From 2021 to 2022, the infant mortality rate – or the death of a child before his or her first birthday – increased by 3% in the United States. Sadly, even before this increase, infant mortality in the United States has been a problem, says Uzma Shah, M.D., chair of pediatrics at Henry Ford Health.
“It’s alarming,” says Dr. Shah. “Reducing infant mortality is one of our main goals. It was last year, it is this year and it will be next year because we understand the changes needed to achieve this are difficult and comprehensive.”
Here, Dr. Shah shares three underlying factors that contribute to infant mortality.
1. Not receiving appropriate prenatal care.
“It’s incredibly important to be regularly seen by an obstetrician to anticipate and manage maternal or fetal problems,” says Dr. Shah. “If someone is receiving appropriate prenatal care, the chances are high that the infant will do well.”
Infant health is strongly tied to maternal health. If left unchecked, maternal conditions that can arise during pregnancy – like gestational diabetes and preeclampsia (or high blood pressure) – can be harmful to both mom and baby. “Uncontrolled diabetes can lead to several complications, one of which includes heart defects in an infant,” says D’Angela Pitts, M.D., a maternal fetal medicine specialist at Henry Ford Health. Preeclampsia can lead to preterm birth, which increases the risk for a host of infant health issues. From 2021 – 2022, infant deaths due to preeclampsia or preterm delivery increased by 8%.
That said, many pregnant people aren’t able to receive appropriate prenatal care. “Some people can’t take time from work for prenatal visits,” says Dr. Pitts. “Others don’t have transportation to and from appointments. It comes down to social determinants of health, or factors such as someone’s economic stability, education access and healthcare access.”
Another factor that may play into infant mortality is unconscious bias. While Black infant mortality rates didn’t substantially increase from 2021 - 2022, Black infants still have the highest rates of infant mortality – more than double that of white infants.
“Every provider is now required to do implicit bias training, but if an obstetrician isn’t taking a patient’s concerns seriously – or if they’re listening to one group over another – they could be sending a patient home when really they’re at high risk for preeclampsia,” says Dr. Pitts. “Diversity is also important. For example, a provider might not know what a rash looks like in a Middle Eastern or Black person. Diversifying the workplace helps with that.”
2. Receiving inadequate care at the time of delivery.
Those who don’t receive appropriate prenatal care may be less likely to have proper support during labor, which can be especially dangerous for high-risk pregnancies and for those who experience unanticipated complications.
They might live in a maternity care desert, or a county without a hospital or birth center offering obstetric care. The March of Dimes reports that more than 2.2 million women of childbearing age in the United States live in a maternity care desert and around 150,000 babies are born each year in a maternity care desert. Black and Native American people are more likely to live in a maternity care desert – and from 2021 to 2022, the infant mortality rate for Native American and Alaska Native infants rose by more than 20%.
3. A lack of education and care after birth.
From 2021 – 2022, the post-neonatal mortality rate – or the mortality rate for infants who survived more than 28 days after birth – increased by 4%. Having the proper infant education when taking baby home is so important for their health and wellbeing.
For example: avoiding substance abuse, abstaining from smoking, knowing how to breastfeed and practicing safe sleep all lower the risk of infant mortality. Unsafe sleep – and exposure to secondhand smoke – cause sudden infant death syndrome (SIDS). It’s also crucial to attend regular pediatric appointments to track baby’s health and growth.
But mom should also see a doctor after birth – especially as undiagnosed postpartum depression may play a role in post-neonatal mortality. “If postpartum depression goes untreated, someone may not be able to adequately care for their child, or they might make dangerous mistakes that increase the risk of infant mortality,” says Dr. Pitts. “The infant mortality crisis is linked to the maternal health crisis – and it’s really a public health crisis. I have patients who deliver and have to go right back to work or they’ll lose their job. They can’t take maternity leave and they can’t attend doctor’s appointments after birth.”
Increasing Support To Reduce The Infant Mortality Rate
If you struggle to attend prenatal or pediatric visits, ask your hospital how they can help you. At Henry Ford Health, social determinants of health screenings are included in maternal health and pediatric appointments.
“If you identify as needing help, one of our nurse navigators will assist you with social services, including facilitating transportation to and from appointments,” says Dr. Pitts. And in pediatrics, Dr. Shah adds: “We are working with Population Health – as well as with our community initiative – to address social determinants of health by providing increased access, opportunities and awareness for our patients and the surrounding community.”
Taking advantage of a doula – or someone who is trained to advocate for and educate a pregnant person – can also be incredibly beneficial. Thankfully, Medicaid has started providing doula coverage.
“This is super important because people can’t always afford a doula,” says Dr. Pitts. “We are starting a new program at Henry Ford Health that will connect doulas to patients to ensure access to advocates in pregnancy. During prenatal visits with your obstetrician, you might not get enough time to talk to your doctor about how to breastfeed, how to prepare the nursery, what you should do for healthy living. A doula can offer that education. Or sometimes, patients have questions but get shy at their prenatal appointments. Your doula can attend these appointments and remind you what to ask. Doulas can be a great source of support and guidance throughout your pregnancy and during your child’s birth.”
Reviewed by Uzma Shah, M.D., FAAP, FAASLD, chair of pediatrics at Henry Ford Health, and D’Angela Pitts, M.D., a maternal fetal medicine specialist who sees patients at Henry Ford Medical Center – New Center One, Henry Ford Medical Center – Ford Road and Henry Ford West Bloomfield Hospital.
