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infant mortality

The statistical rate of infant death during the first year after live birth, expressed as the number of such births per 1,000 live births in a specific geographic area. Neonatal mortality accounts for 70% of infant mortality.

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Children's Health Encyclopedia: Infant Mortality

Definition

The infant mortality rate is the number of deaths of infants under one year of age per 1,000 live births in a given population. In 2002, the United States' infant mortality rate varied widely by race of the mother from 14.3 for infants of black mothers to 5.9 for infants of Hispanic mothers to 5.8 for infants of white mothers. As can be noted, the mortality rate for black infants is more than twice that of white infants. The overall infant mortality rate in 2002 for all races was 7.0 per 1,000 live births, which was a slight increase over the previous year.

Description

Infant mortality rate is one of the key indicators of a nation's health status. When the rate increases, as it did from 2001 to 2002, the factors that precipitated this change need to be assessed and scrutinized. The U.S. infant mortality rate is of great concern because the United States has fallen to the twenty-second nd place among industrialized nations in infant mortality rankings. Therefore, healthcare professionals and the public have stressed the need for better prenatal care, coordination of health services, and the provision of comprehensive maternal-child services.

Infant mortality rates have typically been the highest for the babies of adolescent mothers and lowest for women in their late 20s and early 30s. The rates have also been high for women in their forties and older. In general, infant mortality rates decrease with increasing maternal educational levels. Similarly the infant mortality rate for unmarried mothers is often more than 83 percent higher than the mortality rate for married women. Likewise, the infant mortality rate is characteristically higher for the infants of mothers who smoke than for those of nonsmokers.

The leading cause of infant mortality is congenital malformations, deformations and chromosomal abnormalities with a rate of 20.2 percent. Disorders related to short gestation and low birth weight was the second leading cause of death for all infants at 16.4 percent of all deaths. Sudden infant death syndrome (SIDS) is the third leading cause of infant death. Its incidence decreased by about 9 percent, which it has been doing since 1988. The fourth leading cause of death comes under the heading of newborn affected by maternal complications of pregnancy. This rate actually increased from 2001 to 2002 from 37.2 per 100,000 live births to 42.9 per 100,000 in 2002.

An analysis of the data established that the rise in the infant mortality rate was concentrated in the neonatal period (less than 28 days) and primarily in the first week of life where more than half of all infants' deaths occur. Final birth data for 2002 made it apparent that two key predictors of infant health, the percentage of infants born preterm (less than 37 weeks gestation) and low birth weight (less than 2,500 grams) rose during this time frame. This has been a continuing long-term upward trend. The cesarean section rate for 2002 rose to 26.1, which is the highest ever recorded in the US. The primary cesarean rate was 7 percent higher than the previous year, and the rate of vaginal birth after cesarean (VBAC) experienced a sharp decline. The cesarean rate increase could be due to nonmedical factors as demographics, physician practice patterns, and maternal choice. Other contributing factors may be the use of continuous electronic fetal monitoring and inductions before 41 weeks gestation. Unnecessary interventions can contribute to a rise in cesarean rates. On the other hand, the perinatal mortality rate (the number of late fetal deaths [28 weeks or more gestation] and early neonatal deaths [less than 7 days] per 1,000 live births) remain unchanged.

Common Problems

The infant mortality rate increased in the United States in 2002 for the first time since 1958, which indicates a need to examine what factors contributed to this raise. Is there a difference in mortality rates among racial groups? That is obvious—the rate for blacks is 14.2 and the rate for whites is 5.8. Experts associate this difference with the availability of prenatal care to minorities. It is expensive, and over 40 million Americans do not have health insurance. The mother's socioeconomic status is a possible contributing factor because the leading cause of death was related to congenital malformations, which in some cases can be eliminated with appropriate nutritional intake and prenatal vitamins. Lack of prenatal care could also contribute to the fourth largest cause of infant death, which is maternal complications. Many other industrialized countries have a socialized system of health care, which offers universal access to prenatal care and helps lower country-wide infant mortality rates.

Parental Concerns

Recent data showed good news for parents of teenagers. The teen birth rate declined by 30 percent over the past decade to a historic low and the rate for black teens was down by more than 40 percent. For young black teens (15 to 17 years) the results were even more striking—the rate was cut in half since 1991. The average age at first birth was 25.1 years in 2002, an all-time high in the United States. Birth rates for women 35–39 (41 births per 1,000 women) and 40–44 (eight per 1,000) were the highest in more than three decades. The rate for women ages 20–24 (104 births per 1,000 women) was on the decline and the rate for those 25–29 was stable, but still the highest of all age groups, at 114 per 1,000 women. In contrast, the rate for teens was 43 per 1,000. In addition, just over one in 10 women smoked during pregnancy in 2002, a decline of 42 percent since 1989.

Resources

Organizations

Center of Disease Control and Prevention; 1600 Clifton Rd.; Atlanta, GA 30333.(800)311-3435. Web site: www.cdc.gov.

U.S. Department of Health and Human Services. National Center for Health Statistics. Hyattsville, MD 20782. (301) 458-4000.

Web Sites

Centers for Disease Control. Infant Mortality: Fast Stats. [cited March 6, 2005]. Available online at: .

Child Trends Databank. Infant, Child, and Youth Mortality. [cited March 6, 2005]. Available online at: .

[Article by: Linda K. Bennington, MSN, CNS]

Geography Dictionary: infant mortality

The number of deaths in the first year of life per 1000 children born. See also mortality.

WordNet: infant mortality

Note: click on a word meaning below to see its connections and related words.

The noun has one meaning:

Meaning #1: the death rate during the first year of life
Synonyms: infant deathrate, infant mortality rate

Wikipedia: infant mortality

Infant mortality is defined as the number of infants who are born alive, but die before one year of age. The most common cause of infant mortality worldwide has traditionally been dehydration from diarrhea. Because of the success of spreading information about Oral Rehydration Solution (a mixture of salts, sugar, and water) to mothers around the world, the rate of children dying from dehydration has been decreasing and has become the second most common cause in the late 1990s. Currently the most common cause is pneumonia. Major causes of infant mortality in more developed countries include congenital malformation, infection and SIDS.

Infanticide, abuse, abandonment, and neglect may also contribute to infant mortality.

Related statistical categories:

Perinatal mortality only includes deaths between the foetal viability (28 weeks gestation) and the end of the 7th day after delivery.
Neonatal mortality only includes deaths in the first 28 days of life.
Post-neonatal death only includes deaths after 28 days of life but before one year.
Child mortality includes deaths within the first five years after birth.

Infant mortality rate (IMR) is the number of newborns dying under a year of age divided by the number of live births during the year. The infant mortality rate is also called the infant death rate. In past times, infant mortality claimed a considerable percentage of children born, but the rates have significantly declined in the West in modern times, mainly due to improvements in basic health care, though high technology medical advances have also helped. Infant mortality rate is commonly included as a part of standard of living evaluations in economics.

The infant mortality rate is reported as number of live newborns dying under a year of age per 1,000 live births, so that IMRs from different countries can be compared. A good source for the most recent IMRs as well as under 5 mortality rates (U5MR) is the UNICEF publication 'The State of the World's Children' available at http://www.unicef.org/publications/index_18108.html. For example, the worst U5MR is 284 in Sierra Leone. (That is, 28% of all children born die before they turn 5 years old.) The 29 countries with the highest U5MRs are in Africa. The U5MR of the United States is 8, and there are 31 countries with lower U5MRs, although many of those use a less stringent definition of mortality than the US. Sweden's is among the lowest at 3.

Comparing infant mortality rates

The infant mortality rate correlates very strongly with and is among the best predictors of state failure.^[1] IMR is also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index. But the method of calculating IMR often varies widely between countries based on the way they define a live birth. The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.

The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. The United States counts an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but some other countries differ in these practices. For example, in Germany and Austria, fetal weight must reach one pound to be counted as a live birth, while in some other countries, including Switzerland, the baby must be at least 12 inches long. Both Belgium and France report babies as born lifeless if they are less than 26 weeks' gestation.^[2]

Another well-documented example also illustrates this problem. Historically, until the 1990s Russia and the Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.^[3] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.^[4] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.^[5]

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.^[6]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

Global infant mortality trends

For the world, and for both Less Developed Countries (LDCs) and More Developed Countries (MDCs), IMR declined significantly between 1960 and 2001. World infant mortality rate declined from 198 in 1960 to 83 in 2001.

Infant mortality is inversely related to per capita GDP.

However, IMR remained higher in LDCs. In 2001, the Infant Mortality Rate for Less Developed Countries (91) was about 10 times as large as it was for More Developed Countries (8). For Least Developed Countries, the Infant Mortality Rate is 17 times as high as it is for More Developed Countries. Also, while both LDCs and MDCs made dramatic reductions in infant mortality rates, reductions among less developed countries are, on average, much less than those among the more developed countries.