• Posted April 11, 2023

Survival Improves for Babies of America's Youngest Moms

The death rate among babies born to teen moms has dropped over the past 25 years -- but racial disparities stubbornly persist, a new U.S. government study finds.

Compared with the late 1990s, fewer babies born to teenage mothers are dying in their first year of life, according to the study by the U.S. Centers for Disease Control and Prevention. And those improvements have been seen among Black babies, Hispanic babies and white babies alike.

That's the good news. The bad news, the study found, is that Black infants have persistently had higher death rates compared white babies and Hispanic infants.

And for babies born to Black mothers and Hispanic moms in rural counties, there was no significant improvement over the years. That was in contrast to a declining death rate among infants born to white teens.

The findings -- published April 10 in Pediatrics -- are unsurprising, experts said.

Across all ages, Black women and Native American women, in particular, have long fared worse in access to prenatal care, preterm birth rates, stillbirths and infant deaths.

The factors driving those disparities are complex.

"There is, unfortunately, no simple answer," said Christine Sander, senior director of infant and child wellness at Nationwide Children's Hospital in Columbus, Ohio.

Lack of timely prenatal care is a major contributor, according to Sander. It's also known that many U.S. rural counties are so-called "maternity care deserts," where there are no obstetrics providers.

That could be one reason that infant death rates among Black mothers and Hispanic moms in rural areas have barely budged, according to Sander, who co-wrote an editorial published with the study.

But, she said, there is more to the story. Issues outside health care -- such as lacking a steady income, stable housing and access to affordable, healthy food -- are also tied to infant death rates, Sander pointed out.

And again, people of color are harder-hit by those problems in the United States.

The CDC findings are based on national infant death rates for the years 1996 to 2019. That data includes all deaths of babies younger than 1 year.

Overall, the study found, there was a nearly 17% decline in the infant death rate among mothers ages 15 to 19. It dipped from just over 10 deaths for every 1,000 live births in 1996, to about 8.6 deaths per 1,000 by 2019.

The improvement was seen for Black babies, Hispanic babies and white babies (the only three racial/ethnic groups analyzed).

However, there was a persistent racial divide: Black babies consistently had a higher death rate than white or Hispanic infants. And in rural counties, the death rate among babies born to white teenagers dipped somewhat -- but showed no significant change among infants of Black or Hispanic teens.

Dr. Elizabeth Cherot is chief medical and health officer of the March of Dimes, a nonprofit dedicated to maternal and infant health. She agreed that a complex set of issues is at work.

In its 2022 "Maternity Care Desert" report, the March of Dimes found that 35% of U.S. counties were deserts -- meaning they had no hospitals providing obstetrics care, no birth centers and not a single ob-gyn or certified nurse midwife. Many other counties had "low access" to such care.

Those deserts are not only in rural areas, Cherot stressed. But rural areas and, nationally, people of color are disproportionately affected by limited access to maternity care.

That situation, Cherot said, is only worsening.

And so, too, are racial disparities in mom and infant health: In another report last year, the March of Dimes said the nation's preterm birth rate was at a 15-year high, reaching 10.5% in 2021. Black women and Native American women were 62% more likely to deliver preterm than white women, and their babies were twice as likely to die.

Given the scope of the problem, both Sander and Cherot said, policy changes have to be part of the solution.

Cherot said that extending Medicaid coverage of postpartum care from 60 days to one year is one potential way to improve moms' and babies' access to health care. Medicaid programs are, however, run by states, she noted -- so it's up to them to make changes.

Telehealth could also help bridge the gap in parts of the U.S. where maternity care is scarce, both experts said. An obstacle there, Sander noted, is that the people who need telehealth the most may not have broadband access.

When it comes to something as fundamental as infant survival, "geography should not matter," Cherot said. "But in the United States, geography matters."

More information

The March of Dimes has more on health disparities and pregnancy.

SOURCES: Christine Sander, MHA, senior director, infant and child wellness, Nationwide Children's Hospital, Columbus, Ohio; Elizabeth Cherot, MD, chief medical and health officer, March of Dimes, Arlington, Va.; Pediatrics, April 10, 2023, online