We can do better at reducing U.S. infant mortality rates.

I am embarrassed and saddened each year when I review how the infant mortality rate for the United States compares with that of other nations.

According to the Centers for Disease Control and Prevention, the United States had almost 7 infant deaths for every 1,000 live births in 2002--a total of almost 28,000 babies lost. That ranks us 28th in the world, behind countries that spend much less per capita on health care.

Infant mortality rates also vary greatly between states, to an alarming degree. In 2003, rates ranged from highs of 10.9 infant deaths per 1,000 live births in the District of Columbia and 10.5 deaths in Michigan, to a low of 4.3 deaths in Massachusetts.

Although overall U.S. infant mortality rates are slowly declining, racial and ethnic disparities persist, according to CDC, with 2003 rates ranging from 4.78 infant deaths per 1,000 births for Asian and Pacific Islanders to 13.55 deaths for black infants. Such disparities vary even further at the state level. In 2003, four states--Massachusetts, Minnesota, Oregon and Washington--had 10 black infant deaths for every 1,000 births, some of the lowest in the country for that population. But in Tennessee, 16.9 black babies died for every 1,000 births.

These striking statistics can be ameliorated if we consistently used all of the evidence we have on lowering infant mortality. It is one of the greatest injustices in our nation that a baby's health depends on where a child is born.

One reason for this is that there is no guaranteed set of comprehensive services available nationwide for the four key periods related to infant mortality--before pregnancy, during pregnancy, at birth and during the first year of life. Interventions such as teen pregnancy prevention, nutrition programs, folic acid, insurance coverage and substance abuse treatment need to be available for all women of childbearing age.

Systems-level policies and regulations are also needed in every hospital to ensure more babies survive. Regulations that work include those that define levels of care in hospitals and ensure quality perinatal regionalized care systems as well as those that promote breastfeeding. We know that it takes a village to lower infant mortality and improve health and development of our nation's children.

Having the resources to address the problem is key. States receive funding via the Maternal and Child Health Block Grant with the mandate to be a "point of accountability" for mothers and children. The Healthy Start programs, funded since the early 1990s, have helped communities address barriers related to infant mortality. But such programs are often targeted by budget cuts.

To do better at helping babies survive, we need to develop and sustain the political will to fully fund the Maternal and Child Health Block Grant and Healthy Start. We must also support all services and policies we know improve infant outcomes.

Continuing to provide a patchwork of fragmented services for mothers and infants across the country will not improve our infant mortality rates. We must--and can--do better for women and children.

Deborah Klein Walker, EdD

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