Overview


Infant mortality refers to a death of an infant from 0-364 days old. The infant mortality rate (IMR) is expressed in number of deaths per 1,000 live births and is used as an indicator of population health. Infant mortality can be divided into neonatal mortality (birth to 28 days of life) and postneonatal mortality (28-364 days of life). Infant mortality is commonly reported as part of overall child mortality, also referred to as pediatric mortality (death before the age of five).

Health Impact


Infant mortality in a global context
Rates of infant mortality vary widely across the world. Among developed nations rates of infant mortality can be as low as approximately 2-3 per 1,000 live births, whereas in more impoverished, lesser developed nations, rates easily top 100 per 1,000 live births. Worldwide, the infant mortality rate for 2009 was 40.85 deaths per 1,000 live births. Statistics for infant mortality rate by country can be found from a number of sources, including the CIA World Fact Book, https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html, where a table of current infant mortality rates by country is available. Other data sources are listed in the Online Resources section of this page.

The United States compiles data on causes of infant mortality in addition to causes of neonatal mortality (death of a baby during the first month of life) and child mortality (death of a child under the age of 5 years old); globally however, cause of death statistics are typically only available for neonatal and child mortality.

Among developing nations, primary causes of infant mortality generally include diarrhea, malaria, birth asphyxia, congenital defects, infections, prematurity, and SIDS. In developed nations, infant mortality is not likely to be due to diarrhea or malaria because of the widespread availability of treatments (such as oral rehydration therapy). In most regions, many infant deaths occur during the neonatal period. In 2008, for example, approximately two-thirds of infant deaths in reporting OECD countries (developed nations) were neonatal deaths, while in Southern Asia just over half of infant deaths occurred in the first 28 days of life.[1] [2] [3]



An interactive global map feature from the Inter-agency Group for Child Mortality Estimation (comprised of members from UNICEF, WHO, the World Bank, and the UN Population Division) can be found by following the link below:
http://www.childmortality.org/cmeMain.html


Infant mortality in the United States
Infant mortality rates in the U.S. are among the worst in developed nations, recently ranking 28th out of 32 developed nations.[4] Although the overall infant mortality rate declined from 1997-2007 (the latest year for which data are available), there was no statistically significant difference in the rate for 2006 (6.69) and 2007 (6.75).
According to the CDC,[5] the five leading causes of infant mortality in the U.S. from 2001-2006 were:
  • Birth defects
  • Prematurity and low birth weight
  • Sudden infant death syndrome (SIDS)
  • Maternal complications of pregnancy
  • Heart defects

Separating neonatal deaths, SIDS becomes the leading cause of death among infants 1-12 months old.[6]

Some researchers suggest that one of the primary reasons the U.S. has such a high infant mortality rate compared to many European nations is that the U.S. has a much higher percentage of preterm births (12.4% in 2004), and infant mortality rates are significantly higher among infants born prematurely.[7]



external image db23_Fig3.png
http://www.cdc.gov/nchs/data/databriefs/db23.htm


Infant mortality rates in the U.S. are strikingly different when broken down according to race. Trends in infant mortality rates show that rates among black infants are approximately 2.3 times higher than rates among white infants. In what is at times referred to in public health as the Hispanic paradox or Latina paradox, the infant mortality rate among Hispanics is slightly lower than that of whites.[8] [9]



Medical Anthropology Research and Applied Work


Due to its epidemiological nature, much of the research on infant mortality has occurred within the field of public health, although anthropologists and other scientists have made contributions to understanding infant mortality and how to prevent it.
For example, Hadley and colleagues discuss research which demonstrates that breastfeeding exclusively for the first six months of life reduces infant mortality in addition to providing other beneficial health outcomes for infants. Importantly, the authors state that “These averted deaths would be nonrandomly distributed; the greatest benefits to exclusive breastfeeding would occur in those areas that are resource poor and unhygienic.”[10]
Another aspect of infant mortality studied by anthropologists is the disparity in the U.S. along racial lines of low birth weight babies. Dressler and associates[11] argue that explanatory models based on genetics, differences in socioeconomic status, and health behaviors do not fully account for these disparities, and that the psychosocial stress model and structural-constructivist model may offer better explanations.

On a national policy level, Schleiter and Statham[12] draw parallels between structural adjustment policies implemented in countries such as Zimbabwe and welfare reform in the United States. They warn that in both situations the quality of life for affected women and children decreased as a result of the policies, and that ultimately in the case of Zimbabwe the compounded negative effects of increased poverty, hunger, and homelessness led to an increased infant mortality rate.

SIDS
Sudden infant death syndrome (SIDS) is one of the leading causes of infant mortality, especially in more developed, western nations. Scientists do not fully understand what the causes of SIDS are, although there are a number of well-known risk factors, such as lying a baby in a prone position, putting a baby to sleep on a soft mattress, over-wrapping babies, blocking airflow around the baby's face, and maternal smoking. [13] James McKenna has conducted extensive research on SIDS and cosleeping (sharing the same room or bed) among parents and babies, finding that cosleeping can be beneficial to infants when done with care. McKenna notes that major epidemiological studies have shown that when a caregiver - usually the mother - sleeps in the same room as their baby, the chance of that baby dying from SIDS is reduced by half. Breastfeeding is another factor that reduces the risk of SIDS, and among mothers who breastfeed, bed- or room-sharing is often used at some point.[14]
The Mother-Baby Behavioral Sleep Laboratory http://www.nd.edu/~jmckenn1/lab/ and the Parent-Infant Sleep Lab http://www.dur.ac.uk/sleep.lab/ are two examples of anthropological centers engaging in research on issues of SIDS and cosleeping.

Online Resources


Health Data Interactive, CDC http://205.207.175.93/HDI/ReportFolders/reportFolders.aspx

Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID), CDC http://www.cdc.gov/SIDS/index.htm

March of Dimes Research Center http://www.marchofdimes.com/research/research.html

March of Dimes PeriStats – maternal and infant health data for the U.S. (data also available by state, county, and city) http://www.marchofdimes.com/peristats/

Kaiser Family Foundation http://globalhealthfacts.org/data/topic/map.aspx?ind=91

CIA World Factbook https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

World Health Organization (data on neonatal and child mortality) http://www.who.int/healthinfo/statistics/mortality_child_cause/en/index.html

Centers for Disease Control and Prevention compiles data on infant mortality and causes in the United States http://www.cdc.gov/nchs/fastats/infant_health.htm

Mother-Baby Behavioral Sleep Laboratory http://www.nd.edu/~jmckenn1/lab/

Parent-Infant Sleep Lab http://www.dur.ac.uk/sleep.lab/

Further Reading


McKenna, James
2007 Sleeping With Your Baby: A Parent's Guide to Cosleeping. Platypus Press.

McKenna, James, Helen Ball, and Lee Gettler
2007 Mother-infant sleeping, breastfeeding, and sudden infant death syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. American Journal of Physical Anthropology 134(S45):133-161.

Infant mortality as related to ischemic heart disease:
Singer, Merrill, and Scott Clair
2003 Syndemics and Public Health: Reconceptualizing Disease in Bio-Social Context. Medical Anthropology Quarterly 17(4):423-441.

References


Dezen, Todd P. and Elizabeth Lynch
2010 Infant Mortality Rate Drops Slightly. March of Dimes News desk http://www.marchofdimes.com/news/may3_2010.html

Dressler, William W., Kathryn S. Oths, and Clarence C. Gravlee
2005 Race and Ethnicity in Public Health Research: Models to Explain Health Disparities. Annual Review of Anthropology 34:231-252.

Hadley, Craig, Crystal L. Patil, and Carolyn Gulas
2010 Social Learning and Infant and Young Child Feeding Practices. Current Anthropology 51(4):551-560.

MacDorman, Marian F. and T.J. Matthews
2009 Behind International Rankings of Infant Mortality: How the United States Compares with Europe. NCHS Data Brief http://www.cdc.gov/nchs/data/databriefs/db23.htm

McGlade, Michael S., Somnath Saha, and Marie E. Dahlstrom
2004 The Latina Paradox: An Opportunity for Restructuring Prenatal Care Delivery. American Journal of Public Health 94(12):2062-2065.

Schleiter, Mary Kay and Anne Statham
2002 U.S. Welfare Reform and Structural Adjustment Policies. Anthropological Quartlery 75(4):759-764.

Xu, Jiaquan, Kenneth D. Kochanek, Sherry L. Murphy, Betzaida Tejada-Vera
2010 Deaths: Final Data for 2007. National Vital Statistics Report 58(19).
  1. ^ UN Inter-agency Group for Child Mortality Estimation
    2010 Levels & Trends in Child Mortality. United Nations Children's Fund.
  2. ^ OECD Social Policy Division
    2010 OECD Family Database. www.oecd.org/els/social/family/database
  3. ^ Kaler, Stephen G.
    2008 Diseases of Poverty with High Mortality in Infants and Children: Malaria, Measles, Lower Respiratory Infections, and Diarrheal Illnesses. Annals of the New York Academy of Sciences 1136:28-31.
  4. ^ Dezen, Todd P. and Elizabeth Lynch
    2010 Infant Mortality Rate Drops Slightly. March of Dimes News desk http://www.marchofdimes.com/news/may3_2010.html
  5. ^ Health Data Interactive, CDC http://205.207.175.93/HDI/ReportFolders/reportFolders.aspx
  6. ^ Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID), CDC http://www.cdc.gov/SIDS/index.htm
  7. ^ MacDorman, Marian F. and T.J. Matthews
    2009 Behind International Rankings of Infant Mortality: How the United States Compares with Europe. NCHS Data Brief http://www.cdc.gov/nchs/data/databriefs/db23.htm
  8. ^ McGlade, Michael S., Somnath Saha, and Marie E. Dahlstrom
    2004 The Latina Paradox: An Opportunity for Restructuring Prenatal Care Delivery. American Journal of Public Health 94(12):2062-2065
  9. ^ Xu, Jiaquan, Kenneth D. Kochanek, Sherry L. Murphy, Betzaida Tejada-Vera
    2010 Deaths: Final Data for 2007. National Vital Statistics Report 58(19).
  10. ^ Hadley, Craig, Crystal L. Patil, and Carolyn Gulas
    2010 Social Learning and Infant and Young Child Feeding Practices. Current Anthropology 51(4):551-560.
  11. ^ Dressler, William W., Kathryn S. Oths, and Clarence C. Gravlee
    2005 Race and Ethnicity in Public Health Research: Models to Explain Health Disparities. Annual Review of Anthropology 34:231-252.
  12. ^ Schleiter, Mary Kay and Anne Statham
    2002 U.S. Welfare Reform and Structural Adjustment Policies. Anthropological Quartlery 75(4):759-764.
  13. ^ McKenna, James
    2008 Cosleeping and Biological Imperatives: Why Human Babies Do Not and Should Not Sleep Alone. Neuroanthropology.net (http://neuroanthropology.net/2008/12/21/cosleeping-and-biological-imperatives-why-human-babies-do-not-and-should-not-sleep-alone/).
  14. ^ McKenna, James and Thomas McDade
    2005 Why babies should never sleep alone: A review of the cosleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews 6:134-152.