Infant mortality

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Infant mortality rates, under age 1, in 2013

Infant mortality refers to deaths of young children, typically those less than one year of age. It is measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births.

The leading causes of infant mortality are birth asphyxia, pneumonia, term birth complications[clarification needed], neonatal infection, diarrhea, malaria, measles and malnutrition.[1] Many factors contribute to infant mortality, such as the mother's level of education, environmental conditions, and political and medical infrastructure.[citation needed] Improving sanitation, access to clean drinking water, immunization against infectious diseases, and other public health measures can help reduce high rates of infant mortality.

Child mortality is the death of a child before the child's fifth birthday, measured as the Under-5 Child Mortality Rate (U5MR). National statistics sometimes group these two mortality rates together. Globally, ten million infants and children die each year before their fifth birthday; 99% of these deaths occur in developing nations.[citation needed]

Infant mortality rate was an indicator used to monitor progress towards the Fourth Goal of the Millennium Development Goals of the United Nations for the year 2015. It is now a target in the Sustainable Development Goals for Goal Number 3 ("Ensure healthy lives and promote well-being for all at all ages").[2]



Forms of infant mortality:



Leading causes of congenital infant mortality are malformations, sudden infant death syndrome, maternal complications during pregnancy, and accidents and unintentional injuries.[5] Environmental and social barriers prevent access to basic medical resources and thus contribute to an increasing infant mortality rate; 99% of infant deaths occur in developing countries, and 86% of these deaths are due to infections, premature births, complications during delivery, and perinatal asphyxia and birth injuries.[3] Greatest percentage reduction of infant mortality occurs in countries that already have low rates of infant mortality.[6] Common causes are preventable with low-cost measures. In the United States, a primary determinant of infant mortality risk is infant birth weight with lower birth weights increasing the risk of infant mortality. The determinants of low birth weight include socio-economic, psychological, behavioral and environmental factors.[7]


Causes of infant mortality that are related to medical conditions include: low birth weight, sudden infant death syndrome, malnutrition and infectious diseases, including neglected tropical diseases.

Low birth weight[edit]

Main article: Low birth weight


According to the New England Journal of Medicine, "in the past two decades, the infant mortality rate (deaths under one year of age per thousand live births) in the United States has declined sharply." Low birth weights from African American mothers remain twice as high as that of white women. LBW may be the leading cause of infant deaths, and it is greatly preventable. Although it is preventable, the solutions may not be the easiest but effective programs to help prevent LBW are a combination of health care, education, environment, mental modification and public policy, influencing a culture supporting lifestyle.[9] Preterm birth is the leading cause of newborn deaths worldwide.[10] Even though America excels past many other countries in the care and saving of premature infants, the percentage of American woman who deliver prematurely is comparable to those in developing countries. Reasons for this include teenage pregnancy, increase in pregnant mothers over the age of thirty-five, increase in the use of in-vitro fertilization which increases the risk of multiple births, obesity and diabetes. Also, women who do not have access to health care are less likely to visit a doctor, therefore increasing their risk of delivering prematurely.[11]

Sudden infant death syndrome[edit]

Thousands of infant deaths per year are classified as Sudden infant death syndrome (SIDS). According to the Mayo Clinic, SIDS is the unexplained death, usually during sleep, of a seemingly healthy baby. Although the direct cause of SIDS remains unknown, many doctors believe that there are several factors that put babies at an increased risk of SIDS, including: babies sleeping on their stomachs, exposure to cigarette smoke in the womb or after birth, sleeping in bed with parents, premature birth, being a twin or triplet, being born to a teen mother, and also living in poverty settings. Although the cause is unknown and currently cannot be explained, doctors have come to the conclusion that SIDS is most likely to occur between 2 and 4 months and most deaths occur in the winter time. Recommended precautions include ensuring that infants sleep on their backs, controlling the temperature of the bedroom, employing a crib without toys or excess bedding, and breastfeeding.[12]


Malnutrition frequently accompanies these[which?] diseases, and is a primary factor contributing to the complications of both diarrhea and pneumonia, although the causal links and mechanisms remain unclear. Factors other nutrition also influence the incidence of diarrhea, including socioeconomic status, disruption of traditional lifestyles, access to clean water and sanitation facilities, age and breastfeeding status.

Protein energy malnutrition and micronutrient deficiency are two reasons for stunted growth in children under five years old in the least developed countries. Malnutrition leads to diarrhea and dehydration, and ultimately death. Millions of women in developing countries are stunted due to a history of childhood malnutrition. Women's bodies are thus underdeveloped, and their chances of surviving childbirth decrease. Due to underdeveloped bodies, the probability of an obstructed pregnancy increases. Protein-energy deficiency results in low-quality breastmilk that provides less energy and other nutrition.[3]

Vitamin A deficiency can lead to stunted growth, blindness, and increased mortality due to the lack of nutrients in the body. Two hundred and fifty million infants are affected by Vitamin A deficiency. Among women in developing countries, 40% have iron deficiency anemia, which increases maternal and infant mortality rates, chances of stillbirth, cases of low birth weight babies, premature delivery, and probability of fetal brain damage.[3] One way to prevent Vitamin A deficiency is to educate the mother on the many benefits of breastfeeding. Breastmilk is a natural source of Vitamin A, and supplies the suckling infant with enough Vitamin A.[13]

Infectious diseases[edit]


Seven out of ten childhood deaths are due to infectious diseases: acute respiratory infection, diarrhea, measles, and malaria. Acute respiratory infection such as pneumonia, bronchitis, and bronchiolitis account for 30% of childhood deaths; 95% of pneumonia cases occur in the developing world. Diarrhea is the second-largest cause of childhood mortality in the world, while malaria causes 11% of childhood deaths. Measles is the fifth-largest cause of childhood mortality.[3][15] Folic acid for mothers is one way to combat iron deficiency. A few public health measures used to lower levels of iron deficiency anemia include iodize salt or drinking water, and include vitamin A and multivitamin supplements into a mother's diet.[3] A deficiency of this vitamin causes certain types of anemia (low red blood cell count).[16]


Infant mortality rate can be a measure of a nation's health and social condition.[8][17] It is a composite of a number of component rates which have their separate relationship with various social factors and can often be seen as an indicator to measure the level of socioeconomic disparity within a country.[17]

Organic water pollution is a better indicator of infant mortality than health expenditures per capita. Water contaminated with various pathogens houses a host of parasitic and microbial infections. Infectious disease and parasites are carried via water pollution from animal wastes.[18] Areas of low socioeconomic status are more prone to inadequate plumbing infrastructure, and poorly maintained facilities.[3] The burning of inefficient fuels doubles the rate of children under 5 years old with acute respiratory tract infections.[3] Climate and geography often play a role in sanitation conditions. For example, the inaccessibility of clean water exacerbates poor sanitation conditions.[18]




Socio-economic factors[edit]

Social class is a major factor in infant mortality, both historically and today. Between 1912 and 1915, the Children's Bureau in the United States examined data across eight cities and nearly 23,000 live births. They discovered that lower incomes tend to correlate with higher infant mortality. In cases where the father had no income, the rate of infant mortality was 357% more than that for the highest income earners ($1,250+). Differences between races were also apparent. African-American mothers experience infant mortality at a rate 44% higher than average;[23] however, research indicates that socio-economic factors do not totally account for the racial disparities in infant mortality.[7]

While infant mortality is normally negatively correlated with GDP, there may indeed be some opposing short-term effects from a recession. A recent study by The Economist showed that economic slowdowns reduce the amount of air pollution, which results in a lower infant mortality rate. In the late 1970s and early 1980s, the recession's impact on air quality is estimated to have saved around 1,300 US babies.[24] It is only during deep recessions that infant mortality increases. According to Norbert Schady and Marc-François Smitz, recessions when GDP per capita drops by 15% or more increase infant mortality.[25]

Social class dictates which medical services are available to an individual. Disparities due to socioeconomic factors have been exacerbated by advances in medical technology. Developed countries, most notably the United States, have seen a divergence between those living in poverty who cannot afford medical advanced resources, leading to an increased chance of infant mortality, and others.[17]


In policy, there is a lag time between realization of a problem's possible solution and actual implementation of policy solutions.[clarification needed][26] Infant mortality rates correlate with war, political unrest, and government corruption.[3]

In most cases, war-affected areas will experience a significant increase in infant mortality rates. Having a war taking place where a woman is planning on having a baby is not only stressful on the mother and fetus, but also has several detrimental effects.


Many developing countries rely on foreign aid for basic nutrition. Transport of aid becomes significantly more difficult in times of war. In most situations the average weight of a population will drop substantially.[28] Expecting mothers are affected even more by lack of access to food and water. During the Yugoslav Wars in Bosnia the number of premature babies born increased and the average birth weight decreased.[27]


Medicine and biology[edit]

Developing countries have a lack of access to affordable and professional health care resources, and skilled personnel during deliveries.[3][26] Countries with histories of extreme poverty also have a pattern of epidemics, endemic infectious diseases, and low levels of access to maternal and child healthcare.[33]




Levels of socioeconomic development and global integration are inversely related to a nation's infant mortality rate.[3][35] Dependency perspective occurs in a global capital system. A nation's internal impact is highly influenced by its position in the global economy and has adverse effects on the survival of children in developing countries.[18] Countries can experience disproportionate effects from its trade and stratification within the global system.[36] It aids in the global division of labor, distorting the domestic economy of developing nations. The dependency of developing nations can lead to a reduce rate of economic growth, increase income inequality inter- and intra-national, and adversely affects the wellbeing of a nation's population. A collective cooperation between economic countries plays a role in development policies in the poorer, peripheral, countries of the world.[33]

These economic factors present challenges to governments' public health policies.[18] If the nation's ability to raise its own revenues is compromised, governments will lose funding for its health service programs, including services that aim in decreasing infant mortality rates.[33] Peripheral countries face higher levels of vulnerability to the possible negative effects of globalization and trade in relation to key countries in the global market.[18]



High rates of infant mortality occur in developing countries where financial and material resources are scarce and there is a high tolerance to high number of infant deaths. There are circumstances where a number of developing countries to breed a culture where situations of infant mortality such as favoring male babies over female babies are the norm.[3] In developing countries such as Brazil, infant mortality rates are commonly not recorded due to failure to register for death certificates.[37] Failure to register is mainly due to the potential loss of time and money and other indirect costs to the family.[37] Even with resource opportunities such as the 1973 Public Registry Law 6015, which allowed free registration for low-income families, the requirements to qualify hold back individuals who are not contracted workers.[37]

Another cultural reason for infant mortality, such as what is happening in Ghana, is that "besides the obvious, like rutted roads, there are prejudices against wives or newborns leaving the house." [38] Because of this it is making it even more difficult for the women and newborns to get the treatment that is available to them and that is needed.

Cultural influences and lifestyle habits in the United States can account for some deaths in infants throughout the years. According to the Journal of the American Medical Association "the post neonatal mortality risk (28 to 364 days) was highest among continental Puerto Ricans" compared to babies of the non-Hispanic race. Examples of this include teenage pregnancy, obesity, diabetes and smoking. All are possible causes of premature births, which constitute the second highest cause of infant mortality.[11] Ethnic differences experienced in the United States are accompanied by higher prevalence of behavioral risk factors and sociodemographic challenges that each ethnic group faces.[8]

Gender favoritism[edit]


Genetic components results in newborn females being biologically advantaged when it comes to surviving their first birthday. Males, biologically, have lower chances of surviving infancy in comparison to female babies. As infant mortality rates saw a decrease on a global scale, the gender most affected by infant mortality changed from males experiences a biological disadvantage, to females facing a societal disadvantage.[39] Some developing nations have social and cultural patterns that reflects adult discrimination to favor boys over girls for their future potential to contribute to the household production level. A country's ethnic composition, homogeneous versus heterogeneous, can explain social attitudes and practices. Heterogeneous level is a strong predictor in explaining infant mortality.[35]

Birth spacing[edit]




The mother's educational attainment and literacy are correlated with age of first pregnancy, and probability that the mother attain prenatal and postnatal care. Mothers with a secondary education have a higher probability of waiting until a later age to get pregnant. Once pregnant, they are also more likely to get prenatal and postnatal care, and deliver their child in the presence of a skilled attendant. Women who finish at least a primary-level education have improved nutrition, medical care, information access, and economic independence. Infants reap benefits such as healthy environments, improved nutrition, and medical care. Mothers with some level of education have a higher probability to breastfeeding.[3][18][35] The duration of breastfeeding has the potential to influence the birth space.[40] Women without any educational background tend to have children at an earlier age, thus their bodies are not yet mature enough to carry and deliver a child.[3]


Millennium Development Goals were created to improve the health and well being of people worldwide. Its fourth goal is to decrease the number of mortalities within the infant and childhood population by two thirds, a decrease from 95 to 31 deaths per 1000.[3] Countries slow to abide by the Millennium Development Goal by 2015 are projected to have difficulty in reaching goal four.[26]

Public health[edit]


Reducing chances of babies being born at low birth weights and contracting pneumonia can be accomplished by improving air quality. Improving hygiene can prevent infant mortality. Home-based technology to chlorinate, filter, and solar disinfection for organic water pollution could reduce cases of diarrhea in children by up to 48%.[3][15][18] Improvements in food supplies and sanitation has been shown to work in the United States' most vulnerable populations, one being African Americans. Overall, women's health status need to remain high.[17]

Simple behavioral changes, such as hand washing with soap, can significantly reduce the rate of infant mortality from respiratory and diarrheal diseases.[41] According to UNICEF, hand washing with soap before eating and after using the toilet can save more lives of children than any single vaccine or medical intervention, by cutting deaths from diarrhea and acute respiratory infections.[42]



Medical treatments[edit]


Cultural changes[edit]

Educated females practice a healthier lifestyle. The more educated a woman is the more likely she is to seek out care, give birth in the presence of a skilled attendant, breastfeed, and understand the consequences of HIV/AIDS.[3] Improving women's health and social status is one way to ameliorate infant mortality.[4] Status should rise for females seeking out education.[35] Providing women access to family planning centers can educate mothers on how to plan ahead for their families. Educational means can also teach mothers on the beneficial health practices such as breastfeeding. Government recognizing birth space as a possible health intervention is now working towards making affordable contraception available.[40]

Economic/Social policies[edit]



In certain parts of the U.S., specific modern programs aim to reduce levels of infant mortality. An example of one such program is the 'Healthy Me, Healthy You' program based in Northeast Texas. It intends to identify factors that contribute to negative birth outcomes throughout a 37-county area.[44]

Differences in measurement[edit]

Mortality rates, under age 5, in 2012[45]
Infant mortality rate by region
Life expectancy at birth by region

The infant mortality rate correlates very strongly with, and is among the best predictors of, state failure.[clarification needed][46] IMR is therefore also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index.

However, the method of calculating IMR often varies widely between countries, and is based on how they define a live birth and how many premature infants are born in the country. Reporting of infant mortality rates can be inconsistent, and may be understated, depending on a nation's live birth criterion, vital registration system, and reporting practices.[47] The reported IMR provides one statistic which reflects the standard of living in each nation. Changes in the infant mortality rate reflect social and technical capacities[clarification needed] of a nation's population.[6] The World Health Organization (WHO) defines a live birth as any infant born demonstrating independent signs of life, including breathing, heartbeat, umbilical cord pulsation or definite movement of voluntary muscles.[48] This definition is used in Austria, for example.[49] The WHO definition is also used in Germany, but with one slight modification: muscle movement is not considered to be a sign of life.[50] Many countries, however, including certain European states (e.g. France) and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and increases their rates of perinatal mortality.[51] In the Czech Republic and Bulgaria, for instance, requirements for live birth are even higher.[52]

Although many countries have vital registration systems and certain reporting practices, there are many inaccuracies, particularly in undeveloped nations, in the statistics of the number of infants dying. Studies have shown that comparing three information sources (official registries, household surveys, and popular reporters) that the "popular death reporters" are the most accurate. Popular death reporters include midwives, gravediggers, coffin builders, priests, and others—essentially people who knew the most about the child's death. In developing nations, access to vital registries, and other government-run systems which record births and deaths, is difficult for poor families for several reasons. These struggles force stress on families[clarification needed], and make them take drastic measures[clarification needed] in unofficial death ceremonies for their deceased infants. As a result, government statistics will inaccurately reflect a nation's infant mortality rate. Popular death reporters have first-hand information, and provided this information can be collected and collated, can provide reliable data which provide a nation with accurate death counts and meaningful causes of deaths that can be measured/studied.[37]







Europe and America[edit]

The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can casue problems in making comparisons. Many countries, including the United States, Sweden and Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[56] which are used throughout the European Union.[57] However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[58][59][60] However, the differences in reporting are unlikely to be the primary explanation for the United States' relatively low international ranking. Rather, the report concluded that primary reason for the United States’ higher infant mortality rate when compared with Europe was the United States’ much higher percentage of preterm births. There are a number of factors which may account for this higher rate of preterm births, which include obesity or poor prenatal care.[61]

Regional differences in the reporting of life births.[62]

The US National Institute of Child Health and Human Development (NICHD) has made great strides in lowering US infant mortality rates.[63][not in citation given] Since the institute was created the US infant mortality rate has dropped 70%, in part[vague] due to their research.[citation needed]





The bureaucratic separation of vital death reporting and cultural death rituals stems in part due to structural violence.[68] Individuals living in rural areas of Brazil need to invest large capital for lodging and travel in order to report infant birth to a Brazilian Assistance League office. The negative financial aspects deters registration, as often individuals are of lower income and cannot afford such expenses.[37] Similar to the lack of birth reporting, families in rural Brazil face difficult choices based on already existing structural arrangements when choosing to report infant mortality. Financial constraints such as reliance on food supplementations may also lead to skewed infant mortality data.[37]



Global trends[edit]

UN, medium variant, 2008 rev.[69]
Years Rate Years Rate
1950–1955 152 2000–2005 52
1955–1960 136 2005–2010 47
1960–1965 116 2010–2015 43
1965–1970 100 2015–2020 40
1970–1975 91 2020–2025 37
1975–1980 83 2025–2030 34
1980–1985 74 2030–2035 31
1985–1990 65 2035–2040 28
1990–1995 61 2040–2045 25
1995–2000 57 2045–2050 23



A factor of about 67 separate countries with the highest and lowest reported infant mortality rates. The top and bottom five countries by this measure (taken from The World Factbook's 2012 estimates[71]) are shown below.

Rank Country Infant mortality rate
(deaths/1,000 live births)
1 Afghanistan 121.63
2 Niger 109.98
3 Mali 109.08
4 Somalia 103.72
5 Central African Republic 97.17
218 Sweden 2.74
219 Singapore 2.65
220 Bermuda 2.47
221 Japan 2.21
222 Monaco 1.80


In the United States[edit]

The infant mortality rate in the US decreased by 2.3% to a historic low of 582 infant deaths per 100,000 live births in 2014.[73]

In the 1850s, the infant mortality rate in the United States was estimated at 216.8 per 1,000 babies born for whites and 340.0 per 1,000 for African Americans, but rates have significantly declined in the West in modern times. This declining rate has been mainly due to modern improvements in basic health care, technology, and medical advances.[74] In the last century, the infant mortality rate has decreased by 93%.[8] Overall, the rates have decreased drastically from 20 deaths in 1970 to 6.9 deaths in 2003 (per every 1000 live births). In 2003, the leading causes of infant mortality in the United States were congenital anomalies, disorders related to immaturity, SIDS, and maternal complications. Babies born with low birth weight increased to 8.1% while cigarette smoking during pregnancy declined to 10.2%. This reflected the amount of low birth weights concluding that 12.4% of births from smokers were low birth weights compared with 7.7% of such births from non-smokers.[75] According to the New York Times, "the main reason for the high rate is preterm delivery, and there was a 10% increase in such births from 2000 to 2006." Between 2007 and 2011, however, the preterm birth rate has decreased every year. In 2011 there was a 11.73% rate of babies born before the 37th week of gestation, down from a high of 12.80% in 2006.[76]

Economic expenditures on labor and delivery and neonatal care are relatively high in the United States. A conventional birth averages 9,775 USD with a C-section costing 15,041 USD.[77] Preterm births in the US have been estimated to cost $51,600 per child, with a total yearly cost of $26.2 billion.[78] Despite this spending, several reports state that infant mortality rate in the United States is significantly higher than in other developed nations.[7][79][80] Estimates vary; the CIA's World Factbook ranks the US 55th internationally in 2014, with a rate of 6.17, while the UN figures from 2005-2010 place the US 34th.

Aforementioned differences in measurement could play a substantial role in the disparity between the US and other nations. A non-viable live birth in the US could be registered as a stillbirth in similarly developed nations like Japan, Sweden, Norway, Ireland, the Netherlands, and France – thereby reducing the infant death count.[81] Neonatal intensive care is also more likely to be applied in the US to marginally viable infants, although such interventions have been found to increase both costs and disability. A study following the implementation of the Born Alive Infant Protection Act of 2002 found universal resuscitation of infants born between 20–23 weeks increased the neonatal spending burden by $313.3 million while simultaneously decreasing quality-adjusted life years by 329.3.[82]

The vast majority of research conducted in the late twentieth and early twenty-first century indicates that African-American infants are more than twice as likely to die in their first year of life than white infants. Although following a decline from 13.63 to 11.46 deaths per 1000 live births from 2005 to 2010, non-Hispanic black mothers continued to report a rate 2.2 times as high as that for non-Hispanic white mothers.[83]


Data indicating the IMR disparity between infants Non-Hispanic black mothers and infants of white or Hispanic mothers in the United States from 2000-2010.


The leading causes of infant mortality have changed over time. Unpasteurized milk was the leading cause of infant mortality late in the 19th century.[86] Pasteurization of milk cut infant mortality by around 3/4. [86]

Society and culture[edit]

Other meanings[edit]


See also[edit]

Related statistical categories:



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