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Infant mortality is the death of an infant less than 1 year old. It is commonly described by the infant mortality rate (IMR), which is calculated by dividing the number of newborns dying at under a year of age by the number of live births during the year within a population. Analysts can use such data to compare the health and well-being of people across and within countries. The health status of infants in a society is a gauge of the overall health of the population and is an important predictor of the next generation's health. The significance of infant mortality to public health and epidemiology is that the rate can determine how successful a population is in preventive health measures for pregnant women, the access to and quality of prenatal care, and rate of immunization in a community.

Historically, infant mortality was responsible for the deaths of a significant percentage of children born around the world, and the death of an infant before his or her first birthday was a common occurrence. However, since the 20th century, improvements in basic health care, sanitation, and living conditions have led to a significant decline of IMRs in the West.

Major causes of U.S. infant mortality include congenital abnormalities, preterm/low birth weight, pregnancy-related problems, respiratory distress syndrome, and sudden infant death syndrome (SIDS). The dramatic decrease in the U.S. IMR during the 20th century primarily reflected fewer babies dying from pneumonia and influenza, prematurity, and low birth weight as a result of better, more available technology and medicine. However, among developed countries, the United States has the second worst newborn mortality rate. The poor IMR in the United States is due to substantial disparities in race/ethnicity, education, income, and health within the population. Overall, not all U.S. racial and ethnic groups have benefited equally from the long-term downward trend in infant mortality.

In the United States, prematurity/low birth weight (less than 5.5 pounds at birth) is one of the major determinants of infant mortality and has been the leading cause of death for black infants for more than a decade. In New York City, for example, infants born to black non-Hispanic mothers have an IMR more than twice the rate of those born to white non-Hispanic mothers. This difference is especially stark in communities with a high percentage of black residents. The factors that contribute to these disparities are difficult to isolate as they interact with each other, but some areas studied include the overall health of the mother, socioeconomic status, and social stressors. The stress of marginalization associated with racism has been investigated as a cause of poorer health among minorities. It is probable that these stressors can have an effect on women before conception as well as during pregnancy, which may contribute to poor birth outcomes. There are also disparities between whites and other ethnic groups. For example, compared with non-Hispanic whites, SIDS deaths among American Indian and Alaska Natives are 2.3 times greater. U.S. efforts to decrease infant mortality across ethnic groups focus not only on the individual behaviors of women but also on the communities in which they live, their economic standing, and their social status, since many factors can affect pregnant women and the health of their babies.

Bibliography:

1) Mullings, Leith and Alaka Wali. 2001. Stress and Resilience: The Social Context of Reproduction in Central Harlem. New York: Kluwer Academic/Plenum.

2) Save the Children. 2006. "State of the World's Mothers 2006: Saving the Lives of Mothers and Newborns." Westport, CT: Save the Children.

3) Singh, G. K. and S. M. Yu. 1995. "Infant Mortality in the United States: Trends, Differentials, and Projections, 1950 through 2010." American Journal of Public Health 85:957-64.

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