Despite spending more on healthcare, the United States has the highest infant and maternal mortality rate of any similarly wealthy country. This is widely accepted to the result of generational disparities in healthcare access, quality, and affordability, with lower socioeconomic and minority populations being disproportionately affected, and it appears to be worsening. Our infant mortality rate, defined as the number of infant deaths for every 1,000 live births, had been slowly improving over the past couple of decades, decreasing 22% between 2002 and 2021, though this trend now appears to have reversed.

According to recently published data from the CDC, 2022 saw a significant increase in the infant mortality rate of 3%, going from 5.44 (19,928) in 2021 to 5.60 (20,538 deaths) last year. While this might be a fluke, it represents the first year-to-year increase since 2002. And even if considered a random fluctuation that will regress to the mean, our mean is tragically and consistently terrible.

For some perspective, the infant mortality rate in Germany was 2.344 in 2022, which was down more than 8% from the previous year. Germany is not the outlier. France decreased by 2.5%. Portugal’s rate dropped by almost 5%. Japan’s dropped nearly 2.5% as well, and their infant mortality rate was already extremely low. Now it sits 1.6. Iceland has a rate of 1.4 and also saw a decrease. Country after country, many with less resources than the United States, had fewer dead babies in 2022. We are the outlier.

There are differences in how live births are reported in the United States compared to some other countries that make our numbers look a little worse. Babies that were born prematurely at the edge of viability, and who subsequently died, might be reported as miscarriages or stillbirths in another country while we might count it as a live birth. When accounted for, however, this only narrows the gap by a small amount. When comparing apples to apples, our shockingly high infant mortality rate still stands out.

There are patterns in the deaths that tell a story we have sadly been hearing for a very long time in this country. They were not evenly distributed. First off, the mortality rate of infants of American Indian and Alaska Native (AIAN) women increased from 7.46 to 9.06 per 1,000 live births. Contrast that with infants of Asian, non-Hispanic women, who died at a clip of 3.5 per 1,000 live births in 2022. That group has the lowest of any in the United States, followed by infants of White, non-Hispanic women with a mortality rate of 4.52.

Children most likely to die before their 1st birthday in this country, however, are Black, non-Hispanic infants. Although not a statistically significant difference compared to 2021, infant mortality rates in this group increased from 10.55 to 10.86 in 2022. Though the math is pretty obvious, I feel it’s important to point out here that Black babies are more than twice as likely to die than their White counterparts in this country, which is consistent with the stark difference in mortality between Black and White women during pregnancy.

The most common causes of infant death in 2022 were consistent with previous years. Topping the list was congenital malformations, followed by complications from prematurity and low birthweight, SIDS, unintentional injuries, and maternal complications of pregnancy. With regards to prematurity/low birthweight and pregnancy complications, both of which being more likely when a mother has limited or absent prenatal care, it shouldn’t come as much of a surprise that the health of a mother and her baby are linked. The rate of infant deaths caused by maternal complications increased by 9% last year.

Again, even if the increase in infant mortality seen last year ends up being being a fluke and the general trend of decreasing rates resumes in 2023, there still would’t be much of a reason to celebrate. We have a very long way to go to even approach the rates seen in similarly rich countries. Unfortunately, the roots of our abysmal numbers, and the huge disparity in deaths when comparing different populations, run deep in this country.

You would think that keeping children alive to see their first birthday would be a goal capable of uniting people despite their political differences.

But here we are…again.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.