Expertise in Indiana Health

Infant Mortality

In the United States, Indiana ranks among the highest for the number of babies who die before their first birthday. Despite community involvement and active programs attempting to address factors related to this devastating issue, the state’s infant mortality rate is 20 percent higher than the national average.

Infant mortality is a complex problem. That’s why IU School of Medicine, as part of its strategic plan prioritizing improving population health in Indiana, is partnering with communities throughout the state to address an array of contributing factors—from spacing between pregnancies and maternal care to safe sleep.

Community Health and Social Stability

Twice as many deaths occur in the first year of life than during the next 13 years combined, making infant mortality a leading indicator of a community’s health and social stability. Based on this metric, Indiana is not doing well.

Nationally, the infant mortality rate has decreased over the past ten years—from 6.5 to 5.9 deaths per 1000 live births. While we hope to eventually get to zero, the Healthy People 2020 goal for the United States is 6.0. Indiana, at 7.5—in 2007 as well as in 2016—is still well above that target goal, making this a high-priority issue for the state’s leaders.

In his 2018 State of the State address, Governor Holcomb set a goal to become the best state in the midwest for infant mortality rates by 2024. To help achieve this ambitious goal, IU School of Medicine is working with its clinical partners, including Eskenazi Hospital and IU Health, to address this devastating issue in new ways.

601
infants died in Indiana in 2017
8
Indiana's rank among states with highest infant mortality rates
48
percent of infant mortalities is a result of perinatal risks
32
Indiana counties lack obstetrics services

Causes of Infant Mortality

Nationally and in Indiana, perinatal risks and preterm birth account for about half of infant mortalities. The other half are categorized as Sudden Unexplained Infant Death (SUID), congenital malformations, assaults and accidents, and other causes, including infections.

To determine where babies are at the highest risk, researchers map the infant journey into four periods—maternal health/ prematurity, maternal care, newborn care and infant health. A reference group whose population has a low mortality rate is selected. For example, researchers may select white women, with at least 13 years of education between the ages of 20-40 and who are privately insured. This population tends to have the best outcomes in pregnancies and infant survival.

The difference in infant mortality between this reference group and the rest of the population is defined as excess mortality. This indicates the number of potentially preventable deaths if we presume that the whole population can achieve the same low infant-mortality rates as the reference group. In Indiana, about 40 percent of excess mortality is in maternal health / prematurity and 40 percent is in infant health.

3
percent of zip codes experience 25% of infant deaths
50
percent of all Indiana births ore financed by Medicaid
14
hours between each infant death in Indiana
0
progress in infant mortality incidence over 30 years

Collaborative Projects

Infant mortality results from a complex intersection of biological, social, economic psychological and environmental factors. Data shows that more than a fourth of all infant mortality cases in Indiana occur in three percent of the state’s zip codes, and half of these zip codes are in Marion County. This alarming statistic has created renewed urgency for IU School of Medicine to make meaningful change in the delivery of information and support services to people throughout Indiana, especially those in under-served communities.