The XX Factor

The U.S. Infant Mortality Rate Is Falling, But Still Worse Than Peer Nations

There is still a wide racial disparity in infant mortality.


The U.S.’s relatively high infant mortality rate is one of the darkest stains on the nation’s public-health record. Compared to babies in other wealthy nations, infants in the U.S. are far less likely to make it to their first birthdays—in 2010, a U.S. baby was more than twice as likely to die in its first year than a baby in Norway, the Czech Republic, Portugal, and Japan.

But new data released Tuesday by the Centers for Disease Control and Prevention shows that the U.S. infant mortality rate has fallen 15 percent in the past decade, a promising signal that improvements in health-care policies and access are making an impact. Between 2005 and 2014, the rate decreased from 6.86 to 5.82 infant deaths per 1,000 live births, a decrease of 15 percent.

That still puts the U.S. above the 2010 rates of Europe and developed nations around the world, but a 15 percent decline is no small achievement. Two-thirds of U.S. states and Washington, D.C. saw their rates go down in the period of the CDC’s analysis, including many in the Southeast, and no states saw a statistically significant increase in their rates. Some states, including South Carolina, Vermont, Connecticut, and Colorado, saw their infant mortality rates fall more than 20 percent in the past 10 years. D.C.’s rate dropped nearly 50 percent in that time period, but that may have more to do with rapidly shifting urban demographics than any major overhaul of pre- and post-natal health care.

STAT reports that Vermont tackled infant mortality by providing new parents with at-home nurse visits, educating patients on the dangers of sleeping with their infants, and getting doctors to dissuade patients from scheduling their births before the 39th week of pregnancy. South Carolina cut its rate of women scheduling early deliveries by ceasing Medicaid reimbursements for births scheduled before the end of the full 40-week term, incentivizing women on Medicaid to wait it out. The state also improved contraceptive access for women who’ve had children, because planned pregnancies beget healthier babies. Before 2013, South Carolina didn’t even have an insurance billing code for an implant or intrauterine device administered while the patient was admitted to a hospital. Now, more women have the option of getting an ultra-reliable form of contraception while they’re already in a doctor’s care, just after giving birth.

Despite initiatives and interventions like these, the most troubling aspect of the U.S.’s infant mortality data remains: a wide racial disparity that finds babies born to non-Hispanic black women more than twice as likely to die in their first year as those born to non-Hispanic white women. And in the past decade, while nearly all racial groups saw declines in infant mortality, American Indians and Alaska Natives saw no significant change. A web of social and economic barriers maintain these disparities; better maternal and infant care can only improve infant survival rates so much. When mothers have lived for decades with inadequate access to health care and suffered the health consequences of structural inequities such as food deserts and environmental injustice, as mothers of color disproportionately do, they are far more likely to give birth to low-weight or pre-term babies, who are less likely to survive.

There is no straightforward solution for high rates of infant mortality, because its contributing factors are numerous and tightly intertwined—that’s why policymakers use the rate as one marker for a nation’s health as a whole. But the U.S. did take a big step toward mitigating the racial and economic health disparities reflected in the infant mortality rate with the Affordable Care Act. Before the ACA, most individual insurance policies didn’t cover maternity care; the ACA mandated that coverage. It also guaranteed coverage for contraception and preventive care with no out-of-pocket costs to the patient, making it easier for women to maintain their health and have children when they want to and can afford them. Between 2013 and 2015, the first two full years that the ACA was in effect, the uninsured rate among women of reproductive age fell by more than a third, giving millions of women and their potential children access to consistent care for what might have been the first time.

It’s impossible to measure any direct effect the ACA has had on U.S. infant mortality rates, and some positive effects may not appear for years down the line, when young adults who have better health care start to have kids of their own. However, babies do stand a better chance of survival when their mothers visit medical professionals while pregnant, and pregnant women are more likely to make prenatal doctor’s appointments if those appointments are covered by insurance. Funny, then, that members of the party that believes fertilized eggs are full-blown human beings have advocated so strongly against mandatory maternity-care coverage, which could help those fertilized eggs live past their first birthday outside the womb. With such arguments as “Why would you force someone to pay for something they’re not going to use?”, “has a man ever delivered a baby?”, and “I don’t need maternity care,” Republican legislators have made the case that maternity care should not be on the federal government’s mandatory coverage list because men don’t need it. But men, who can happily move through life with a little less health insurance, were once boys, and those boys were once infants. Good maternity care isn’t just for mothers—it’s for everyone.