For the first time in more than two decades, the United States saw an increase in infant mortality in 2022.
According to a report released Wednesday by the National Center for Health Statistics, the overall infant mortality rate rose by 3% from 2021 to 2022. The infant mortality rate rose by 3%, while the post-neonatal mortality rate rose by 3%. babies who survived past 28 days – up 4%.
Newborn deaths due to maternal complications – such as preeclampsia or premature birth – and bacterial sepsis also increased by 8% and 14%, respectively.
“We live in a country with significant resources, so the infant mortality rate and increase are shockingly high,” Dr. Sandy Chung, president of the American Academy of Pediatrics, wrote in an email to CNN. “As pediatricians who help children grow into healthy adults, one death of each child is too many. The infant mortality rate in this country is unacceptable.
For public health experts, infant mortality is often a useful indicator of the nation’s health care system as a whole, said Daniel Ely, a health statistician at NCHS and one of the report’s authors. This year’s increase in infant mortality, she said, could be either a “freak moment” in a year or a sign of an underlying health care problem. They’ll have to see next year’s data to know for sure.
The increase in child mortality may also be a product of the COVID-19 pandemic, which has strained communities and health care resources, said Rachel Hardeman, a professor of health and racial equity at the University of Minnesota.
A year earlier, in 2021, an analysis by the US Centers for Disease Control and Prevention found that while the total number of infant deaths increased from 2020, the death rate remained the same at 5.44 deaths per 1000 live births.
The new report, citing preliminary data, found the rate had risen to 5.60 infant deaths per 1,000 births, corresponding to 20,538 infant deaths in 2022.
“This is clearly the wrong direction,” said Dr. Elizabeth Cherot, president and CEO of the March of Dimes, a nonprofit organization that advocates for maternal and infant health. “Overall, I’m just disheartened.”
The NCHS study found that the infant mortality rate in 2022 increased among mothers aged 25-29. Death rates also rose among premature infants, male infants, and among infants born in Georgia, Iowa, Missouri, and Texas. However, Nevada has seen a decline in infant mortality.
The report also found that different racial groups had different infant mortality rates. For babies born to American Indian or Alaska Native women, the death rate rose more than 20% from about 7.4 deaths per 1,000 births to more than 9 deaths per 1,000 births. Infant mortality among white women also increased by about 3%.
Infant mortality among black women did not increase much, the report found, but black infants had the highest overall infant mortality rates: nearly 11 deaths per 1,000 births, or more than twice the rate of white infants.
“We know that for people who live in or near poverty and for certain racial and ethnic groups, there are significant challenges in accessing a doctor or getting treatment,” Chung wrote. “This can lead to mothers and babies presenting for care when they are sicker and more likely to have serious outcomes, even death.”
Cherot and Hardeman described areas with these accessibility challenges as “maternity deserts,” where people—predominantly women of color—may have to drive long distances to find scarce labor or maternity units.
These women also face a higher risk of preterm birth, Cherrot said — and when combined with barriers to access to health care, the likelihood of complications for the babies is “extremely high.”
“In a country as rich as ours, no one should have difficulty accessing health care,” Chung wrote. “We need to change policies to help lift families out of poverty and help them access health care sooner, before it’s too late.”
According to Hardeman, racism and marginalization, particularly for Indigenous and black people, can also have a physiological impact on health outcomes. Educating doctors and other health care providers about the links between inequality and health, she said, could “eliminate” some of the racial disparities in infant health.
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Based on his previous research, in fact, Hardeman found that when black babies were delivered by black doctors, a greater number survived—especially during difficult births or maternal complications.
According to the report, maternal complications and bacterial sepsis, or infection, are responsible for the higher rate of newborn deaths than before. Maternal health and infant mortality are often intertwined, Cherot explained, and maternal complications such as preeclampsia and diabetes are on the rise, leading to high maternal mortality rates compared to other high-income countries.
However, the NCHS study reports only the latest numbers, with no explanation for why infant mortality may be rising. Cherot hopes researchers dive into the data to better understand the basis for rising child mortality.
“I see a 14% increase [in infant mortality from bacterial sepsis]Cherot said. “When I see a double digit number, I start to worry. There are many more questions than answers with this data.”
“I think we have a lot more questions to be able to get to the heart of what’s going on,” Hardeman added.