Infant mortality rose in the U.S. for the first time since 2002, here's where Wisconsin stands

For the first time in 20 years, the infant mortality rate in the U.S. rose in 2022, the Centers for Disease Control and Prevention announced last week .

The nationwide rate rose from 5.4 to 5.6, meaning more than five of every 1,000 babies died before their first birthday in 2022. In Wisconsin, the infant mortality rate is slightly worse than the national average, according to the CDC.

Experts say the numbers signal a troubling trend of worsening infant and maternal health across the country, including in Wisconsin. The U.S. has a higher infant mortality rate than other high-income countries , and Wisconsin ranks among the bottom half of states.

"Every time there is a baby who dies before the age of one, that is a tragedy," said Dr. Jasmine Zapata, the state's epidemiologist and chief medical officer for maternal child health. "It's more than just numbers, statistics to analyze. These are real families and real lives impacted."

Here’s why infant mortality rates are rising nationwide and how Wisconsin compares with the rest of the country.

Are infant mortality rates rising in Wisconsin?

Infant mortality rates have been decreasing overall in Wisconsin since the early 2010s — but not by much, according to the Wisconsin Department of Health Services .

In the past decade, the state’s infant mortality rate was the highest in 2017, with 6.3 of every 1000 babies dying. The rate fell to 5.3 in 2021 but ticked back up to 5.6 in 2022, DHS reported.

The CDC report logged slightly worse numbers in Wisconsin than DHS: It found the state's infant mortality rate was 5.8 in 2022, with 348 babies dying.

Dr. Nathan Lepp, a neonatal specialist at UW-Madison, said it’s too soon to tell whether the rising rates are a “blip or trend.” Infant mortalities may remain overall steady or decreasing, despite the slight surge.

“Even if it’s just a blip, I think this is an opportunity for us to say it’s still too high,” Lepp added. “We are still much higher than where we should be as a nation with the resources and the healthcare we have.”

Some parts of Wisconsin also lag in another key metric of neonatal and infant health: preterm births, or the number of babies born 37 weeks of pregnancy. The preterm birth rate in Wisconsin in 2022 was 10.3%, slightly better than the national rate of 10.4%, according to March of Dimes, a nonprofit group working to improve maternal and infant health .

But 13 Wisconsin counties had preterm birth rates over 11%, March of Dimes reported . Menominee ranked worst with a rate of 16.9%, while Milwaukee was fifth-worst with a rate of 11.9%.

What are the leading causes of infant deaths?

The CDC cited five leading causes for infant deaths nationwide in 2022, in the following order:

• Congenital malformations (19.5% of deaths)
• Disorders related to short gestation and low birth weight (14.0% of deaths)
• Sudden infant death syndrome, or SIDS (7.4% of deaths)
• Unintentional injuries (6.6% of deaths)
• Maternal complications (5.9% of deaths)

These patterns largely hold true in Wisconsin: low birth weights and sudden unexpected infant death syndrome are among the leading causes of death, especially for Black and Native populations, according to DHS.

The age of a pregnant person can also affect their baby's health. Infant mortality rates were highest among pregnant people under 15 years old, with 14.25 deaths for every 1000 births, according to the CDC. After that, mortality rates decrease, but begin to tick back up when the maternal age reaches 35. Pregnant people over 40 experienced 6.73 deaths for every 1000 births.

Lepp said it's difficult to tell what might have caused these birth and infant health complications to tick up in 2022, both nationally and in Wisconsin. The pandemic may have played a role, as pregnant people were especially vulnerable to more severe COVID-19 infections.

Some experts also said the 2022 Supreme Court decision revoking the federal right to abortion may have exacerbated poor maternal health outcomes. The long-term effects of overturning Roe v. Wade are still unknown, Lepp said, but it may have an impact on maternal and infant health in states like Wisconsin with limited abortion access .

"In Wisconsin — and this is pure speculation — you may see some of those rates related to congenital malformations, chromosomal anomalies go up," Lepp said, "because, in some states, where you would have been able to end the pregnancy, you're no longer allowed to, so you have to carry baby to birth, and then they could die after birth."

Racial and ethnic disparities in infant health

One pattern persists across national and state data: Black, Native and Hispanic infants consistently have poorer health outcomes than white infants.

In 2022, nearly 11 of every 1000 Black infants nationwide died before their first birthday, according to the CDC. Rates for American Indian or Alaska Native and Native Hawaiian infants were similarly high at 9.06 and 8.5, respectively, compared to 4.52 for white infants.

The disparities are even more stark in Wisconsin. From 2019 to 2021, Black infants in Wisconsin were three times more likely to die before their first birthday than non-Hispanic white infants, according to a 2023 DHS report . American Indian or Alaska Native infants saw a mortality rate 1.5 times higher than white infants.

How to take preventative steps against infant mortality

Experts said many of the factors contributing to infant mortality are systemic, and state and local governments need to take policy steps to mitigate the issue.

Eleven counties in Wisconsin are "maternity care deserts," meaning there are zero obstetric providers or hospitals providing obstetric care in the area, according to March of Dime. The care desert counties are: Douglas, Washburn, Iron, Rusk, Pepin, Lincoln, Forest, Kewaunee, Adams, Marquette and Lafayette.

Zapata said these disparities often boil down to systemic inequities that make pregnancy more difficult for certain people. She encouraged all pregnant people, especially Black and Native people, to advocate for themselves in health care settings. Black people have disproportionately reported their pain being dismissed during pregnancy.

"If you have a question, if something doesn't feel right in your body, speak up. And even if you feel like you're not heard the first time, say it again and bring somebody else with you," Zapata said. "Make sure that you are trusting your body and trusting your gut."

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To reduce risk factors, people can take steps "to enter a pregnancy in as healthy of a state as possible," she said. Avoiding alcohol and smoking, seeking mental health support and reducing stress, and monitoring health conditions like diabetes and hypertensions are some steps she recommended.

After a baby is born, Zapata encouraged new parents to stay in touch with their healthcare provider about any questions or concerns they have. The CDC also recommends having babies sleep on their back on a firm, flat surface to reduce the risk of SIDS.

But, Zapata said, the burden should not be on the individual to reduce pregnancy risk factors. There are several policy steps the state can take, including increasing funding to infant health programs, expanding access to quality health care services and address racial bias in the health care system, she said.

"Sometimes, despite individuals' best efforts, because of the environment that they're living in, because of the different social determinants of health and systemic things, their baby still dying because our systems are failing them," Zapata said.

This article originally appeared on Milwaukee Journal Sentinel: Infant mortality rose in the U.S. for the first time since 2002, here's where Wisconsin stands