Dear reader,
Last week, we began a weekly conversation from Headway about the indicators that help us understand how the U.S. and the wider world are changing, starting with the birthrate. Today, we continue that conversation with what you might consider the birthrate’s troubling opposite: our rates of infant mortality.
There’s no way around this: The proportion of babies who die before their first birthdays is a measure of heartbreak. Yet for most of our lifetimes, as the rate has fallen, it’s also been a window into a real success story. The past century and change saw an astonishing rise in our collective abilities to keep babies alive.
In the past few years, however, that long record of progress has faltered. We asked the reporter Tim Balk to tell us where it stands.
— Matt Thompson
So we’re backsliding?
For the first time in 20 years, the infant mortality rate rose in 2022 — hitting 5.6 infant deaths for every 1,000 births. Health experts were alarmed, but as of the second quarter of 2025, the rate is now closer to its prepandemic level, standing at 5.4, according to provisional estimates. The rate is determined by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention, which collects data from state health agencies.
Surviving infancy used to be a roll of the dice. Keeping a vast majority of babies alive is considered one of the signature successes of public health.
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As late as 1885, more than 300 babies died for every 1,000 births in the U.S., according to a study in the New England Journal of Medicine.
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In 1975, the number was about 16, according to the government.
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The number of babies dying continued to decline with only occasional exceptions all the way until the Covid-19 pandemic. The cause of the spike is hard to pinpoint, but some studies suggest it has to do with abortion restrictions that were enacted at the time.
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Mortality rates are especially high in states where laws were passed to restrict abortions after Roe v. Wade was overturned in 2022.
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Because of the laws, a mother carrying a fetus with severe congenital disorders may now be more likely to carry to term a child that cannot survive after birth.
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Abortion restrictions can also limit a mother’s access to care, which is critical to an infant’s survival.
This has played out in Southern states, where some of the country’s most stringent abortion laws were passed.
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In Arkansas, the rate climbed to 8.2 in 2023, up from 7.5 in 2014.
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The situation is especially bleak in Mississippi, where a public health emergency was declared in August after the rate hit 9.7.
Where else do we see disparities?
Other factors also influence how likely a baby is to die, including the wealth of the mother and of the state where she lives. For example, experts say that Mississippi, one of America’s poorest states, has fewer programs to help mothers navigate the health care system. As in other rural states, the rate is high there because women often have to travel far for care.
By contrast, infant death is rarer in wealthy states like Massachusetts and Vermont, where the rate is below 4.0. New Hampshire’s rate dropped to 2.9 in 2023, down from 4.4 in 2020, according to government data.
Disparities also fall significantly along racial lines. In 2023, death was more than twice as common for infants of Black mothers as for those of white mothers. The gap is wider now than it was during slavery.
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Infant mortality is one of many areas where health outcomes reflect racial wealth gaps.
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Experts say that ongoing racism in the health care system may deter Black patients from seeking care, which could increase infant mortality.
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While the rate is relatively low for white women, groups that have higher birthrates — including Black, American Indian and Alaska Native mothers — have much higher rates of infant death. If the country made significant strides with those groups, it would most likely be positioned to experience substantial progress overall.
Where does the U.S. stand worldwide?
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Dr. Neel Shah, chief medical officer of Maven Clinic for women’s and family health, said disparities in access to prenatal and neonatal care were particularly severe in the U.S. This was one reason the U.S. ranked 59th in global infant mortality in 2023 — far below its peers.
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The U.S. is wedged between Qatar and Romania, according to the Commonwealth Fund, a New York research group.
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It is far behind Australia (3.2), France (3.0) and Japan (1.8).
The relatively high rate in the U.S. can also be attributed to stressful environmental factors, according to Dr. Atheendar Venkataramani, a health economist at the University of Pennsylvania. When a mother is exposed to poverty or crime or cannot receive basic care during a pregnancy, it can be detrimental to the health of the unborn child. Progress in those areas appears stagnant in the U.S., Dr. Venkataramani said, making the infant mortality rate an indicator of much more than just the health of babies.
“It’s really like looking in the mirror of society when you look at those numbers,” he said.
What can I read to learn more?
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More babies appear to be dying during sleep, a trend that has confounded experts.
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One study published in 2024 suggested that falling bat populations have led farmers to use more pesticides to kill insects — which might have caused regional infant mortality rates to rise.
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Researchers have also found that the death of a mother may increase the risk that an infant will die, too.
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“A Good Time to Be Born,” by Dr. Perri Klass, explores how advances in science and public health give 21st-century parents the remarkable expectation that their children will outlive them.
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Several physicians who pioneered lifesaving medical treatment for premature babies have died in the last few years, and their obits offer a glimpse into what it took to bring the infant death rate down over the 20th century.
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A 2024 analysis published in The Lancet credits vaccinations for 40 percent of the “observed decline in global infant mortality” that has happened since 1974.
— Tim Balk
Your turn
Test your knowledge:
In August, a decade-long study on poverty that was conducted in Kenya found that which intervention lowered infant mortality rates by nearly half?
Tell us your thoughts: Has access to health care affected how you think about having and raising children? Have you or has someone close to you ever experienced the loss of an infant, and did the experience open your eyes to ways our society could be better? Please email your thoughts to [email protected].
What we heard: Several of you wrote in last week to comment on our falling birthrates, and most of your messages had a surprisingly consistent theme: Maybe we should be having fewer babies.
One reader from California likened the argument for continued population growth to deficit spending. “More children and then workers produce economic advantages now, but then all those people become retirees who need to be supported later,” the respondent wrote, adding, “This can’t go on forever.”
Another reader felt that the biggest benefits of a falling human population will be to the planet itself: “Less pollution, less deforestation, less mass extinctions of other species, etc., etc. Obviously I will not be around to see that happen, but I hope it does.”
As our New York Times colleague Amanda Taub wrote this week, though, population decline is likely to pose genuine and significant challenges, just as our skyrocketing population growth once did.
The Headway initiative is funded through grants from the Ford Foundation, the William and Flora Hewlett Foundation and the Stavros Niarchos Foundation (SNF), with Rockefeller Philanthropy Advisors serving as a fiscal sponsor. The Woodcock Foundation is a funder of Headway’s public square. Funders have no control over the selection, focus of stories or the editing process and do not review stories before publication. The Times retains full editorial control of the Headway initiative.
The post Infant Mortality Fell for Decades. Why Did That Stop? appeared first on New York Times.
