An 18-month-old girl plays outside on the front porch of her home in West Virginia.

18-month-old Tymber plays outside on the front porch of her home in West Virginia. Nearly every state has pockets of promise and great disadvantage. Photo credit: Victoria Zegler

How Infant Mortality Rates in U.S. Differ by State

Closing equity gaps and making all states and counties in the United States great places to raise kids would give millions more children full childhoods that set them up for successful futures. In its 2020 U.S. Complement to the Global Childhood Report, Save the Children takes a closer look where and why children in America are dying at a young age.

The report examined data from more than 2,600 counties and county equivalents in all 50 states, revealing deep and far-reaching equity gaps for kids in America, based solely on where they grow up. In the bottom-ranked counties, children die at rates up to 5 times those of children in the highest ranked counties in their state.

We know this is unacceptable. No child should die from a preventable cause.

These gaps are a direct result of decades of systemic inequality that holds children and their communities back. Save the Children is committed to ensuring every child – regardless of race, place or family income – has a healthy start, the opportunity to learn, and protection from harm.

How Child Death Rate Differs by State

Children in the most disadvantaged counties die at rates up to 5 times those of children in the highest ranked counties in the same state. In Virginia, for example, York County has a child death rate of 27 per 100,000, while in Petersburg City the rate is 128 per 100.

More children die (per capita) in Jackson County, South Dakota – 1 child in 420 each year – than in any other U.S. county. This is comparable to child death rates (ages 0-14) in Cambodia and Iraq.

Differences across racial and ethnic groups are particularly striking. Across America, black babies are more than twice as likely to die before their first birthday as white babies. Black babies are more than 3 times as likely to die from complications related to prematurity as compared to white babies[i].

Infant Mortality Rate State-Level Findings

In 2018, 21,467 babies in the United States died before their first birthday.

Mississippi has the nation’s highest rate of children dying before their first birthday: 8.5 deaths per 1,000 live births – well above the national average of 5.6. The nation’s lowest infant death rates are found in New Hampshire and New Jersey.

Evidence shows differences in infant mortality rates across urban and rural settings could be related to differences in maternal conditions during pregnancy, including poverty, health and lifestyle choices, and access to health care services.

In order to reduce infant deaths, these findings suggest states need to address racial and ethnic disparities disadvantaging black children in both rural and urban areas.

Further, solutions must be highly contextualized to address the differences in direct and underlying causes of infant death in urban and rural areas.

Child Homicide and Suicide Rate Violence State-Level Findings

In 2018, 5,700 children were murdered or committed suicide.

Alaska and South Dakota had the highest rates of violent deaths, as measured by homicides and suicides among children aged 0 to 19, each with over 14 violent deaths per 100,000 children – twice the national average of 7. Other states with double digit violent death rates are: New Mexico (12.8), Missouri (11.9), Montana (11.4), Mississippi (10.7), South Carolina (10.6), Nevada (10.5), Tennessee (10.5), Alabama (10.4), Louisiana (10.4) and Colorado (10.1).

How Many Children Could Be Saved?

Save the Children has estimated how many childhoods could be saved if all counties become great places to raise kids.

If each state performed as well overall as its highest ranked county on child survival  – in other words, if state-level childhood equity gaps were closed completely – there would be 15,000 fewer child deaths.

2 of every 5 child deaths would be prevented (44%). Some of the greatest gains would be made in Georgia, Iowa, Missouri, Rhode Island and Tennessee, where child death rates under age 18 would fall by 60% or more. Closing survival gaps would mean 1,400 fewer deaths per year in Texas and 1,700 fewer deaths in California.

We know this change is possible. Together, we can ensure every last child has the childhood – and future – they deserve.

[i] U.S. Complement to the Global Childhood Report 2018


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