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 9.1 infant deaths per 1,000 live births in 2016 is higher than the 8.3 infant deaths per 1,000 live births in 2015. In 2016, there were 59,090 live births in Alabama and the infant mortality rate represented 537 infants who did not reach one year of age. An increase of 43 infant deaths from 2015.
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 2016, that remained true with the infant mortality rate for black mothers being 15.1 infant deaths per 1,000 live births compared to 6.5 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 congenital anomalies (birth defects), low birthweight, preterm births before 37 weeks gestation, Sudden Infant Death Syndrome (SIDS)..
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 265 of the 537 infant deaths in 2016. 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 at least 18 months 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 2016, 12.0 percent of all live births were preterm; up slightly from the 11.7 percent of all live births in 2015. 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, Sudden Unexplained Infant Death, 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 2016, 130 infants died in Alabama from sleep associated causes. These infant deaths accounted for 24 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 crib approved by the Consumer Product Safety Commission.
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 2016, 10.1 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 7.7 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 4,526 in 2016. The rate of teen women smoking during pregnancy decreased to a record low of 8.1 percent of all live births in 2016. The percent of births at 39 weeks gestation has increased from 38.6 percent in 2011 to 42.9 percent in 2016.
Strategies to reduce infant mortality in Alabama
- Increase the use of progesterone to women with a history of prior preterm birth.
- Reduce tobacco use among women of childbearing age.
- Encourage women to wait at least 18 months between giving birth and becoming pregnant again.
- Expand the Well Woman Preventive visit to provide pre-conception and interconception care.
- Continue safe sleep education effforts.
- Continue collaborative efforts to address the opiod epidemic.
- Expand the Fetal and Infant Mortality Review activities at the community level.
- Identifying, studying and learning the factors that play a role in infant survival; implementing initiatives at the community level to improve infant health and vitality statewide.
- Establishing a Maternal Mortality Review Committee to analyze the maternal deaths that occur within the state so as to improve maternal health outcomes.
Page last updated: January 24, 2018