Number 120, April 2013 
 
 PDF Version (770 KB) 
 
 Marian F. MacDorman, Ph.D.; Donna L. Hoyert, Ph.D.; and T.J. Mathews, M.S. 
 
 Key findings 
 
 Following a plateau from 2000 through 2005, the U.S. infant mortality rate declined 12% from 2005 through 2011. Declines for neonatal and postneonatal mortality were similar. 
 
 From 2005 through 2011, infant mortality declined 16% for non-Hispanic black women and 12% for non-Hispanic white women. 
 
 Infant mortality declined for four of the five leading causes of death during the 2005–2011 period. 
 
 Infant mortality rates declined most rapidly among some, but not all, Southern states from 2005 through 2010. Despite these declines, states in the South still had among the highest rates in 2010. Rates were also high in 2010 in some states in the Midwest. 
 
 Infant mortality is an important indicator of the health of a nation (1,2). This report describes the recent decline in the U.S. infant mortality rate from 2005 through 2011. Changes in infant mortality rates over time are examined by age at death, maternal race and ethnicity, cause of death, and state. The linked birth/infant death data set (linked file) is generally the preferred source for infant mortality rates by race and ethnicity (3,4). This is particularly important for racial and ethnic groups other than non-Hispanic white, non-Hispanic black, and Hispanic. For these three groups, rates calculated from the mortality and linked files have been very similar for many years, and trends are unlikely to differ (3–5). Thus, data from the mortality file are used for this analysis because of their greater timeliness (3,6). Data for 2011 are preliminary (6). Because preliminary data are not available by state, data for the 2005–2010 period were used for the geographic analysis. 
 
 Keywords: infant death, trends, geographic differences, National Vital Statistics System 
 
 U.S. infant, neonatal, and postneonatal mortality rates declined from 2005 through 2011. 
 
 Figure 1. Infant, neonatal, and postneonatal mortality rates: United States, 2000 and 2005–2011 
 
 NOTE: Data for 2011 are preliminary. 
 
 SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set. 
 
 After significant declines throughout the 20th century, the U.S. infant mortality rate plateaued from 2000 through 2005 (7). In 2005, the infant mortality rate was 6.87 infant deaths per 1,000 live births, not significantly different from the rate of 6.91 in 2000 (Figure 1). 
 
 Subsequently, the U.S. infant mortality rate declined significantly from 2005 to 2006, did not change significantly from 2006 to 2007, and then declined significantly each year from 2007 through 2010. 
 
 In 2011, the U.S. infant mortality rate was 6.05 infant deaths per 1,000 live births (based on preliminary data), 12% lower than the rate of 6.87 in 2005, but not significantly lower than 6.15 in 2010. 
 
 From 2005 through 2011, the neonatal mortality rate (deaths under age 28 days per 1,000 live births) declined 11%, and the postneonatal mortality rate (deaths at ages 28 days to under 1 year per 1,000 live births) declined 14%. 
 
 From 2005 through 2011, the U.S. infant mortality rate declined most rapidly for non-Hispanic black women. 
 
 The U.S. infant mortality rate declined 12% for both the total population and non-Hispanic white women from 2005 through 2011 (Figure 2). 
 
 The infant mortality rate declined the most for non-Hispanic black women (16%), and the least for Hispanic women (9%). 
 
 
 
 Historically, infant mortality rates for non-Hispanic black women have been more than twice those for non-Hispanic white women, while rates for Hispanic women have been similar to those for non-Hispanic white women (3). 
 
 Figure 2. Percent change in infant mortality rates, by race and ethnicity: United States, 2005–2011 
 
 NOTE: Data for 2011 are preliminary. 
 
 SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set. 
 
 The infant mortality rate declined for four of the five leading causes of infant death from 2005 through 2011. 
 
 The leading cause of infant death in 2011 was congenital malformations, followed by short gestation/low birthweight, Sudden infant death syndrome (SIDS), maternal complications, and unintentional injuries (Figure 3). Together, these five leading causes accounted for 56% of all infant deaths in the United States in 2011 (6). 
 
 During 2005–2011, the infant mortality rate declined 6% for congenital malformations. 
 
 The infant mortality rate declined 9% for short gestation/low birthweight and 7% for maternal complications, both causes that occur primarily among preterm infants (8). 
 
 The SIDS rate declined 20% from 2005 through 2011, although this decline may be due in part to changes in the way SIDS is diagnosed and reported (9). The rate for unintentional injuries did not change significantly from 2005 to 2011. 
 
 Figure 3. Infant mortality rates for the five leading causes of infant death in 2011: United States, 2005 and 2011 
 
 NOTE: Data for 2011 are preliminary. SIDS is Sudden infant death syndrome. 
 
 SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set. 
 
 From 2005 through 2010, infant mortality declined most rapidly for selected Southern states. 
 
 Sixteen states and the District of Columbia had statistically significant declines in their infant mortality rates from 2005 through 2010 (Figure 4). 
 
 Four states (Georgia, Louisiana, North Carolina, and South Carolina) and the District of Columbia had a decline of 20% or more in their infant mortality rate from 2005 through 2010. These areas have had persistently high infant mortality rates for many years (1,2). 
 
 Several other Midwestern and Southern states with higher-than-average infant mortality rates (1,6) also experienced significant declines: Florida, Illinois, Kansas, Michigan, Mississippi, Missouri, Tennessee, and Texas. States with the largest declines tended to be states with the highest rates. 
 
 No states had a statistically significant increase in infant mortality during this period. 
 
 Figure 4. Decline in infant mortality rates, by state: United States, 2005–2010 
 
 NOTE: Access data table for Figure 4 [PDF - 165 KB]. 
 
 SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set. 
 
 In 2010, the U.S. infant mortality rate was highest among selected states in the South and Midwest regions. 
 
 In 2010, 13 states and the District of Columbia had infant mortality rates of 7.00–7.99, and two additional states (Mississippi and Alabama) had infant mortality rates of 8.00 or higher. In contrast, 12 states had infant mortality rates below 5.00 (Figure 5). 
 
 Although infant mortality rates declined most rapidly among selected Southern states, selected states in the South and Midwest regions still had the highest infant mortality rates in 2010. Pennsylvania and Rhode Island also had high infant mortality rates (7.00 or above) in 2010. 
 
 Differences by state reflect, in part, differences in the population composition of states by race and ethnicity. 
 
 Figure 5. Infant mortality rates, by state: United States, 2010 
 
 NOTE: Access data table for Figure 5 [PDF - 165 KB]. 
 
 SOURCE: CDC/NCHS, National Vital Statistics System, mortality data set. 
 
 Summary 
 
 After a plateau from 2000 through 2005, the U.S. infant mortality rate declined by 12% to a rate of 6.05 in 2011. Provisional infant mortality counts for the first half of 2012 suggest a continued downward trend (10). Infant mortality declined from 2005 through 2011 for all major racial and ethnic groups, with the most rapid decline among non-Hispanic black women. Among leading causes of death, infant mortality declined for four of the five leading causes. Infant mortality rates declined most rapidly from 2005 through 2010 for selected Southern states; still, rates in 2010 remained higher in the South and Midwest than in other regions. 
 
 In 2008, the United States ranked 27th in infant mortality rate among Organization for Economic Cooperation and Development countries (11), and a previous report linked the United States' relatively unfavorable infant mortality ranking to its higher percentage of preterm births (12). Despite the recent infant mortality decline, comparing the 2011 U.S. infant mortality rate with the 2008 international rankings would still have the United States ranked 27th. 
 
 Definitions 
 
 Infant death: Death of an infant before his or her first birthday. 
 
 Infant mortality rate: Number of infant deaths per 1,000 live births. 
 
 Neonatal mortality rate: Number of deaths before age 28 days per 1,000 live births. 
 
 Postneonatal mortality rate: Number of deaths from age 28 days to under 1 year per 1,000 live births. 
 
 Preterm birth: Birth before 37 completed weeks of gestation. 
 
 Data source and methods 
 
 Data presented in this report were based on information from death certificates filed in state vital statistics offices, and subsequently compiled into national data by the National Center for Health Statistics. Data for 2011 are preliminary (6). Causes of death are classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (13). Causes of death are sorted into rank order according to the number of deaths, beginning with the largest number; see the Technical Notes section of National Vital Statistics Reports on annual final deaths data for more detail (5). Text statements were tested for statistical significance using methods described elsewhere (3), and a statement that a given infant mortality rate is higher or lower than another rate indicates that differences in the rates are statistically significant. 
 
 About the authors 
 
 Marian F. MacDorman, Donna L. Hoyert, and T.J. Mathews are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Vital Statistics. 
 
 References 
 
 Suggested citation 
 
 MacDorman MF, Hoyert DL, Mathews TJ. Recent declines in infant mortality in the United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: National Center for Health Statistics. 2013. 
 
 Copyright information 
 
 All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. 
 
 National Center for Health Statistics 
 
 Charles J. Rothwell, M.S., Acting Director 
 
 Jennifer H. Madans, Ph.D., Associate Director for Science 
 
 Division of Vital Statistics 
 
 Delton Atkinson, M.P.H., M.P.H., P.M.P., Acting Director ||||| The states with the steepest declines in infant deaths — Georgia, Louisiana, North Carolina and South Carolina — have long been plagued with some of the nation’s highest infant mortality rates, Dr. MacDorman added. In all four states the rate dropped by more than 20 percent from 2005 to 2010, the latest year for which state data are available. The District of Columbia, which has expanded a home-visit program for poor pregnant women and stepped up other efforts to keep mothers and their babies healthy, saw the biggest drop: from 14.05 deaths per 1,000 births in 2005 to 7.86 in 2010. 
 
 The states with the highest infant mortality rates are Mississippi and Alabama, according to the report. But even Mississippi saw its rate drop by 15 percent from 2005 to 2010. 
 
 Dr. MacDorman said the nation’s rate of premature births — babies born before 37 weeks of gestation — peaked at 12.8 percent in 2006 and had dropped every year since then. That is a likely factor in the decline of the infant mortality rate, she said. In 2009, the latest year for which C.D.C. data is available, two-thirds of all infant deaths in the United States were among preterm babies. 
 
 Another possible factor is a recent emphasis on preventing planned early deliveries. A growing number of hospitals are not allowing mothers to schedule births before 39 weeks without a medical reason. In 2011, the March of Dimes started a public education campaign, Healthy Babies are Worth the Wait, to reduce medically unnecessary deliveries before 39 weeks of gestation. The Department of Health and Human Services began a similar effort, Strong Start, last year. 
 
 “It’s been going on for a few years now and I think it has had an impact,” Dr. MacDorman said of concerted efforts to discourage early deliveries. “It’s maybe leading to just a little change in the culture.” 
 
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 Infant mortality dropped in four of the five leading causes of death from 2005 to 2011: congenital malformations, short gestation/low birth weight, sudden infant death syndrome and maternal complications. The death rate from unintentional injuries rose slightly. 
 
 The decline in deaths attributed to sudden infant death syndrome was particularly striking — the rate went down by 20 percent — but that could have resulted from changes in the way SIDS is diagnosed and reported, Dr. MacDorman said. 
 
 While improving, the nation’s infant mortality rate is still high compared with the rates in a number of other developed countries. In 2008, the United States ranked 27th in infant mortality among the 30 countries in the Organization for Economic Cooperation and Development, according to the National Center for Health Statistics. 
 
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 Janice A. Freedman, executive director of the North Carolina Healthy Start Foundation, a nonprofit group focused on reducing infant death and illness, said that it was difficult to pinpoint reasons for the 20 percent drop in her state’s infant mortality rate from 2005 to 2010, but that better education about preventing SIDS was probably one factor. 
 
 At the same time, Ms. Freedman said she was concerned that state budget constraints would hamper continuing efforts to curb infant deaths. 
 
 “We are cutting budgets and so we are concerned that babies don’t get lost in the politics,” she said. “Numbers can bump up and down, and there are still racial disparities. So there’s still a lot of work to be done.” 
 
 Dr. Kevin Ryan, chief of the women’s and children’s health section of the North Carolina Division of Public Health, said a particularly important goal was to improve the health of women before they become pregnant, focusing on diet, exercise and prevention of chronic diseases like diabetes. 
 
 “In years past, the key was access to early, high-quality prenatal care,” Dr. Ryan said. “We’re looking more and more at addressing the whole life cycle of girls and young women, not just focusing on the period of pregnancy. That’s going to be critical to our success in continuing to improve birth outcomes.”
– After holding steady from 2000 through 2005, the US infant mortality rate dropped 12% from 2005 through 2011, according to a new CDC report. In 2011, the rate was 6.05 deaths of babies less than a year old for every 1,000 births, down from 6.87 in 2000. Premature births also have been dropping since 2006, and many hospitals and other organizations have been working to prevent mothers from scheduling deliveries before 39 weeks without a valid medical reason. Researchers say both those factors likely contributed to the drop in the infant mortality rate, the New York Times reports. Southern states, which have some of the highest infant mortality rates in the country, saw some of the biggest improvements. In Georgia, Louisiana, North Carolina, and South Carolina, the rate declined by more than 20%. Black women, who have also typically seen higher infant mortality rates than white women, experienced a decline of 16%. One report author calls it "encouraging," but says the gap is still too large. The biggest drop was in the District of Columbia, which went from 14.05 deaths per 1,000 births in 2005 to 7.86 by 2010. It has been improving services to moms, babies, and poor pregnant women. The highest infant mortality rates are in Mississippi and Alabama.