Infant Mortality

Infant mortality reflects the overall state of maternal health as well as the quality and accessibility of primary health care available to pregnant women and infants in a geographical region. Alabama's infant mortality rate of 8.3 infant deaths per 1,000 live births in 2015 is lower than the 8.7 infant deaths per 1,000 live births in 2014.  In 2015, there were 59,651 live births in Alabama and the infant mortality rate represented 494 infants who did not reach one year of age. 

Disparities by race continue to persist when looking at pregnancy outcomes.  Traditionally in Alabama, the rate of infant mortality for black mothers is twice the rate of white mothers.  In 2015, that rate increased to nearly three times with the infant mortality rate for black mothers being 15.3 infant deaths per 1,000 live births compared to 5.2 infant deaths per 1,000 live births for white mothers.

Most often, there is no single factor that causes the death of an infant, and it is often the result of a number of contributing factors. Leading factors in Alabama that contribute to infant mortality include low birthweight, preterm births before 37 weeks gestation, Sudden Infant Death Syndrome (SIDS), Sudden Unexplained Infant Death (SUID), and unsafe sleep-related conditions associated with strangulation and suffocation.

Birthweight is a significant factor directly related to infant morbidity and mortality.  Babies born too soon or too small encounter significant risks of serious, costly, and devastating life-long health conditions.  Very low birthweight is defined as weighing less than 1,500 grams (3 pounds, 5 ounces) and these infants accounted for 233 of the 494 infant deaths in 2015.  These very small and fragile babies are at risk of developing major, long-term physical and cognitive problems with consequences impacting families and state resources.  The definitive cause(s) of being born low birthweight remains unknown; however, the increasing magnitude of the problem has continued to gain attention.  Currently, the few measures that can reduce risk factors include prevention of unintended or mistimed pregnancies, spacing births two years apart, and being healthy before and between pregnancies. 

Prematurity is the second leading contributing factor in infant death.  Prematurity is the birth of an infant at least three weeks before a baby's due date or 37 weeks of gestation.  In 2015, 11.7 percent of all live births were preterm.  Important growth and development occurs throughout pregnancy, but especially in the final months and weeks of gestation.  Being born preterm carries serious, medical, developmental, and potentially behavioral problems that can last a lifetime.  Addressing prematurity is complex and has no one single solution.  Infants who survive due to the advancements of modern medicine and technology may spend weeks or months hospitalized in a neonatal intensive care unit.  Not only is premature birth an emotional roller coaster for families, but being born preterm costs ten times more than being born full-term at 39 weeks or more gestation.

An additional concern in Alabama resulting in a high number of infant deaths includes SIDS, SUID, and unsafe sleep related conditions.  These deaths occur among infants less than one year old and are diagnosed after a complete examination of the death scene, an autopsy, and a review of the infant's medical history.  Although the causes of death in many of these infants cannot be explained, most occur while the infant is sleeping in an unsafe sleeping environment (co-sleeping with others, accidental suffocation and/or strangulation, or roll-over).  In 2015, 108 infants died in Alabama from sleep associated causes.  These infant deaths accounted for 22 percent of the total infant mortality rate.  Prevention and risk reduction begins with always placing an infant alone in their own sleep area, on their back with no pillows, bumper pads, soft bedding, or toys, and in a safety-approved crib.

The lifestyle conditions of the mother, such as socio-economic status, where she was raised and educated, as well as choices such as smoking and drug misuse, have an impact upon the unborn child.  In 2015, 10.4 percent of all live births were to mothers who admitted to smoking during pregnancy.  Infants born to mothers who smoke are three times more likely to die than infants born to nonsmoking mothers.  Mothers using or dependent on opiates are on the rise in Alabama.  The effects of these substances on the unborn infant are creating serious challenges for perinatal providers as they treat newborns that experience the withdrawal effects associated with a condition known as neonatal abstinence syndrome. 

On a positive note, the percent of births to teen mothers was the lowest ever recorded at 8.0 percent of all live births.  This number has been consistently trending down since 2007 in Alabama.  Over a ten-year period, the number of births to all teens has decreased from a high of 8,776 in 2007 to 4,790 in 2015.  The rate of teen women smoking during pregnancy decreased to a record low of 9.2 percent of all live births in 2015.  The percent of births less than 37 weeks gestation has remained steady over the last five years with the 2014 and 2015 rates being 11.7 percent of all live births.  Additionally, the percent of births at 39 weeks gestation has increased from 38.6 percent in 2011 to 43.6 percent in 2015.

Factors Contributing to Alabama's High Rate of Infant Deaths

  • Low birthweight babies
  • Preterm infants
  • SIDS, SUID and unsafe sleep environments
  • Substance abuse including smoking and neonatal abstinence syndrome
  • Maternal chronic health conditions existing before and during pregnancy
  • Short birth intervals
  • Mistimed or unintended pregnancies

Page last updated: April 14, 2017