by Mary Jessica Hammes
September 01, 2008

It’s a grim fact—in 2005, 33 U.S. states had higher infant mortality rates than the national average of 6.37 deaths out of 1,000 live births—a national average that could be much better.

According to the CIA World Factbook, 42 countries have better infant mortality rates than the U.S., which ranked at 180 out of 222 countries.

Recently, public health officials have become alarmed by the increase in some states’ infant mortality rates. Last year, the New York Times reported that infant death rates were rising in the Southeast, or staying at levels much higher than the national average; some doctors in the article blamed a lack of prenatal care resources in severely impoverished areas, as well as obesity. (Indeed, maternal obesity may add major complications during pregnancy, which then puts babies at risk for preterm birth and infant death, according to a recent report from Trust for America’s Health and the Robert Wood Johnson Foundation.)

In August, it was reported that in Alabama—a state whose infant mortality rate is one of the highest in the nation—the infant mortality rate in 2006 was 9 deaths per 1,000 live births; in 2007, it was 10. The infant mortality rate increased slightly for black and Hispanic infants; for white infants, the rate was the highest it has been in over a decade.

Also concerning is the disparity between black and white families. According to the CDC, the infant mortality rate among black women (13.6 deaths per 1,000 live birth) is more than twice that of white women (5.66 deaths).

There are many factors that contribute to high infant mortality rates—like substance abuse, poor nutrition, lack of prenatal care, chronic illness, and sudden infant death syndrome, according to the CDC.

But there’s another fact we should examine: those states with the highest infant mortality rates also have the lowest rates of breastfeeding. And the states with high rates of breastfeeding are also the ones with the lowest infant mortality rates.

We already know that breastfeeding can reduce infant mortality rates. In fact, breastfeeding could prevent up to 720 post-neonatal deaths in the U.S. each year, according to 2004 research from the National Institute of Environmental Health Sciences.

Let’s dig a little deeper.

According to the Annie E. Casey Foundation, state public health departments and news reports, Mississippi has the highest rate of infant mortality at 14.1 deaths per 1,000 live births (after the District of Columbia, which isn’t ranked). Louisiana follows at 10.4, then Alabama at 10, Delaware at 9, Tennessee at 8.9, North Carolina at 8.8, Ohio at 8.3, Georgia at 8.2, and Oklahoma and West Virginia tie at 8.1.

Utah has the lowest rate at 5 deaths per 1,000 live births, followed by Minnesota and Washington tied at 5.1, Massachusetts and New Jersey tied at 5.2, and California and Iowa tied at 5.3.

According to the U.S. Census Bureau, the national percentage of people living in poverty (using a three-year average, from 2005–2007) is 12.5 percent. Of the top 10 states with the highest mortality rates, all but one are above the national average. Mississippi’s poverty rate is the highest, at 21.1 percent; Louisiana’s is 17.1 percent, and Alabama’s is 15.2 percent.

Now let’s look at the states with the low infant mortality rates. With the exception of California, they are all below the national average: Utah’s poverty rate is 9.4 percent; Minnesota’s is 8.5 percent; and Washington’s is also 9.4 percent.

The CDC’s annual breastfeeding report card features an mPINC (Maternity Practices in Infant Nutrition and Care) score, which measures the extent that each state’s birth facilities support breastfeeding; the maximum score is 100. Not all of the states with high infant mortality rates had low mPINC scores, although the top three did (Mississippi’s score was 50, Louisiana’s was 54, and Alabama’s was 55). The states with low mortality rates had slightly higher mPINC scores (Utah’s was 61, Minnesota’s was 65 and Washington’s was 72), but their rates of long-term breastfeeding were higher. For instance, in Mississippi, 50.2 percent of women ever breastfed, with 21.8 percent still breastfeeding at six months; in Utah, 90.3 percent of women ever breastfed, with 60.4 percent still breastfeeding at six months.

Also, 9 of the 10 states with the lowest infant mortality rates met the CDC’s Healthy People 2010 goal for breastfeeding.

It’s clear that high rates of poverty and obesity—and low rates of breastfeeding—are present in communities with high infant mortality rates.

Which makes one wonder: do impoverished and obese women tend to breastfeed less?

In 2004, mothers living below the poverty line were less likely to breastfeed, according to the CDC’s National Immunization Study. Perhaps this has to do with education: the same study found that 52 percent of college-educated mothers breastfed, as opposed to 35 percent of women with some college education, and 28 percent with a high school degree.

And, it turns out, overweight mothers—especially white and Hispanic women—do breastfeed less, according to 2004 research published in The Journal Of Nutrition. baby gooroo recently reported on a new study that suggests obese women may benefit from extra support during breastfeeding.

How can the U.S. improve its infant mortality rates? Perhaps it could look to the example of Sweden. We’ll pick that country since it mirrors the U.S. in an interesting way: both held the position of just missing being the top and last country in a recent study. In a 2007 UNICEF report on child wellbeing in rich countries, Sweden ranked next to first (right after the Netherlands) for the highest material wellbeing, health and safety, educational wellbeing, family and peer relationships, behaviors and risks, and subjective wellbeing. Out of 21 nations, the U.S. ranked next to last.

In Sweden, 97 percent mothers breastfeed immediately following birth. According to Sweden’s National Board of Health and Welfare, 70 percent of children born in 2000 were still being breastfed at six months. And Sweden’s infant mortality rate is just 2.75 deaths out of 1,000 live births.