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U.S. infant mortality from all causes rose 3% in the year 2021 to 2022 — the first increase since 2001, according to a report from the National Center for Health Statistics (NCHS).

The trend represents a sharp reversal, as between 2000 and 2020, infant deaths decreased by 21%.

Danielle Ely, Ph.D., a co-author of the NCHS report, told Decatur, Illinois, TV station WAND he wasn’t sure if the increase was an anomaly or the start of a new, disturbing trend.

“The study provides a description of some of the basic relationships between risk factors and infant mortality rates,” said Ely, adding that it was just a “first step in determining what is going on with infant health in our country.”

Ely suggested the study could be “used to identify some of the higher risk subgroups, which might be used later on for prevention efforts.”

The only conclusion evident from the NCHS data is that something changed in 2021 — but what?

An NBC News analysis mentioned three possibilities: healthcare access, the overturn of national abortion rights and COVID-19 stress.

Dr. Tracey Wilkinson at the Indiana University School of Medicine told NBC that the increase in infant mortality was a consequence of the 2022 U.S. Supreme Court decision that transferred control over abortion from the federal government back to the states.

This position follows from two premises: Fewer infants would die if more fetuses were aborted, and most abortions occur in women already disadvantaged in some way, and therefore with suboptimal healthcare access.

Women in their twenties accounted for 57% of U.S. abortions in 2020, more than half of abortions were among nonwhites and 86% occurred in unmarried women. Close to 60% of women undergoing abortions are either poor or at risk for poverty. But the fact that rates went up for whites but much less for Blacks negates Wilkinson’s argument.

The NCHS report calls out four “red” states — Georgia, Iowa, Missouri and Texas — with statistically significant mortality increases of 13%, 30%, 16% and 8%, respectively, as the only jurisdictions with increases of statistical significance.

However, the report didn’t mention blue-state Delaware with a 57% increase, or Maine, where numbers rose by 27%, and why these increases, which were large relative to other states’ data, were not noteworthy.

Healthcare access and COVID-19 stress are related since the study period occurred at the height of the pandemic when telemedicine was mainstreamed at the expense of in-person care.

Dr. Pat Gabbe, a clinical professor of pediatrics at Ohio State University, told NBC that some telemedicine may not have served all pregnant women equally well.

“Every time we’ve measured infant mortality, it has trended down, and what’s changed? Covid. It’s disrupted all the community support we developed that helped women access prenatal care.”

The pandemic also led to job loss and economic instability, causing people to lose employer-provided health coverage.

One possible change between 2021 and 2020 was the availability of gene therapy products to prevent COVID-19 (vaccinations). The mRNA products were not authorized for pediatric use until June 2022, and only for children 6 months or older, so their direct impact on infant mortality likely was minimal (the study period looked at 2021-2022).

But the NCHS analysis focused on maternal and not infant risk factors: The outcome was infant death, the input or “intervention” was the mother’s vaccination status.

The COVID-19 vaccines were authorized for pregnant women in April 2021, so vaccination could have affected the survivability of their fetuses and newborns within the study period.

However, the NCHS found that Blacks were more than 3 times more likely than whites to refuse vaccination, and also experienced a much smaller increase in infant mortality.

Asian Americans were 56% more likely than whites to refuse vaccination and their mortality rates improved.

Highlights from the report:

  • The infant mortality rate in 2022 was 5.60 per 1,000 live births, up from 5.44 in 2021, a 3% increase over 2021.
  • Categories with notable increases were neonatal (3%, from 3.49 to 3.58) and postneonatal (age less than 4 weeks) infants (from 1.95 to 2.02, or 4%) and Native American and Alaskan children (7.46 to 9.06).
  • Smaller increases were observed for children of white mothers (4.36 to 4.52), Blacks (10.55 to 10.86), Native Hawaiian or Pacific Islanders (7.76 to 8.50), and Hispanics (4.79 to 4.88).
  • A drop from 3.69 to 3.50 for children of Asian American mothers was not statistically significant, but the rise from 5.15 to 5.37 for infants born to women ages 25-29 was. No other maternal age experienced a meaningful change.
  • Mortality rose slightly for most preterm (less than 37 weeks of gestation) categories, with significant differences for all preterms analyzed together and for early preterm (less than 34 weeks of gestation) infants, but increases were not statistically significant for any other preterm group.
  • Compared to 2021, 2022 infant deaths fell significantly in one U.S. state — Nevada — but rose significantly in Georgia, Iowa, Missouri and Texas. Changes in the remaining states and the District of Columbia were not statistically significant.
  • Small declines were also noted for low birth weight babies, those with complications of the umbilical cord or placenta, and children with circulatory or bleeding issues.
  • Of the 10 leading causes of infant mortality, most were unchanged statistically from 2021 to 2022. The largest increases were for newborn sepsis (+14%) and maternal complications (+9%). Circulatory diseases (-10%), umbilical cord or placental abnormalities (-5%) and short gestation (-3%) decreased.

“The reported increase in infant mortality rates is disturbing and disappointing,” said Dr. Sandy L. Chung, president of the American Academy of Pediatrics, through her organization’s media department.

“We live in a country with abundant resources. Yet the infant mortality rate in the United States is shockingly high. There are many different reasons for this. We do know that families in poverty face many challenges including access to nutritious food and affordable healthcare. Racial and ethnic disparities related to accessible healthcare — including prenatal health services — are just one of the many possible reasons for lower birth weights of babies and sometimes, infant deaths.”

Chung was likely referring to ethnic outcome disparities reported by NCHS, but the report summary linked above does not mention poverty, disadvantaged status or socioeconomics. Plus the mortality increase for children of Black mothers was small and not statistically significant, while the 4% increase for children of white mothers was.

Since not all members of ethnic minorities are poor, a separate analysis would be required to untangle the more complex relationship between ethnicity, income or disadvantaged status and the ability to access health services.