"Infant mortality rate." The phrase alone conjures up unpleasant feelings, and looking into the subject any deeper can be pretty unsettling. No one wants to talk about babies who have died, and for good reason. And that reluctance to talk about and investigate the deaths of newborns perpetuates a dangerous epidemic: in the United States, there are still a lot of states with incredibly high infant mortality rates, and it's a problem that doesn't appear to be improving anytime soon.
In fact, in some states, the infant mortality rate has actually increased, and that's a problem. For example, the rate of 9.1 infant deaths per 1,000 live births in 2016 in Alabama is the highest since 2008, according to the Alabama Department of Public Health.
And the numbers are worse for some populations than for others. State health officials in Alabama said the mortality rate for black infants was more than twice that of white infants, and that's extremely troubling. In one part of Ohio, residents seem to have a similar issue. In the Summit County area, infant mortality statistics are among the highest in the state, and "African-Americans are the majority of those affected," according to Cleveland.com.
So which states have the highest infant mortality rates, and why? Many of them lack quality care for low-income pregnant people before and after child birth, or lack educational materials for new moms about safe sleeping positions. There are actually a few ways experts think it's possible to turn the numbers around.
Louisiana is number five for infant mortality rates by state, according to data from the Centers for Disease Control and Prevention from 2015. The Annie E. Casey Foundation, which looks at the well-being of children in the United States, similarly ranked it at 46th out of all 50 states on its list in 2015.
Louisiana Department of Health Secretary Rebekah Gee told The Advocate that increased access to health care for thousands of people in Louisiana — thanks in part to the Medicaid expansion that was part of the Affordable Care Act — should lead to more healthy babies in the future.
The good news is, the state has made strides to improve its numbers in recent years. Gee noted that expanded education about safe sleeping habits for babies, and the administration of a drug to women who've previously had premature births that might help reduce their chance at having another one, have helped contribute to a decline in the state's infant mortality rates.
Georgia ranks number four on the CDC's infant mortality rates list. At a rate of 7.8 per 1000 births, it ranks 47th on the Casey Foundation list for children's well-being as well. Between 2007- 2011, Georgia’s infant mortality rate was 7.3 deaths per 1000 live births, according to the Georgia Department of Public Health.
However, Georgia "has had perhaps the largest improvement in the past decade" when it comes to infant mortality rates, according to The New York Times.
The state reportedly began a Safe to Sleep campaign to educate parents about safe sleep habits for babies, introduced a program to increase access to long-acting reversible contraception, and worked to decrease early elective deliveries — which can increase the risks of "feeding, breathing and developmental problems." Georgia may be higher on the list right now, but the state is working hard to change that.
As previously mentioned, Alabama is pretty high on the list of states with high infant mortality rates. The CDC listed a rate of 8.3 per 1,000 births in 2015. However, in a news release on Thursday, the Alabama Department of Public Health said the rate had reached 9.1 infant deaths per 1,000 live births in 2016. That's an extremely troubling jump, if they're using the exact same data and methodology as the CDC.
State Health Officer Dr. Scott Harris told WRAL the state plans to use strategies like reducing tobacco use in women of childbearing age and encouraging women to hold off at least 18 months between giving birth and becoming pregnant again to reduce the numbers. What's troubling about that particular solution is that it seems to rely solely on women to make lifestyle changes. In addition to "encouraging "women not to become pregnant again too quickly, will they be given better, more affordable access to contraception to assist with that goal? If not, that's obviously a serious problem.
Additionally, reducing the total number of infants born wouldn't reduce the number of infant deaths because of better health practices; infant mortality rates would just go down because there'd be fewer babies born. The important part here is reducing the number of infant deaths per 1,000 live births, which seems to require a change in Alabama's delivery processes, and health care for mothers and babies before birth and in the year following.
Instead of just telling women to avoid pregnancy, Alabama could look to areas that have improved their infant mortality rates for solutions. In the District of Columbia, for example, the state expanded a home-visit program for poor pregnant women, and increased other efforts to keep moms and their babies healthy. After doing that, it saw a big drop in infant mortality rates — from 14.05 deaths per 1,000 births in 2005 to 7.86 in 2010, according to The New York Times.
Alabama will reportedly also continue safe sleep education efforts, the way other states have done to improve infant mortality rates in recent years.
The state of Delaware is second on the list for worst states for infant mortality rates, according to the CDC. At 9.0 deaths per 1,000 live births, the numbers in this East Coast state are definitely high.
Back in 2005, the Governor’s Infant Mortality Task Force released a report on Delaware’s high infant mortality rate that included 20 recommendations to reduce the number of babies in the state who die before their first birthday, according to the Delaware Department of Health and Social Services. It also set out to "eliminate the racial disparity in the rate at which these babies die," showing that the state recognized that infant mortality rates differ by race and ethnicity.
High-quality prenatal care, expanded access to health care, and funding and support for initiatives to better understand the infant mortality rates in Delaware were among some of the solutions the task force recommended. More recently, the state suggested continuing its home visiting programs for high-risk mothers to further reduce the state's infant mortality rate.
Topping the list for infant mortality rates in the U.S. is Mississippi. Mississippi’s infant mortality rate is on par with Botswana and Bahrain, according to The New York Times. With 9.3 deaths per 1,000 live births, the state's infant mortality rate is very high, and very troubling.
In 2014, Mississippi had the highest percentage of preterm births in addition to the highest infant mortality rate in the country, according to The Hechinger Report, which looks at inequality and innovation in education. That outlet suggested that the state use home-visiting programs that can help with parenting skills, and offer information about breastfeeding, nutrition, and safe sleep habits, can help struggling mothers and babies.
In 2015, State Health Officer Dr. Mary Currier told members of the House Appropriations Committee that the state needed $1.5 million for an infant mortality initiative, according to The Clarion-Ledger. That money was to be put towards improving health in mothers before pregnancy, reducing "non-medically indicated deliveries" prior to 39 weeks’ gestation, and to encourage mothers to have their babies sleep alone in a crib, on their backs, in smoke-free environments, among other strategies.
No matter where you live, everyone should want the infant mortality rates in this country to go down. Infant mortality initiatives are a good start, and most communities likely have outreach programs to help mothers in their area. If you're curious how you can help, contact your state's health department.