Fewer Babies Are Dying In US, But Gains Aren’t Equal

Native communities have seen the smallest drop over the last decade, and poverty is likely to blame

Illustration: Tara Jacoby
Mar 21, 2017 at 4:49 PM ET

There’s good news for most of America’s babies in a new report from the Centers for Disease Control and Prevention. The infant mortality rate in the United States dropped 15 percent between 2005 and 2014, reaching historic lows throughout the country. But black people still have the highest rates by far in the nation, and Native Americans saw by far the smallest decrease over the last decade, showing how unequal improvements have been.

As of 2014, the rate for black people is 10.9 deaths per 1,000 births, while the rate for Native Americans is 7.6 — roughly equivalent to Libya and Macedonia, respectively. But while black people have seen significant improvement in the past decade — with infant mortality rate dropping about 20 percent from the 2005 high—Native Americans haven’t seen as big a shift at only a five percent decrease in the past ten years. This is likely a stark reminder of how much poverty is at the root of the problem.

The CDC data brief just offers the numbers, without additional context to explain these disparate trends — to understand that, a paper published earlier this month by the National Academy of Medicine helps. Three researchers from the University of Arizona’s Native American Training and Research Center and the nearby Pima County Health Department — which serves several reservations — link the higher infant mortality rate to the broader challenges many indigenous communities face. These include generally poorer nutrition for mothers and children, higher levels of alcohol and tobacco use by pregnant women, more pollution and environmental degradation, greater incidence of domestic violence, and more.

Many of these issues are intrinsically rooted in poverty, which disproportionately affects both Native Americans and black people, the two ethnic groups with the highest infant mortality. A 2014 paper in the Journal of American Public Health charted how those socioeconomic issues translated into deadly health problems for Native American babies. Between 1999 and 2009, both unintentional injuries and homicide were three times more common for indigenous infants than their white counterparts. Circulatory diseases were twice as common, while flu and pneumonia were four times as common. Even the seemingly random specter of sudden infant death syndrome was nearly three times as common, which the University of Arizona researchers attribute to more smoking and drinking in indigenous households and poor sleeping habits that are in part the result of bad housing situations.

While improved health care access could help native communities, it’s not a panacea, as Pima County Health Department director Francisco Garcia writes at the beginning of the paper.

He recalls the case of a pregnant woman who had to be helicoptered out of her rural community after her intoxicated partner attacked her. “Our team recognized that while we could successfully get her safely through her pregnancy, the real challenges she and her daughter faced would come upon her return home,” he recalls. “For American Indian people, context matters and is a key determinant of health and mortality.”