Infant Mortality: What Is CDC Doing?

CDC is committed to improving birth outcomes. This requires public health agencies working together with health care providers, communities, and partners to reduce infant deaths in the United States. This joint approach can help address the social, behavioral, and health risk factors that affect birth outcomes and contribute to infant mortality. On this page, you will learn more about CDC’s research, programs, and efforts to better understand and reduce infant mortality.

CDC's Division of Reproductive Health

Improvements in Perinatal Care
Preterm birth, or being born too early (before 37 weeks of pregnancy), is the biggest contributor to infant death. CDC scientists, in collaboration with our partners, are working to understand the multiple reasons for preterm births and advance new strategies for prevention. CDC provides support to state Perinatal Quality Collaborative (PQC) initiatives in California, New York, Illinois, Massachusetts, North Carolina, and Ohio. State PQCs are networks of perinatal care providers and public health professionals working together to implement best practices to improve pregnancy outcomes for women and newborns. This includes real-time reporting of perinatal clinical quality measures that help doctors and other health care providers prevent prematurity and improve outcomes for infants born too early and too small.

One of the goals of CDC’s work with PQCs is the dissemination of strategies used by high-functioning PQCs to states in various stages of development. CDC worked with experts to create a resource guide to help support the work of state PQCs, Developing and Sustaining Perinatal Quality Collaboratives: A Resource Guide for States [PDF - 566KB]. In addition, in partnership with CDC-funded collaboratives, CDC's Division of Reproductive Health hosts regular Webinars that allow PQCs to share strategies related to their development as well as specific perinatal quality improvement initiatives. Recordings of previous Webinars are archived and available for viewing. CDC and the March of Dimes are also working together to launch the National Network of Perinatal Quality Collaboratives, that aims to support PQCs and provide opportunities for the sharing of organizational and functional best practices between PQCs across the country.

Improving Our Understanding of SIDS and SUID
In 2014, there were about 3,500 sudden unexpected infant deaths (SUID) in the United States. This is about 15% of all infant deaths. SUID is the death of an infant less than 1 year of age that occurs suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation. Most SUIDs are reported as one of three types: SIDS, unknown causes, or accidental suffocation and strangulation in bed.

CDC has SUID monitoring programs in 16 states and 2 jurisdictions, covering 30% of all SUID cases in the United States. The SUID Case Registry builds on the National Center for Fatality Review and Prevention system and brings together information about the circumstances associated with SUID cases, as well as information about investigations into these deaths. Participating states and jurisdictions use SUID Case Registry data to develop strategies to reduce future deaths.

In addition, CDC’s Division of Reproductive Health and the National Center for Injury Prevention and Control worked together with the International Association of Indigenous Aging on 1,000 Grandmothers, a project that created opportunities for tribal elders (especially grandmothers) to mentor and educate young Native American parents on safe sleep practices for infants. This strategy is featured as an innovative project to address sudden unexpected infant death on the Healthy People 2020 Who’s Leading the Health Indicators website. It’s the first Native American program to earn national recognition for Healthy People 2020.  

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Pregnancy Risk Assessment Monitoring System (PRAMS)

The PRAMS surveillance system collects data on maternal attitudes and experiences before, during, and shortly after pregnancy from women who recently delivered a live-born infant. Forty-seven states, New York City, Washington DC, Puerto Rico, and the Great Plain Tribal Chairmen’s Health Board participate in the system, which covers approximately 83% of all live births in the United States. PRAMS data are used by CDC and the state’s public health agencies to better understand and monitor changes in maternal and child health indicators and inform efforts to reduce infant mortality.

Local and state efforts have been successful in identifying infant mortality risks using PRAMS data. For example, according to PRAMS data, about 30% of West Virginia mothers smoke during their pregnancy. To help reduce smoking among pregnant women, West Virginia launched the media campaign Tobacco Free Pregnancy Initiative in 2009 to promote the use of the existing quitline by pregnant smokers and their families. In the first 6 weeks of the campaign, 100 pregnant women or their family members enrolled in tobacco cessation services offered by the quitline.

Hawaii PRAMS also used PRAMS data to identify infant mortality risks. In a publication titled Hawaii Safe Sleep Quick Facts, PRAMS data related to infant sleep practices showed that for infants born in Hawaii in 2009-2010, almost one-quarter were most often laid to sleep in high-risk sleep positions (either on their side or stomach), one third “always” or “often” slept in the same bed with someone else, and nearly two-thirds usually slept in an environment with one or more risk factors: pillows, bumper pads, plush blankets, or stuffed toys; not sleeping in a crib or portable crib; and not sleeping on a firm or hard mattress. In December of 2012, Healthy Mothers Healthy Babies Coalition of Hawaii (HMHB) used Hawaii PRAMS prevalence estimates from the Hawaii Safe Sleep Quick Facts to support an application for funding from the CJ Foundation for SIDS. The application was successful, and in early 2013, HMHB was awarded $5,000 to support the addition of comprehensive family-oriented safe sleep education into the Hawaii Cribs for Kids Program. For more PRAMS success stories, visit PRAMS Data to Action Success Stories.

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Maternal and Child Health Epidemiology Program

The Maternal and Child Health Epidemiology Program (MCHEP) builds state, local, and tribal capacity to effectively use maternal and child health epidemiologic research and scientific information to affect public health program and policy related to women, children, and families’ health. CDC works directly with states and localities by assigning an epidemiologist as a consultant for the state’s Maternal and Child Health (MCH) programs. To better understand infant health and mortality, CDC’s MCHEP assignees conduct data analyses and recommend actions to improve birth outcomes. In 2016, MCHEP had 14 MCH Epidemiology assignees, 4 MCH Council of State and Territorial Epidemiology fellows, and 2 Epidemic Intelligence Officers located in state health departments.

The MCHEP, in partnership with the Association of Maternal and Child Health Programs, the March of Dimes, the Health Resources and Services Administration, Maternal and Child Health Bureau, and a small group of states, released an infant mortality toolkit. The purpose of the State Infant Mortality Toolkit is to help health care agencies and organizations analyze and interpret available perinatal-related data. The standardized approach to the infant mortality assessment process presented in the toolkit will help states identify and analyze the needs of their maternal and infant populations, and assist them in their efforts to develop and evaluate programs and policies aimed at improving maternal, child, and infant health.

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CDC’s National Center for Birth Defects and Developmental Disabilities

Birth defects affect 1 in 33 babies and are a leading cause of infant mortality in the United States. In addition, babies who survive and live with birth defects are at increased risk for developing many lifelong physical, cognitive, and social challenges.

CDC works to identify causes of birth defects, find opportunities to prevent them, and improve the health of those living with birth defects. By applying a public health approach incorporating three essential elements—surveillance or disease tracking, research to identify causes, and prevention research and programs—we can rapidly translate scientific findings into appropriate public health interventions. Understanding the potential causes of birth defects can lead to recommendations, policies, and services to help prevent them. CDC works toward a day when every child is born in the best health possible.

Tracking birth defects: Accurately identifying infants and young children with birth defects is the first step in understanding how to prevent birth defects and reducing their effect. This is generally achieved through birth defects tracking systems. Tracking where, when and how often birth defects occur, and who they affect gives us important clues about birth defects prevention and allows us to evaluate our efforts. CDC tracks birth defects through several state tracking systems and regional programs, including the Metropolitan Atlanta Congenital Defects Program.

Researching birth defects: Most birth defects are thought to be caused by a complex mix of factors. These factors include our genes, behaviors, and things in the environment. For some birth defects, we know the cause. But for most, we don't. And we don't understand how well factors work together to cause birth defects. Research can help us answer many of these questions.

The National Birth Defects Prevention Study (NBDPS) is the largest population-based study in the United States looking at risk factors and potential causes of birth defects. CDC funds the study and collects data with researchers from other study sites, collectively called the Centers for Birth Defects Research and Prevention (CBDRP).
Results from the NBDPS teach us more about what might raise or lower the risk of having a baby with a birth defect. The NBDPS has made key contributions in understanding the risks of certain birth defects when specific medications are used just before and during pregnancy. Data from the study have also clearly demonstrated that maternal obesity is a strong risk factor for a number of major birth defects and have confirmed the association between maternal smoking and having a baby with a cleft lip or cleft palate.

Preventing birth defects: Although we do not know the cause of most birth defects, the good news is that we know how to prevent some birth defects. For example, researchers have learned that taking folic acid before and during the early weeks of pregnancy greatly reduces the risk of serious defects of the brain and spine, called neural tube defects or NTDs. This research finding led to the advice that all women who can become pregnant should take 400 micrograms of folic acid daily. We have also learned that drinking alcohol during pregnancy can cause the baby to be born with fetal alcohol spectrum disorders (FASDs). Therefore, CDC works with partners to educate women about the risk of drinking alcohol during pregnancy.  

Improving our ability to prevent birth defects is an important public health priority issue that requires continued commitment. CDC’s National Center on Birth Defects and Developmental Disabilities hopes to learn more about the potential role of environmental exposures, medications, maternal infections, maternal diabetes, obesity, and genetic risk factors in causing birth defects. The expansion of tracking and research efforts holds great promise in identifying new causes of birth defects and strengthening birth defects prevention strategies.

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CDC’s National Center for Injury Prevention and Control

Tracking and researching child injuries: To better understand the problem of child injury, CDC’s National Center for Injury Prevention and Control tracks data trends and conducts research on unintentional childhood injuries and child abuse. Injuries to children, whether unintentional or from abuse and neglect are often predictable and preventable—they are not “accidents.”

Preventing child injury:

CDC is committed to preventing unintentional injuries by supporting solutions that will save lives and help children live to their fullest potential. Progress has been made in preventing child injury. According to the National Action Plan for Child Injury Prevention (released in 2012), child injury death rates have decreased 29% in the last decade. Yet injury is still the leading cause of death for children and teens and the fifth leading cause of death for infants. More can be done to keep our children safe. Everyone—including parents, health care providers, educators, and community members—can take steps to prevent unintentional injury where they live, work, and play. CDC has created helpful resources for parents and public health professionals to help prevent unintentional child injury from occurring in the first place:

• The National Action Plan on Child Injury Prevention was developed by CDC and more than 60 stakeholders to spark action across the nation.
• Child passenger restraint guidelines were developed by CDC to keep child passengers safe on every trip. Motor vehicle injuries are a leading cause of death among children in the United States. Using the correct car seat or booster seat can be a lifesaver.
• The Protect the Ones You Love initiative was created to raise parents’ awareness about the leading causes of childhood injury in the United States and how they can be prevented.
• Color Me Safe is a coloring book designed for children ages four to seven. It can help parents talk with their children about safety at home and on the go!
• Preventing child abuse and neglect is a preventable public health problem. CDC's research and programs work to understand the problem of child abuse and neglect and prevent them before they begin. For example:
  • CDC’s Essentials for Childhood framework is intended for communities committed to the positive development of children and families, and specifically to the prevention of child abuse and neglect, by ensuring safe, stable, and nurturing relationships and environments for all children. The framework has four goal areas and suggests steps based on the best available evidence to achieve each goal. The steps suggested in the Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments— along with your commitment to preventing child abuse and neglect—can help create neighborhoods, communities, and a world in which every child can thrive. 

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CDC’s National Center for Health Statistics

Infant mortality rates (the number of infant deaths that occur for every 1,000 live births) are based on all resident death certificates for babies who died before their first birthday in the 50 states and the District of Columbia. In addition, as part of the Vital Statistics Cooperative Program, each state provides to CDC’s National Center for Health Statistics (NCHS) matching birth and death certificate numbers for each infant younger than 1 year of age who died in the state. NCHS uses these matches to extract final edited data from the NCHS natality (birth) and mortality (death) statistical files that are created from the birth and death certificate data provided by the states. These data are linked to form a single statistical record, thereby establishing a national linked record file. The purpose of this linkage is to provide researchers additional variables to conduct more detailed analyses of infant mortality.