as continuous breast-feeding,
vaccinations and improved nutrition.
Infant mortality rate was an indicator used to monitor progress
towards the Fourth Goal of the
Millennium Development Goals
Millennium Development Goals of the
United Nations for the year 2015. It is now a target in the
Sustainable Development Goals
Sustainable Development Goals for Goal Number 3 ("Ensure healthy lives
and promote well-being for all at all ages").
Throughout the world, infant mortality rate (IMR) fluctuates
drastically, and according to Biotechnology and Health Sciences,
education and life expectancy in the country is the leading indicator
of IMR. This study was conducted across 135 countries over the
course of 11 years with Africa having the highest infant mortality
rate of any other region studied with 68 deaths per 1,000 live births.
2.1.1 Low birth weight
2.1.2 Sudden infant death syndrome
2.1.4 Infectious diseases
2.3 Early childhood trauma
2.4 Socio-economic factors
2.6 Medicine and biology
2.8.1 Gender favoritism
2.8.2 Birth spacing
3.1 Public health
3.2 Medical treatments
3.3 Cultural changes
4 Differences in measurement
4.1 Europe and America
5.1 United States
5.1.1 African American
7 See also
9 External links
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.
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.
Neonatal mortality is newborn death occurring within 28 days
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.
Postneonatal mortality is the death of children aged 29 days to one
year. The major contributors to postneonatal death are malnutrition,
infectious disease, troubled pregnancy, Sudden Infant
and problems with the home environment.
Causes of infant mortality directly lead to the death.
Environmental and social barriers prevent access to basic medical
resources and thus contribute to an increasing infant mortality rate;
99% of infant deaths occur in developing countries, and 86% of these
deaths are due to infections, premature births, complications during
delivery, and perinatal asphyxia and birth injuries. Greatest
percentage reduction of infant mortality occurs in countries that
already have low rates of infant mortality. Common causes are
preventable with low-cost measures. In the United States, a primary
determinant of infant mortality risk is infant birth weight with lower
birth weights increasing the risk of infant mortality. The
determinants of low birth weight include socio-economic,
psychological, behavioral and environmental factors.
Causes of infant mortality that are related to medical conditions
include: low birth weight, sudden infant death syndrome, malnutrition
and infectious diseases, including neglected tropical diseases.
Low birth weight
Main article: Low birth weight
Low birth weight makes up 60–80% of the infant mortality rate in
The New England Journal of Medicine
The New England Journal of Medicine stated that
"The lowest mortality rates occur among infants weighing 3,000 to
3,500 g (6.6 to 7.7 lb). For infants born weighing
2,500 g (5.5 lb) or less, the mortality rate rapidly
increases with decreasing weight, and most of the infants weighing
1,000 g (2.2 lb) 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."
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, lack of prenatal
care, maternal sickness during pregnancy, and an unhygienic home
environments. Along with birth weight, period of gestation makes
up the two most important predictors of an infant's chances of
survival and their overall health.
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." Low
birth weights from African American mothers remain twice as high as
that of white women. LBW may be the leading cause of infant deaths,
and it is greatly preventable. Although it is preventable, the
solutions may not be the easiest but effective programs to help
prevent LBW are a combination of health care, education, environment,
mental modification and public policy, influencing a culture
Preterm birth is the leading cause of
newborn deaths worldwide. Even though America excels past many
other countries in the care and saving of premature infants, the
percentage of American woman who deliver prematurely is comparable to
those in developing countries. Reasons for this include teenage
pregnancy, increase in pregnant mothers over the age of thirty-five,
increase in the use of in-vitro fertilization which increases the risk
of multiple births, obesity and diabetes. Also, women who do not have
access to health care are less likely to visit a doctor, therefore
increasing their risk of delivering prematurely.
Sudden infant death syndrome
Main article: Sudden infant death syndrome
Thousands of infant deaths per year are classified as sudden infant
death syndrome (SIDS). According to the Mayo Clinic, SIDS is the
unexplained death, usually during sleep, of a seemingly healthy baby.
Although the direct cause of SIDS remains unknown, many doctors
believe that there are several factors that put babies at an increased
risk of SIDS, including: babies sleeping on their stomachs, exposure
to cigarette smoke in the womb or after birth, sleeping in bed with
parents, premature birth, being a twin or triplet, being born to a
teen mother, and also living in poverty settings. Although the cause
is unknown and currently cannot be explained, doctors have come to the
conclusion that SIDS is most likely to occur between 2 and 4 months
and most deaths occur in the winter time. Recommended precautions
include ensuring that infants sleep on their backs, controlling the
temperature of the bedroom, employing a crib without toys or excess
bedding, and breastfeeding.
Malnutrition in children
Malnutrition frequently accompanies these[which?] diseases, and is a
primary factor contributing to the complications of both diarrhea and
pneumonia, although the causal links and mechanisms remain unclear.
Factors other nutrition also influence the incidence of diarrhea,
including socioeconomic status, disruption of traditional lifestyles,
access to clean water and sanitation facilities, age and breastfeeding
Protein energy malnutrition and micronutrient deficiency are two
reasons for stunted growth in children under five years old in the
least developed countries.
Malnutrition leads to diarrhea and
dehydration, and ultimately death. Millions of women in developing
countries are stunted due to a history of childhood malnutrition.
Women's bodies are thus underdeveloped, and their chances of surviving
childbirth decrease. Due to underdeveloped bodies, the probability of
an obstructed pregnancy increases. Protein-energy deficiency results
in low-quality breastmilk that provides less energy and other
Vitamin A deficiency
Vitamin A deficiency can lead to stunted growth, blindness, and
increased mortality due to the lack of nutrients in the body. Two
hundred and fifty million infants are affected by Vitamin A
deficiency. Among women in developing countries, 40% have iron
deficiency anemia, which increases maternal and infant mortality
rates, chances of stillbirth, cases of low birth weight babies,
premature delivery, and probability of fetal brain damage. One way
Vitamin A deficiency
Vitamin A deficiency is to educate the mother on the many
benefits of breastfeeding.
Breastmilk is a natural source of Vitamin
A, and supplies the suckling infant with enough Vitamin A.
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. Newborns can
acquire infections during birth from bacteria that are present in
their mother's reproductive tract. The mother may not be aware of the
infection, or she may have an untreated pelvic inflammatory disease or
sexually transmitted disease. These bacteria can move up the vaginal
canal into the amniotic sac surrounding the baby. Maternal blood-borne
infection is another route of bacterial infection from mother to baby.
Neonatal infection is also more likely with the premature rupture of
the membranes (PROM) of the amniotic sac.
Seven out of ten childhood deaths are due to infectious diseases:
acute respiratory infection, diarrhea, measles, and malaria. Acute
respiratory infection 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
Measles is the fifth-largest cause of childhood
Folic acid for mothers is one way to combat iron
deficiency. A few public health measures used to lower levels of iron
deficiency anemia include iodize salt or drinking water, and include
vitamin A and multivitamin supplements into a mother's diet. A
deficiency of this vitamin causes certain types of anemia (low red
blood cell count).
Infant mortality rate can be a measure of a nation's health and social
condition. It is a composite of a number of component rates
which have their separate relationship with various social factors and
can often be seen as an indicator to measure the level of
socioeconomic disparity within a country.
Organic water pollution is a better indicator of infant mortality than
health expenditures per capita. Water contaminated with various
pathogens houses a host of parasitic and microbial infections.
Infectious disease and parasites are carried via water pollution from
animal wastes. Areas of low socioeconomic status are more prone to
inadequate plumbing infrastructure, and poorly maintained
facilities. The burning of inefficient fuels doubles the rate of
children under 5 years old with acute respiratory tract
infections. Climate and geography often play a role in sanitation
conditions. For example, the inaccessibility of clean water
exacerbates poor sanitation conditions.
People who live in areas where particulate matter (PM) air pollution
is higher tend to have more health problems across the board.
Short-term and long-term effects of ambient air pollution are
associated with an increased mortality rate, including infant
mortality. Air pollution is consistently associated with post neonatal
mortality due to respiratory effects and sudden infant death syndrome.
Specifically, air pollution is highly associated with SIDs in the
United States during the post-neonatal stage. High infant
mortality is exacerbated because newborns are a vulnerable subgroup
that is affected by air pollution. Newborns who were born into
these environments are no exception. Women who are exposed to greater
air pollution on a daily basis who are pregnant should be closely
watched by their doctors, as well as after the baby is born. Babies
who live in areas with less air pollution have a greater chance of
living until their first birthday. As expected, 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
The key pollutant for infant mortality rates is carbon monoxide.
Carbon monoxide is a colorless, odorless gas that does great harm
especially to infants because of their immature respiratory
system. Another major pollutant is second-hand smoke, which is a
pollutant that can have detrimental effects on a fetus. According to
the American Journal of Public Health, "in 2006, more than 42 000
Americans died of second hand 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 Blacks, as were 28% of those dying of
respiratory distress syndrome, 25% dying of other respiratory
conditions, and 24% dying of sudden infant death syndrome." The
American Journal of
Epidemiology also stated that "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 on racial disparities in infant
mortality suggests a link between the institutionalized racism that
pervades the environment and high rates of African American infant
mortality. In synthesis 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."
It is important to note that infant mortality rates do not decline
among African Americans even if their socio-economic status does
improve. Parker Dominguez at the University of Southern California has
made some headway in determining the reasoning behind this, claiming
black women are more prone to psychological stress than other women of
different races in the United States. Stress is a lead factor in
inducing labor in pregnant women, and therefore high levels of stress
during pregnancy could lead to premature births that have the
potential to be fatal for the infant.
Early childhood trauma
Early childhood trauma includes physical, sexual, and psychological
abuse of a child ages zero to five years-old. Trauma in early
development has 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 in a fully developed body. Studies estimate that 1–2 per
100,000 U.S. children annually are fatally injured. Unfortunately, it
is reasonable to assume that these statistics under represent actual
mortality. Three-quarters (74.8 percent) of child fatalities
in FFY 2015 involved children younger than 3 years, and children
younger than 1 year accounted for 49.4 percent of all fatalities.
In particular, correctly identifying deaths due to neglect is
problematic and children with sudden unexpected death or those with
what appear to be unintentional causes on the surface often have
preventable risk factors which are substantially similar to those in
families with maltreatment.
There is a direct relationship between age of maltreatment/injury and
risk for death. The younger an infant is, the more dangerous the
Family configuration, child gender, social isolation, lack of
support, maternal youth, marital status, poverty, parental ACES, and
parenting practices are thought to contribute to increased
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 incomes tend to correlate with
higher infant mortality. In cases where the father had no income, the
rate of infant mortality was 357% more than that for the highest
income earners ($1,250+). Differences between races were also
apparent. African-American mothers experience infant mortality at a
rate 44% higher than average; however, research indicates that
socio-economic factors do not totally account for the racial
disparities in infant mortality.
While infant mortality is normally negatively correlated with GDP,
there may indeed be some opposing short-term effects from a recession.
A recent study by
The Economist showed that economic slowdowns reduce
the amount of air pollution, which results in a lower infant mortality
rate. In the late 1970s and early 1980s, the recession's impact on air
quality is estimated to have saved around 1,300 US babies. It is
only during deep recessions that infant mortality increases. According
to Norbert Schady and Marc-François Smitz, recessions when GDP per
capita drops by 15% or more increase infant mortality.
Social class dictates which medical services are available to an
individual. Disparities due to socioeconomic factors have been
exacerbated by advances in medical technology. Developed countries,
most notably the United States, have seen a divergence between those
living in poverty who cannot afford medical advanced resources,
leading to an increased chance of infant mortality, and others.
In policy, there is a lag time between realization of a problem's
possible solution and actual implementation of policy
Infant mortality rates correlate
with war, political unrest, and government corruption.
In most cases, war-affected areas will experience a significant
increase in infant mortality rates. Having a war taking place where a
woman is planning on having a baby is not only stressful on the mother
and foetus, but also has several detrimental effects.
However, 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. Attaining 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 epidemic given the medical
conditions during war.
Many developing countries rely on foreign aid for basic nutrition.
Transport of aid becomes significantly more difficult in times of war.
In most situations the average weight of a population will drop
substantially. Expecting mothers are affected even more by 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
There have been several instances in recent years of systematic rape
as a weapon of war. Women who become pregnant as a result of war rape
face even more significant challenges in bearing a healthy child.
Studies suggest that women who experience sexual violence before or
during pregnancy are more likely to experience infant death in their
children. Causes of infant mortality in abused women range
from physical side effects of the initial trauma to psychological
effects that lead to poor adjustment to society. Many women who became
pregnant by rape in Bosnia were isolated from their hometowns making
life after childbirth exponentially more difficult.
Medicine and biology
Developing countries have a lack of access to affordable and
professional health care resources, and skilled personnel during
deliveries. Countries with histories of extreme poverty also
have a pattern of epidemics, endemic infectious diseases, and low
levels of access to maternal and child healthcare.
The American Academy of Pediatrics recommends that infants need
multiple doses of vaccines such as diphtheria-tetanus-acellular
pertussis vaccine, Haemophilus influenzae type b (Hib) vaccine,
Hepatitis B (HepB) vaccine, inactivated polio vaccine (IPV), and
pneumococcal vaccine (PCV). Research was conducted by the Institute of
Immunization Safety Review Committee concluded that there
is no relationship between these vaccines and risk of SIDS in infants.
This tells us that not only is it extremely necessary for every child
to get these vaccines to prevent serious diseases, but there is no
reason to believe that if your child does receive an immunization that
it will have any effect on their risk of SIDS.
Political modernization perspective, the neo-classical economic theory
that scarce goods are most effectively distributed to the market, say
that the level of political democracy influences the rate of infant
mortality. Developing nations with democratic governments tend to be
more responsive to public opinion, social movements, and special
interest groups for issues like infant mortality. In contrast,
non-democratic governments are more interested in corporate issues and
less so in health issues. Democratic status effects the dependency a
nation has towards its economic state via export, investments from
multinational corporations and international lending institutions.
Levels of socioeconomic development and global integration are
inversely related to a nation's infant mortality rate.
Dependency perspective occurs in a global capital system. A nation's
internal impact is highly influenced by its position in the global
economy and has adverse effects on the survival of children in
developing countries. Countries can experience disproportionate
effects from its trade and stratification within the global
system. It aids in the global division of labor, distorting the
domestic economy of developing nations. The dependency of developing
nations can lead to a reduce rate of economic growth, increase income
inequality inter- and intra-national, and adversely affects the
wellbeing of a nation's population. A collective cooperation between
economic countries plays a role in development policies in the poorer,
peripheral, countries of the world.
These economic factors present challenges to governments' public
health policies. If the nation's ability to raise its own revenues
is compromised, governments will lose funding for its health service
programs, including services that aim in decreasing infant mortality
rates. Peripheral countries face higher levels of vulnerability to
the possible negative effects of globalization and trade in relation
to key countries in the global market.
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, lending itself to increasing
High rates of infant mortality occur in developing countries where
financial and material resources are scarce and there is a high
tolerance to high number of infant deaths. There are circumstances
where a number of developing countries to breed a culture where
situations of infant mortality such as favoring male babies over
female babies are the norm. In developing countries such as
Brazil, infant mortality rates are commonly not recorded due to
failure to register for death certificates. Failure to register is
mainly due to the potential loss of time and money and other indirect
costs to the family. Even with resource opportunities such as the
1973 Public Registry Law 6015, which allowed free registration for
low-income families, the requirements to qualify hold back individuals
who are not contracted workers.
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."
Because of this it is making it even more difficult for the women and
newborns to get the treatment that is available to them and that is
Cultural influences and lifestyle habits in the United States can
account for some deaths in infants throughout the years. 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 babies of the non-Hispanic race. Examples of this
include teenage pregnancy, obesity, diabetes and smoking. All are
possible causes of premature births, which constitute the second
highest cause of infant mortality. Ethnic differences experienced
in the United States are accompanied by higher prevalence of
behavioral risk factors and sociodemographic challenges that each
ethnic group faces.
Historically, males have had higher infant mortality rates than
females. The difference between male and female infant mortality rates
have been 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 due to
infections, and chronic degenerative diseases. However, since 1970,
certain cultures emphasizing males has led to a decrease in the infant
mortality gap between males and females. Also, medical advances have
resulted in a growing number of male infants surviving at higher rates
than females due to the initial high infant mortality rate of
Genetic components results in newborn females being biologically
advantaged when it comes to surviving their first birthday. Males,
biologically, have lower chances of surviving infancy in comparison to
female babies. As infant mortality rates saw a decrease on a global
scale, the gender most affected by infant mortality changed from males
experiences a biological disadvantage, to females facing a societal
disadvantage. Some developing nations have social and cultural
patterns that reflects adult discrimination to favor boys over girls
for their future potential to contribute to the household production
level. A country's ethnic composition, homogeneous versus
heterogeneous, can explain social attitudes and practices.
Heterogeneous level is a strong predictor in explaining infant
Birth spacing is the time between births. Births spaced at least three
years apart from one another are associated with the lowest rate of
mortality. The longer the interval between births, the lower the risk
for having any birthing complications, and infant, childhood and
maternal mortality. Higher rates of pre-term births, and low
birth weight are associated with birth to conception intervals of less
than six months and abortion to pregnancy interval of less than six
months. Shorter intervals between births increase the chances of
chronic and general under-nutrition; 57% of women in 55 developing
countries reported birth spaces shorter than three years; 26% report
birth spacing of less than two years. Only 20% of post-partum women
report wanting another birth within two years; however, only 40% are
taking necessary steps such as family planning to achieve the birth
intervals they want.
Unplanned pregnancies and birth intervals of less than twenty-four
months are known to correlate with low birth weights and delivery
complications. Also, women who are already small in stature tend to
deliver smaller than average babies, perpetuating a cycle of being
The mother's educational attainment and literacy are correlated with
age of first pregnancy, and probability that the mother attain
prenatal and postnatal care. Mothers with a secondary education have a
higher probability of waiting until a later age to get pregnant. Once
pregnant, they are also more likely to get prenatal and postnatal
care, and deliver their child in the presence of a skilled attendant.
Women who finish at least a primary-level education have improved
nutrition, medical care, information access, and economic
independence. Infants reap benefits such as healthy environments,
improved nutrition, and medical care. Mothers with some level of
education have a higher probability to breastfeeding. The
duration of breastfeeding has the potential to influence the birth
space. Women without any educational background tend to have
children at an earlier age, thus their bodies are not yet mature
enough to carry and deliver a child.
Millennium Development Goals
Millennium Development Goals were created to improve the health and
well being of people worldwide. Its fourth goal is to decrease the
number of mortalities within the infant and childhood population by
two thirds, a decrease from 95 to 31 deaths per 1000. Countries
slow to abide by the Millennium Development Goal by 2015 are projected
to have difficulty in reaching goal four.
Reductions in infant mortality are possible in any stage of a
country's development. Rate reductions are evidence that a country
is advancing in human knowledge, social institutions and physical
capital. Governments can reduce the mortality rates by addressing the
combined need for education (such as universal primary education),
nutrition, and access to basic maternal and infant health services. A
policy focus has the potential to aid those most at risk for infant
and childhood mortality allows rural, poor and migrant
Reducing chances of babies being born at low birth weights and
contracting pneumonia can be accomplished by improving air quality.
Improving hygiene can prevent infant mortality. Home-based technology
to chlorinate, filter, and solar disinfection for organic water
pollution could reduce cases of diarrhea in children by up to
48%. Improvements in food supplies and sanitation has been
shown to work in the United States' most vulnerable populations, one
being African Americans. Overall, women's health status need to remain
Simple behavioral changes, such as hand washing with soap, can
significantly reduce the rate of infant mortality from respiratory and
diarrheal diseases. According to UNICEF, hand washing with soap
before eating and after using the toilet can save more lives of
children than any single vaccine or medical intervention, by cutting
deaths from diarrhea and acute respiratory infections.
Future problems for mothers and babies can be prevented. It is
important that women of reproductive age adopt healthy behaviors in
everyday life, such as taking folic acid, maintaining a healthy diet
and weight, being physically active, avoiding tobacco use, and
avoiding excessive alcohol and drug use. If women follow some of the
above guidelines, later complications can be prevented to help
decrease the infant mortality rates. Attending regular prenatal care
check-ups will help improve the baby's chances of being delivered in
safer conditions and surviving.
Focusing on preventing preterm and low birth weight deliveries
throughout all populations can help to eliminate cases of infant
mortality and decrease health care disparities within communities. In
the United States, these two goals have decreased infant mortality
rates on a regional population, it has yet to see further progress on
a national level.
Technological advances in medicine would decrease the infant mortality
rate and an increased access to such technologies could decrease
racial and ethnic disparities. It has been shown that technological
determinants are influenced by social determinants. Those who cannot
afford to utilize advances in medicine tend to show higher rates of
infant mortality. Technological advances has, in a way, contributed to
the social disparities observed today. Providing equal access has the
potential to decrease socioeconomic disparities in infant
mortality. Specifically, Cambodia is facing issues with a disease
that is unfortunately killing infants. The symptoms only last 24 hours
and the result is death. As stated if technological advances were
increased in countries it would make it easier to find the solution to
diseases such as this. Recently, there have been declines in the
United States that could be attributed to advances in technology.
Advancements in the
Neonatal Intensive Care Unit can be related to the
decline in infant mortality in addition to the advancement of
surfactants. However, the importance of the advancement of
technology remains unclear as the number of high-risk births increases
in the United States.
Educated females practice a healthier lifestyle. The more educated a
woman is the more likely she is to seek out care, give birth in the
presence of a skilled attendant, breastfeed, and understand the
consequences of HIV/AIDS. Improving women's health and social
status is one way to ameliorate infant mortality. Status should
rise for females seeking out education. Providing women access to
family planning centers can educate mothers on how to plan ahead for
their families. Educational means can also teach mothers on the
beneficial health practices such as breastfeeding. Government
recognizing birth space as a possible health intervention is now
working towards making affordable contraception available.
Granting women employment raises their status and autonomy. Having a
gainful employment can raise the perceived worth of females. This can
lead to an increase in the number of women getting an education and a
decrease in the number of female infanticide. In the social
modernization perspective, education leads to development. Higher
number of skilled workers means more earning and further economic
growth. According to the economic modernization perspective, this is
one type economic growth viewed as the driving force behind the
increase in development and standard of living in a country. This is
further explained by the modernization theory- economic development
promotes physical wellbeing. As economy rises, so do technological
advances and thus, medical advances in access to clean water, health
care facilities, education, and diet. These changes may decrease
Economically, governments could reduce infant mortality by building
and strengthening capacity in human resources. 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 immunized against diseases such as measles.
Increasing the number of skilled professionals is negatively
correlated with maternal, infant, and childhood mortality. Between
1960 and 2000, the infant mortality rate decreased by half as the
number of physicians increased by four folds. With the addition of
one physician to every 1000 persons in a population, infant mortality
will reduce by 30%.
In certain parts of the U.S., specific modern programs aim to reduce
levels of infant mortality. An example of one such program is the
'Healthy Me, Healthy You' program based in Northeast Texas. It intends
to identify factors that contribute to negative birth outcomes
throughout a 37-county area. An additional program that aims to
reduce infant mortality 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 U.S. 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 death.
Differences in measurement
Mortality rates, under age 5, in 2012
Infant mortality rate by region
Life expectancy at birth by region
The infant mortality rate correlates very strongly with, and is among
the best predictors of, state failure.[clarification needed] IMR
is therefore also a useful indicator of a country's level of health or
development, and is a component of the physical quality of life index.
However, the method of calculating IMR often varies widely between
countries, and is based on how they define a live birth and how many
premature infants are born in the country. Reporting of infant
mortality rates can be inconsistent, and may be understated, depending
on a nation's live birth criterion, vital registration system, and
reporting practices. The reported IMR provides one statistic which
reflects the standard of living in each nation. Changes in the infant
mortality rate reflect social and technical capacities[clarification
needed] of a nation's population. 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. This
definition is used in Austria, for example. The WHO definition is
also used in Germany, but with one slight modification: muscle
movement is not considered to be a sign of life. Many countries,
however, including certain European states (e.g. France) and Japan,
only count as live births cases where an infant breathes at birth,
which makes their reported IMR numbers somewhat lower and increases
their rates of perinatal mortality. In the Czech Republic and
Bulgaria, for instance, requirements for live birth are even
Although many countries have vital registration systems and certain
reporting practices, there are many inaccuracies, particularly in
undeveloped nations, in the statistics of the number of infants dying.
Studies have shown that comparing three information sources (official
registries, household surveys, and popular reporters) that 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 stress on
families[clarification needed], and make them take drastic
measures[clarification needed] in 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 data which provide
a nation with accurate death counts and meaningful causes of deaths
that can be measured/studied.
UNICEF uses a statistical methodology to account for reporting
differences among countries:
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.
Another challenge to comparability is the practice of counting frail
or premature infants who die before the normal due date as
miscarriages (spontaneous abortions) or those who die during or
immediately after childbirth as stillborn. Therefore, the quality of a
country's documentation of perinatal mortality can matter greatly to
the accuracy of its infant mortality statistics. This point is
reinforced by the demographer Ansley Coale, who finds dubiously high
ratios of reported stillbirths to infant deaths in Hong Kong and Japan
in the first 24 hours after birth, a pattern that is consistent with
the high recorded sex ratios at birth in those countries. It suggests
not only that many female infants who die in the first 24 hours are
misreported as stillbirths rather than infant deaths, but also that
those countries do not follow WHO recommendations for the reporting of
live births and infant deaths.
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.
Collecting the accurate statistics of infant mortality rate could be
an issue in some rural communities in developing countries. In those
communities, some other alternative methods for calculating infant
mortality rate are emerged, for example, popular death reporting and
household survey. The country-to-country variation in child
mortality rates is huge, and growing wider despite the progress. Among
the world's roughly 200 nations, only
Somalia showed no decrease in
the under-5 mortality rate over the past two decades.The lowest rate
in 2011 was in Singapore, which had 2.6 deaths of children under age 5
per 1,000 live births. The highest was in Sierra Leone, which had 185
child deaths per 1,000 births. The global rate is 51 deaths per 1,000
births. For the United States, the rate is eight per 1,000 births.
Infant mortality rate (IMR) is not only a group of statistic but
instead it is a reflection of the socioeconomic development and
effectively represents the presence of medical services in the
countries. IMR is an effective resource for the health department to
make decision on medical resources reallocation. IMR also formulates
the global health strategies and help evaluate the program success.
The existence of IMR helps solve the inadequacies of the other vital
statistic systems for global health as most of the vital statistic
systems usually neglect the infant mortality statistic number from the
poor. There are certain amounts of unrecorded infant deaths in the
rural area as they do not have information about infant mortality rate
statistic or do not have the concept about reporting early infant
Europe and America
The exclusion of any high-risk infants from the denominator or
numerator in reported IMRs can cause problems in making comparisons.
Many countries, including the United States,
Sweden and Germany, count
an infant exhibiting any sign of life as alive, no matter the month of
gestation or the size, but according to United States some other
countries differ in these practices. All of the countries named
adopted the WHO definitions in the late 1980s or early 1990s,
which are used throughout the European Union. However, in 2009,
the US CDC issued a report that stated that the American rates of
infant mortality were affected by the United States' high rates of
premature babies 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 of babies under
500 g and/or 22 weeks of gestation. However, the
differences in reporting are unlikely to be the primary explanation
for the United States' relatively low international ranking. Rather,
the report concluded that primary reason for the United States’
higher infant mortality rate when compared with Europe was the United
States’ much higher percentage of preterm births.
Regional differences in the reporting of life births.
The US National Institute of Child Health and Human Development
(NICHD) has made great strides in lowering US infant mortality
rates.[not in citation given] Since the institute was created the
US infant mortality rate has dropped 70%, in part[vague] due to their
Until the 1990s, Russia and the Soviet Union did not count, as a live
birth or as an infant death, extremely premature infants (less than
1,000 g, less than 28 weeks gestational age, or less than
35 cm in length) that were born alive (breathed, had a heartbeat,
or exhibited voluntary muscle movement) but failed to survive for at
least seven days. Although such extremely premature infants
typically accounted for only about 0.5% of all live-born children,
their exclusion from both the numerator and the denominator in the
reported IMR led to an estimated 22%–25% lower reported IMR. In
some cases, too, perhaps because hospitals or regional health
departments were held accountable for lowering the IMR in their
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.
In certain rural developing areas, such as northeastern Brazil, infant
births are often not recorded in the first place, resulting in the
discrepancies between the infant mortality rate (IMR) and the actual
amount 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 their recent suffering
from a lost child, and produce broad disclaimers in the IMR reports
that the information has not been properly reported, resulting in
these discrepancies. Little has been done to address the underlying
structural problems of the vital registry systems in respect to the
lack of reporting from parents in rural areas, and in turn has created
a gap between the official and popular meanings of child death. 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. It is not to be said that vital registry systems are not an
accurate representation of a region's socio-economic situation, but
this is only the case if these statistics are valid, which is
unfortunately not always the circumstance. "Popular death reporters"
is an alternative method for collecting and processing statistics on
infant and child mortality. Many regions may benefit from "popular
death reporters" who are culturally linked to infants may be able to
provide more accurate statistics on the incidence of infant
mortality. According to 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. By combining the
methods of household surveys, vital registries, and asking "popular
death reporters" this can increase the validity of child mortality
rates, but there are many barriers that can reflect the validity of
our statistics of infant mortality. One of these barriers are
political economic decisions. Numbers are exaggerated when
international funds are being doled out; and underestimated during
The bureaucratic separation of vital death reporting and cultural
death rituals stems in part due to structural violence.
Individuals living in rural areas of Brazil need to invest large
capital for lodging and travel in order to report infant birth to a
Brazilian Assistance League office. The negative financial aspects
deters registration, as often individuals are of lower income and
cannot afford such expenses. Similar to the lack of birth
reporting, families in rural Brazil face difficult choices based on
already existing structural arrangements when choosing to report
infant mortality. Financial constraints such as reliance on food
supplementations may also lead to skewed infant mortality data.
In developing countries such as Brazil the deaths of impoverished
infants are regularly unrecorded into the countries vital registration
system; this causes a skew statistically. Culturally validity and
contextual soundness can be used to ground the meaning of mortality
from a statistical standpoint. 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 ethnographic data that
will ultimately lead to a better portrayal of the magnitude of infant
mortality in the region. 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
World historical and predicted infant mortality rates per 1,000 births
UN, medium variant, 2008 rev.
See also: List of countries by infant mortality rate
For the world, and for both less developed countries (LDCs) and more
developed countries (MDCs), IMR declined significantly between 1960
and 2001. According to the State of the World's Mothers report by Save
the Children, the world IMR declined from 126 in 1960 to 57 in
However, IMR was, and remains, higher in LDCs. In 2001, the IMR for
LDCs (91) was about 10 times as large as it was for MDCs (8). On
average, for LDCs, the IMR is 17 times as higher than that of MDCs.
Also, while both LDCs and MDCs made significant reductions in infant
mortality rates, reductions among less developed countries are, on
average, much less than those among the more developed
A factor of about 67 separate countries with the highest and lowest
reported infant mortality rates. The top and bottom five countries by
this measure (taken from The World Factbook's 2012 estimates) are
Infant mortality rate
(deaths/1,000 live births)
Central African Republic
According to Guillot, Gerland, Pelletier and Saabneh "birth histories,
however, are subject to a number of errors, including omission of
deaths and age misreporting errors."
1906 headline imploring parents to attend to the cleanliness of their
infants, and to expose them to the "clean air" outdoors.
The infant mortality rate in the US decreased by 2.3% to a historic
low of 582 infant deaths per 100,000 live births in 2014.
Of the 27 most developed countries, the U.S. has the highest Infant
Mortality Rate, despite spending much more on health care per
capita. Significant racial and socio-economic
differences in the United States affect the IMR, in contrast with
other developed countries, which have more homogeneous populations. In
particular, IMR varies greatly by race in the US. The average IMR for
the whole country is therefore not a fair representation of the wide
variations that exist between segments of the population. 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.
In the 1850s, the infant mortality rate in the United States was
estimated at 216.8 per 1,000 babies born for whites and 340.0 per
1,000 for African Americans, but rates have significantly declined in
the West in modern times. This declining rate has been mainly due to
modern improvements in basic health care, technology, and medical
advances. In the last century, the infant mortality rate has
decreased by 93%. Overall, the rates have decreased drastically
from 20 deaths in 1970 to 6.9 deaths in 2003 (per every 1000 live
births). In 2003, the leading causes of infant mortality in the United
States were congenital anomalies, disorders related to immaturity,
SIDS, and maternal complications. Babies born with low birth weight
increased to 8.1% while cigarette smoking during pregnancy declined to
10.2%. This reflected the amount of low birth weights concluding that
12.4% of births from smokers were low birth weights compared with 7.7%
of such births from non-smokers. 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 there was a 11.73% rate of babies born before the 37th week of
gestation, down from a high of 12.80% in 2006.
Economic expenditures on labor and delivery and neonatal care are
relatively high in the United States. A conventional birth averages
9,775 USD with a C-section costing 15,041 USD. Preterm births in
the US have been estimated to cost $51,600 per child, with a total
yearly cost of $26.2 billion. Despite this spending, several
reports state that infant mortality rate in the United States is
significantly higher than in other developed nations.
Estimates vary; the CIA's World Factbook ranks the US 55th
internationally in 2014, with a rate of 6.17, while the UN figures
from 2005-2010 place the US 34th.
Aforementioned differences in measurement could play a substantial
role in the disparity between the US and other nations. A non-viable
live 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 the infant death
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 Infant Protection Act
of 2002 found universal resuscitation of infants born between 20–23
weeks increased the neonatal spending burden by $313.3 million while
simultaneously decreasing quality-adjusted life years by 329.3.
Data indicating the IMR disparity between infants Non-Hispanic black
mothers and infants of white or Hispanic mothers in the United States
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 following a decline from 13.63 to 11.46 deaths
per 1000 live births from 2005 to 2010, non-Hispanic black mothers
continued to report a rate 2.2 times as high as that for non-Hispanic
Contemporary research findings have demonstrated that nationwide
racial disparities in infant mortality are linked to the experiential
state of the mother and that these disparities cannot be totally
accounted for by socio-economic, behavioral or genetic factors.
The Hispanic paradox, an effect observed in other health indicators,
appears in the infant mortality rate, as well. Hispanic mothers see an
IMR comparable to non-Hispanic white mothers, despite lower
educational attainment and economic status. 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." According to Mustillo's 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." 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."
While earlier parts of this article have addressed the racial
differences in infant deaths, a closer look into the effects of racial
differences within the country is necessary to view discrepancies.
Non-Hispanic Black women lead all other racial groups in IMR with a
rate of 11.3, while the Infant Mortality Rate among white women is
5.1. Black women in the United States experience a shorter life
expectancy than white women, so while a higher IMR amongst black women
is not necessarily out of line, it is still rather disturbing.
While the popular argument leads to the idea that due to the trend of
a lower socio-economic status had by black women there is in an
increased likelihood of a child suffering. While this does correlate,
the theory that it is the contributing factor falls apart when we look
at Latino IMR in the United States. Latino people are almost just 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 Rates of blacks and Latinos are 24.1%
and 21.4% respectively. 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. Also, as black women 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
Some believe black women are predisposed to a higher IMR, meaning
ancestrally speaking, all black women from African descent should
experience an elevated rate. This theory is quickly disproven by
looking at women of African descent who have immigrated to the United
States. These women who come from a completely different social
context are not prone to the incredibly high IMR experienced by
American-born black women.
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 claims African American women experience
stress at much higher rates than any other group in the country.
Stress produces particular hormones that induce labor and contribute
to other pregnancy problems. Considering early births are one of the
leading causes of death of infants under the age of one, induced labor
is a very legitimate factor. The idea of stress spans socio-economic
status as Parker Dominguez claims stress for lower-class women comes
from unstable family life and chronic worry over poverty. For black
middle-class women, battling racism, real or perceived, can be an
Arline Geronimus, a professor at the University of Michigan School of
Public Health calls the phenomenon "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
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 in particular 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.
This section needs expansion. You can help by adding to it. (October
The leading causes of infant mortality have changed over time.
Unpasteurized milk was the leading cause of infant mortality late in
the 19th century. Pasteurization of milk cut infant mortality by
List of countries by infant mortality rate
Related statistical categories:
Perinatal mortality only includes deaths between the foetal 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 within the first five years after
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