Infant mortality rate shows need to take better care of moms

By Lisa Jarvis

Tuesday, Nov. 28, 2023 | 2 a.m.

New provisional data from the Centers for Disease Control and Prevention offer a horrible statistic: The infant death rate in the U.S. rose by 3% in 2022 to 5.6 deaths per 1,000 live births, the first significant increase in about 20 years.

It’s too soon to know if this is the start of a terrible trend or one bad year. Public health researchers will need time and more granular data to unravel the factors contributing to the rise in infant deaths.

Nonetheless, the data reflect hard truths about the state of infant and maternal health care in the U.S. — and there are reasons to worry the situation could worsen. We should consider even one year’s reversal in infant deaths, a rate already exceeding that of the country’s economic peers, as a sign that more should be done to improve the prospects for moms and babies in the U.S.

Marie Thoma studies reproductive and maternal and infant health at the University of Maryland School of Public Health. When she saw the data, “my stomach just dropped,” she says.

The CDC pointed out a few specific areas of concern: The increase in deaths was most pronounced in babies born to Alaska Native and American Indian women, as well as white women and in births that were preterm (less than 37 weeks’ gestation) and early preterm (less than 34 weeks). Moreover, more deaths were due to maternal complications and bacterial sepsis.

The question is whether this is a one-year blip or part of a more concerning shift. Public health experts stress that there’s not enough information yet to draw conclusions about why more babies died last year. But they also stress that we can’t talk about infant deaths without talking about the ongoing crisis in maternal health. Moms and babies are a package deal, and the failures on one reflect failures for the other.

And it’s fair to say that “the pressures on reproductive health are stacking up,” which could have consequences for infant health in the coming years, says Laurie Zephyrin, senior vice president for Advancing Health Equity at the Commonwealth Fund. Those pressures include increasingly limited access to abortion care services, rising rates of maternal mortality and morbidity, growing swaths of the country that lack maternal care, and lack of insurance coverage.

Maternal deaths in the U.S. more than doubled between 1999 and 2019, with American Indian and Alaska Native and Black women faring much worse than other groups. The numbers further deteriorated during the early part of the pandemic, and while provisional CDC data suggest an improvement in 2022 and 2023, they still remain significantly higher than before COVID hit.

Those unconscionable statistics have forced some policy changes that could benefit moms and, by extension, babies. States, for example, seem to recognize that taking care of mom is critical for taking care of baby. Already 38 states and Washington, D.C., have extended the time that women are covered by Medicaid after birth from six weeks to a full year, and seven more states plan to do so, according to KFF. Given about 40% of births in the U.S. are covered by Medicaid, the hope is that lengthier insurance coverage, which first became available in April 2022, can help move the needle on maternal mortality and morbidity.

But the counterweight to that good news is that some 10 million people and counting, including some 1.8 million children (including infants), have been dropped from Medicaid as pandemic-era rules guaranteeing continuous coverage unwind. There’s a reasonable fear that infant and maternal mortality rates could worsen if people aren’t getting appropriate care, whether that’s before, during or after a pregnancy.

It’s also tempting to draw a line from newly implemented abortion bans to infant deaths. After all, three of the four states with the most significant increases in the death rate (Georgia, Missouri and Texas) had the most restrictive laws either leading into or immediately following the mid-2022 dissolution of Dobbs.

And while one recent study suggests bans could lead to a rise in infant deaths, it’s too soon to tell if that will be broadly true. Among the fears is that women will be forced to carry out pregnancies that aren’t viable due to severe genetic or other birth defects. An analysis by CNN found that such deaths rose by 21% in Texas following severe restrictions on abortion.

States with bans already had the worst infant and maternal mortality rates, and giving birth there could get riskier: A Commonwealth Fund analysis found that states with abortion restrictions have a higher proportion of so-called “maternity care deserts,” or counties lacking obstetric providers and hospitals offering obstetric care — a disparity that could widen as some OB-GYNs choose to leave states with strict bans.

Researchers undoubtedly will spend the coming months picking apart what happened in 2022 to understand how to prevent infant mortality in the U.S. from worsening. But there are already many emerging forces working against maternal and infant health. The key question is whether policy to improve obstetric care can keep up with policy that undercuts it.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.