Running head: INFANT MORTALITY RATES IN AFRICAN AMERICANS 1

Infant Mortality Rates in African Americans

Lauren Hutson

HCR230 Fall 2019

According to the Center for Disease Control, the Infant Mortality Rate or IMR is an

important marker of the overall health of a population (MacDorman, 2013). IMR is a ratio of

deaths in children under 1 year of age out of the total number of live births (Murphy, 2017).

Statistics show that African Americans are at higher risk than any other ethnic groups in the

United States. In 2012 the director of the CDC, Dr. Thomas Frieden stated that “African

American infants in this country still die at twice the rate of white infants” (CDC, 2012). There

are multiple causes for infant deaths, including both environmental and biological factors and

African Americans are found to have a higher prevalence of health risks in multiple areas that are

linked to infant deaths (CDC, 2012).

Health Problem & Challenges

Infant mortality rates are associated with maternal health, medical care before and after

birth, socioeconomic conditions, and cultural health practices (MacDorman, 2013). In 2017,

sudden infant death syndrome was the fourth leading cause of infant deaths, behind congenital

malformations, low birth weight, and maternal complications (Murphy, 2017). 2010 data showed

the IMR at 6.15 deaths per 1000 live births, while 2017 data showed a reduction to 5.79 deaths

per 1000. However, despite the progress, the United States still has a higher IMR than other

countries. Dr. Frieden stated in 2012 that the IMR rate in the US was 3 times the lowest IMR in

the world and we rank “30th or 31st internationally” (CDC, 2012).

Differences in IMR occur not only between race, but also age, and by state. Between

2006 and 2008, the lowest IMR in the country was for non-hispanic white women in new Jersey

at 3.78 deaths per 1000 live births, and highest in Hawaii for non-hispanic black women with
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18.54 deaths per 1000 live births. These statistics show how extreme the disparities can be

between ethnic groups.

Infant mortality rates are higher for those women who are adolescents, women who are

over 35, unmarried, have low levels of education, and those who smoke (Marian, 2013).

Challenges with these groups of women may also include socioeconomic factors and access or

affordability of prenatal health care.

Prenatal health care can lower the rate of pre-term births, which are responsible for both

low birth weight deaths and most congenital malformations, which are two leading causes for

infant mortality. Approximately 12% of US births are pre-term according to 2007 data. These

numbers continue to decline, but are still higher than many other developed countries in the

world. Pre-term births are a large cause of death in non-hispanic black and Native- American

infants, and are far higher than the pre-term birth rates of non-hispanic white babies. Many

babies who are born pre-term are not cared for in level 3 NICU units, and the hospitals they are

born in are not equipped to handle their needs (CDC, 2012).

Pre-natal smoking is a risk behavior that occurs in 11.5% of all US live births and

accounts for many pre-term births. While smoking during pregnancy is more prevalent in white

women than black women, black and white people metabolize nicotine differently and black

people have higher rates of nicotine related illness. (CDC, 2012).

SIDS or Sudden Infant Death Syndrome is another leading cause of infant mortality.

SIDS has been linked to sleep position of infants, showing that babies who are placed on their

stomach at 2.3-13.1% higher risk of dying. Dr. Rachel Moon said at a 2012 session of Grand

Rounds that infants who have been placed to sleep on their stomachs, who bed-share, or who
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have soft objects and loose bedding in their sleep area have higher mortality rates than infants

who are placed on their backs to sleep, on firm surfaces, alone, without extra soft materials

around them. The CDC’s PRAMS survey data has shown that back-to-sleep position is 20%

lower in non-hispanic blacks and native-americas than non-hispanic whites. Bed-sharing and soft

sleeping surfaces are also more common in these groups (CDC,2012).

Cultural Strengths & Barriers

Socioeconomic status of individuals is likely to play a role in some of these risk

behaviors. People in smaller living areas might not have room for a separate bed or crib, or might

not be able to afford a crib for their baby. Unless educated on the topic, young and inexperienced

mothers will not understand the risk of asphyxiation when a baby is put down to sleep on their

stomach or on a soft sleep surface. Low-income mothers might have a difficult time taking time

off work to seek adequate prenatal care, and could face obstacles in finding or being able to

afford such care. This could be a cause of higher rates of pre-term births in these groups.

Additionally, those living in low-income neighborhoods are unlikely to have a level 3 NICU in

the immediate area, and transportation obstacles such as a lack of public transportation or

personal vehicle could mean that in many cases, these mothers are ending up at hospitals that are

not as well equipped to handle pre-term babies, leading to higher rates of infant mortality. These

hospitals may additionally be underfunded and understaffed, leading to lower quality care.

Higher rates of bed sharing in African Americans could be a due to the climate in which

the individual is living. Low-income individuals are less likely to run heaters in the winter, and

siblings might share beds to stay warm in freezing winters. People who are cold and who lack

well insulated housing are also more likely to have excessive loose bedding such as comforters

and additional layers of blankets.

continue smoking during pregnancy due to a lack of fully understanding all the risks associated .

Nicotine is also used to help temporarily relieve stress, and individuals who struggle financially

often live in a state of constant stress.

Religion can also play a factor in preventable causes of death. Those who do not wish to

change risk behaviors and who believe infant deaths to be God’s will might be particularly

challenging. Early education on the risks of smoking and making regular healthcare and

education available to entire communities, as well as promoting healthcare and listing the risks

of smoking in the media could be ways to reach people who might not seek science-based

answers themselves.

Strategies for Care Delivery

Several strategies have been utilized in the prevention of pre-term birth, and there are

programs to reduce SIDS rates as well. Attacking these two leading causes of IMR in the US

have already shown some progress in reducing infant deaths.

In November 2011, the American Academy of Pediatrics published revised

recommendations for reducing the risk of SIDS. The strongest recommendations were: back-to-

sleep for every sleep, use a firm sleep surface, room-sharing without bed-sharing, keep soft

objects and loose bedding out of the crib, get prenatal care during pregnancy, avoid smoke

exposure during pregnancy and after birth, avoid alcohol and drug use during pregnancy and

after birth, and breast feed as long as possible.

A national campaign was launched by The National Institute of Child Health and

Development to promote safe sleep environments in 1994 called the Back-to-Sleep Campaign

(Trachtenberg, 2011). “There was a sudden decrease in number of cases after the 1994 initiation
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of the BTS campaign, such that the SIDS rate decreased from 1.34 per 1000 births in 1991 to

0.64 per 1000 in 2008, with the decline observed across all races” (Trachtenberg, 2011). This

campaign spread awareness of SIDS and educated the public on how to prevent SIDS, and was

successful in reducing the number of infant deaths.

Other smaller programs aimed at reducing SIDS include Cribs for Kids, which provides

low cost cribs to organizations who then distribute them for free or at cost to needy parents-

thereby reducing possible bed sharing. Baltimore City Health Department’s ABC campaign

educated the public about the safe sleep position: Alone, on your Back, in a Crib.

Health care professionals are responsible for demonstrating to parents that babies are to

be placed on their back to rest, and told that SIDS can be prevented through responsible

behaviors, and every child can be at risk. It is important for healthcare workers to show as much

care as is expected of parents at home. A healthcare working demonstrating a lack of care by

placing a child on their stomach might make parents believe their child isn’t at risk, and they

don’t have to follow the recommended preventative measures (CDC, 2012).

At the city-level, officials can make sure there is adequate public transportation to take

people from low-income areas to hospitals and clinics for pre-natal care and for delivery. Bus

routes should pass close enough to these places that someone at any stage of pregnancy could use

public transportation, even in bad weather, to have access to quality healthcare. This could

prevent pre-term births, and babies born away from quality NICUs.

Conclusion

Years of statistics show that African Americans-Americans have a higher IMR than other

ethnic groups in the country. Some of the leading causes are preventable and with continued aid

programs and education, IMR rates have been and should continue declining. The
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implementation of programs to help people who are at risk can make a difference in the IMR for

the nation, especially to populations who are most at risk. The Back-to-Sleep campaign and its

success is only one example of how widespread involvement in healthcare solutions nationwide

can create an impact. Healthcare and government must work together to ensure disparities in

health are addressed and proper action is taken to rectify these disparities. Dr. Frieden said it all

when he spoke about infant mortality rates of black vs white children. He said its “completely

unacceptable, and we need to do everything possible to end disparities not just in infant mortality

but in other aspects of health in the US.”(CDC,2012).

References

Centers for Disease Control and Prevention (CDC). (2012, October 17). Public Health
Approaches to Reducing U.S. Infant Mortality. Retrieved October 4, 2019, from
https:// www.youtube.com/watch?v=MM_G0MPdCJM.

MacDorman, M. F., & Mathews, T. J. (2013, November 22). Infant Deaths - United States,
2005–2008. Retrieved October 3, 2019, from https://www.cdc.gov/mmwr/preview/
mmwrhtml/su6203a29.htm?s_cid=su6203a29_w.

Murphy SL, Xu JQ, Kochanek KD, Arias E. Mortality in the United States, 2017. NCHS Data
Brief, no 328. Hyattsville, MD: National Center for Health Statistics. 2018.

Trachtenberg, F. L., Haas, E. A., Kinney, H. C., Stanley, C., & Krous, H. F. (2011, December
14). Risk Factor Changes for Sudden Infant Death Syndrome After Initiation of Back-to-Sleep
Campaign. Retrieved October 4, 2019, from https://pediatrics.aappublications.org/
content/pediatrics/129/4/630.full.pdf.