More babies are dying in the US: Details on the troubling trend
USA TODAY
Nov 2, 2023
A teenage mom delivered a baby boy in fetal distress at 25 weeks gestation. Doctors tried to resuscitate the child – with ventilation, cardiac compressions, chest tubes and other methods – to no avail. The neonatologist later discovered that the mother had a previously undiagnosed case of syphilis.
The baby’s death at a Wisconsin hospital illustrates some the dangers babies face in their first year of life. It's also the type of scenario doctors are examining as they try to understand a grim new trend. For the first time in two decades, the number of U.S. infants who died in their first year of life is on the rise, according to provisional data from the National Center for Health Statistics, or NCHS.
“We don’t live in a vacuum,” Dr. Dennis Costakos, director of neonatal and perinatal medicine at the Mayo Clinic Health System in La Crosse, Wisconsin, told USA TODAY. “The health of the baby is often directly related to the health of the mother.”
Experts consider infant mortality a key indicator of overall population health. The latest federal statistics reflect a jump in the death rate for just one year, 2022; however, they raise concerns because the U.S. has also failed in other key population metrics:
maternal mortality rate has increased and
the average life expectancy is declining.
Increases 'add up to general trend'
The
NCHS report marks the first statistically significant increase in infant deaths since 2002. Before this report, the U.S. had seen a 22% decline in child deaths over 20 years, although the U.S. continually had higher infant death rates than other high-income countries.
The change in 2022 data represents a notable moment for public health officials: an increase to 5.6 infant deaths per 1,000 live births, compared with 5.44 in 2021.
“All of these increases, even the small increases, they all just add up to a general trend,” report author Danielle Ely, an NCHS health statistician, told USA TODAY.
The report used figures from the National Vital Statistics System of birth and death records across 50 states and the District of Columbia for children's first year of life. The provisional figures will be finalized in a report expected next spring. However, its authors decided to release the data early to provide a warning to healthcare providers and officials of the growing trend.
The figures also correspond with the child poverty rate doubling in 2022. Another factor for providers to consider:
expanded Medicaid coverage that was available during the COVID-19 pandemic has been cut.
Keeping women and children in good health has to be a conscientious, proactive undertaking said Georgia Machell, interim president and CEO of the National WIC Association, a nonprofit that represents nutrition service provider agencies that implement the Special Supplemental Nutrition Program for the Women, Infants and Children program.
“There needs to be investment in the safeguards in order to support families to reduce infant mortality,” Machell said.
The increase in 2022 infant deaths spanned several demographic groups, with some demographic groups being spared.
The largest statistical uptick in infant deaths was among babies born to Native American and non-Hispanic white women between 2021 and 2022 – for Indigenous infants, from 7.46 to 9.06 per 1,000 births, and for white infants, from 4.36 to 4.52. The infant death rate among children born to Black women climbed from 10.55 to 10.86. Native Hawaiians and other Pacific Islanders also saw a small rise in infant deaths (from 7.76 to 8.5), as did Hispanic people (4.79 to 4.88), though deaths of infants born to Asian American women declined, from 3.69 to 3.5.
Additionally, there were rises in the death rates of babies born preterm – at less than 37 weeks gestation – as well as the rates of infants who died less than 28 days after birth, and those who died 28 days or more into their first year. There were small increases in death rates of babies of mothers 24 and younger and babies born to women 30 to 39. And there was a significant jump in deaths of babies born to mothers 25 to 29.
Among the 10 leading causes of death for babies, maternal complications and bacterial sepsis saw increases in mortalities, the report said.
These states saw biggest rise in infant mortality rates
The deaths were far higher in some regions of the country: Georgia, Iowa, Missouri and Texas saw significant increases in infant mortality rates.
Several of these states moved to restrict abortion access since the U.S. Supreme Court outlawed the constitutional right to abortion in June 2022, though experts warned it may be too soon to gauge any correlation between restricted access to reproductive healthcare and infant mortality.
“Any time we see it trending in the wrong direction, our alarm bells are going off,” said Dr. Allison Gemmill, an assistant professor at Johns Hopkins University’s Bloomberg School of Public Health and a demographer, in a phone interview.
Gemmill has forthcoming research suggesting there was a rise in infant and neonatal mortality in Texas after lawmakers in 2021 enacted
Senate Bill 8, a law banning abortion once a fetal heartbeat is detected, usually around six weeks of pregnancy.
Among high-income countries, the U.S. spends far more on healthcare, yet it has the highest infant and maternal death rate, a
recent study from the Commonwealth Fund found. In the U.S., maternal mortality rates have jumped in recent years, particularly among Black and Native women. Black women had death rates nearly three as high as non-Hispanic white women.
The latest national figures are alarming for Dr. Ayman El-Mohandes, dean of the City University of New York’s Graduate School of Public Health and Health Policy, but he said it is far more alarming that the U.S. has been unable to significantly reduce its mortality rate below what it was in 2000, when 6.89 out of 1,000 births resulted in a baby dying in its first year. Since 2000, infant deaths in the U.S. only declined by one per 1,000 births.
The American infant mortality rate of 5.6 per 1,000 births is about three times as high as Norway's, which El-Mohandes said is notable.
“We need to know who we are comparing ourselves to,” El-Mohandes said, “and what infant mortality can look like.”
The U.S. has put spacecraft on Mars in the past two decades, El-Mohandes said. He hopes the country puts equal emphasis on reducing the number of babies who die before their first birthday.
Report finds more babies are dying in the U.S. amid rising maternal death rates.The U.S. had seen a 22% decline in infant deaths.
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