Infant mortality is divided into neonatal deaths, those occurring less than 28 days after birth, and postneonatal, infants who survive the first 28 days but die before they reach their first year. More than two-thirds of infant deaths (18,728 in 1999) are neonatal. Most neonatal deaths are associated with (1) low birth weight, (2) congenital malformation, deformations, and chromosomal abnormalities, (3) conditions caused by complications in the mother's pregnancy, (4) respiratory distress, and (5) by complications of placenta, cord, and membranes. Such causes account for more than 62% of all neonatal deaths.
One third of infant deaths (9,209 in 1999) were postneonatal. The leading cause of death was sudden infant death syndrome (SIDS) followed by congenital malformations, deformations, and chromosomal abnormalities. The third cause was accidents.
Male infants have a higher death rate than female — as men have a lower life expectancy, generally, than women.
Data by race for all races and groups were not available in detail for 1999 as of this writing. Data that follow are for 1998, except as indicated. The highest rates experienced are by African Americans (13.9 per 1,000 live births, 14.6 in 1999), the lowest by Asians and Pacific Islanders (5.5); the lowest rates in 1999 mentioned by the Centers for Disease Control were for Chinese infants (2.9) and for Japanese infants (3.4). White non-Hispanics had a rate of 6.0 (5.8% in 1999). People of Hispanic origin were slightly lower than whites (5.8 vs. 6%). American Indians and Alaskan Natives had a 9.3% infant mortality rate in 1998.
While the subject here is mortality, the good news is that the trend in infant deaths is down — from 12.6 per 1,000 live births in 1980 to 7.1 twenty years later. This is a good sign. As a CDC article states, "infant mortality is one of the most widely used general indices of health in the United States and other countries."8 A low infant mortality rate indicates that healthy, well-fed mothers brought more children to full term, that the children had a normal weight at birth, that the mother received prenatal care and education, that she did not smoke or indulge in alcohol and drugs, that the infant was breastfed after birth and received appropriate medical care, that complications, if present, were detected early and treated with modern interventions — because the mother had access to proper medical care. The CDC is certainly very active in its efforts to bring about this happy state. At the time when the article cited was written (1991), the infant mortality rate was 8.9 and the goal was to achieve a rate of no more than 7 per 1,000 live births. In 1999, that goal had been almost achieved.
A look further back, to 1940, illustrates just how far we have come. In that year, the white infant mortality rate was 43.2 and the black rate 72.9. Whatever else may be said about the U.S. healthcare system, it seems to work.
The differences between blacks and whites, however, continue to be great. The black rate in 1999 was more than twice that of the overall rate and 2.5 times the white rate — despite a downward trend overall. The gap, observed before in these pages, is not fully explained by the lower average household income of blacks but points as well to other factors. In 1999, black median household income was $27,910, that of Hispanics $30,735. Yet the Hispanic rate was just slightly lower than the white infant mortality rate as already mentioned above. White income was $42,504.
We conclude this series by a closer look at SIDS — crib deaths — which illustrate the CDC's — and state health departments' — efforts to lower infant mortality — even in an absence of clear knowledge.
Sources: Centers for Disease Control and Prevention. National Vital Statistics Report. v. 49, nos. 8 and 11. 21 September 2001 and 12 October 2001.
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