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The Infant Mortality Rate in the U.S., Explained: What Really Kills Babies

New parents are filled with fears — some founded, some not. Here's what really kills babies in America.

Infant mortality rates have steadily declined in the United States for decades. This is very good news for countless parents and children alive today. But the fact remains, 22,335 babies die every year in America. These deaths are a tragedy for tens of thousands of families and are anxiety-inducing for millions of other parents of infants. Already primed with fear of their fragile bundle, new parents are especially susceptible to boogeymen from random news reports and secondhand stories about things that will kill their baby. This is why it’s important to be familiar with the facts. When it comes to infant mortality, what should parents actually worry about? 

In other words, what really kills American babies? There is a clear answer to this: Prenatal complications, issues during birth and labor, birth defects, infectious disease, homicide, car crash, and drowning are the most likely ways a baby dies in America, in that order. Dig deeper into these numbers and a story reveals itself about where America fails its most vulnerable population, and how parents can keep their kids safe — and themselves sane. 

The infant mortality rate in the United States, based on the latest data available, is 5.8 per 1,000 births. Internationally, this is a very high death rate, higher than most developed nations like Hungary (4.9), Cuba (4.4) Spain (3.3) Singapore (2.4) and Japan (2). Out of the 36 wealthy nations in the Organisation for Economic Co-operation and Development, the United States ranks 33rd.

Why? Much of it happens before the child is born. In most infant deaths in the United States, it’s highly unlikely that risk factors weren’t identified during pregnancy or at the time of birth. The majority of infants that die in America do so because of complications related to congenital birth defects or factors that occurred during gestation. 

The sobering reality is that for one the majority of parents who lose a baby, the death is a possible, if not probable outcome, of an issue they already understood. 

Some 11,000 infant deaths occur related to issues during pregnancy, or about 49 percent of all infant deaths in the U.S.The biggest factors in these deaths are pre-term delivery and low birth weight. In fewer circumstances, infants die due to maternal complications such as the premature rupture of membranes and births involving multiple babies including twins and triplets.

By contrast, some 4,580 infant deaths are related to congenital chromosomal birth defects like anencephaly (failure of a significant portion of the brain to form) or spina bifida — another 20.5 percent. That means the sobering reality is that for the majority of parents who lose a baby, the death is a possible, if not probable outcome, of an issue they already understood. 

The risk of death at birth is woefully uneven when viewed by race. Black, Native American, and Hispanic parents are far more likely than white parents to lose a baby at birth in the United States. The risk of infant death in the first year for black mothers is double that of white mothers. 

Once infants leave the hospital, the biggest risk of death becomes Sudden Unexpected Infant Deaths (SUID). This is an umbrella diagnosis for deaths that occur for no discernible reason, usually while a child is sleeping. SUID deaths include SIDS (essentially an unexpected, but diagnosable death in an otherwise healthy baby under 1-year-old), deaths from unknown causes, and accidental strangulation or suffocation in bed.

Rates for all SUID deaths have been stable since reaching a historic low in 2000. According to the latest data, in 2017 a total of 1,329 babies died of unknown causes, 1,363 died from SIDS, and 949 died from strangulation in bed. These three account for more than 16 percent of all infant deaths in the U.S.

After three months, the risk of a baby dying becomes vanishingly small.

The risk of deaths related to SUID peaks when a baby is 3-months old and declines rapidly from there. The risk of SUID deaths are further mitigated if parents are non-smokers and place their baby to sleep on their back, in a room with a fan, in a crib with a firm mattress covered only by a tight, bottom sheet.

In the first month, one of the biggest risks of death apart from SUID is by infectious or parasitic diseases. These took some 467 infants in 2017 and includes everything from Septicemia (a bacterial blood poisoning that killed 143 babies in 2017) to diarrhea or gastroenteritis due to infection (176 in 2017.)

After three months, the risk of a baby dying becomes vanishingly small. From 3-months-old to 1-year-old, after accidental suffocation, the leading cause of death to babies is homicide. There were 302 infant homicides in the U.S. in 2017. A full 70 percent of these homicides were committed by a family member. 

A baby is far less likely to die in a motor vehicle accident than to be killed. There were 91 babies under 1-year-old killed in traffic accidents in 2017. Also among the top causes of injury-related deaths in babies is drowning, accounting for 43 deaths in 2017. Of those drowning deaths 29 occurred while a baby was in the bathtub. 

Many baby deaths — the 30.5 percent not related to pregnancy, birth, or chromosomal injuries — are rare and preventable. In the end, parents who are worried about the death of their baby should understand that they can manage the risk of death by following safe sleep practices, keeping track of their mental health and seeking help if they are in crisis, driving carefully, and the correct use of pool fences and infant car seats. The even better news is that every year a child is alive, their risk of death decreases dramatically. Which is to say, new parents should take a breath. The chances are it will all turn out alright.