In the United States, Black (non-Hispanic) infants have the highest mortality rate of any racial or ethnic group. In 2023, the rate was 10.93 deaths per 1,000 live births, more than double the national average of 5.61. American Indian and Alaska Native infants had the second-highest rate at 9.20, followed by Native Hawaiian or Other Pacific Islander infants at 8.21.
For comparison, the rate for Hispanic infants was 5.03, for white (non-Hispanic) infants 4.48, and for Asian (non-Hispanic) infants 3.44. The gap between the highest and lowest groups is more than threefold.
Leading Causes of Death in Black Infants
The single largest contributor is complications from being born too early and too small. In 2023, disorders related to short gestation and low birth weight caused 201 deaths per 100,000 live births among Black infants, making it the leading cause by a wide margin. Birth defects and chromosomal abnormalities ranked second at 146.5 per 100,000. Sudden infant death syndrome (SIDS) ranked third at 94.4 per 100,000.
That first cause, prematurity, is where the racial gap is most visible. Black women in the U.S. deliver preterm at a rate of about 14.4%, roughly 50% higher than the rate for white women (9.3%) or Hispanic women (10.0%). Babies born early face higher risks of breathing problems, infections, and organ immaturity, all of which can be fatal in the first year of life.
Sudden Unexpected Infant Death
Sudden unexpected infant death, a category that includes SIDS and accidental suffocation during sleep, hits two groups especially hard. Between 2017 and 2022, American Indian and Alaska Native infants consistently had the highest rates, at roughly 229 to 241 deaths per 100,000 live births. Black infants saw their rate climb from 192.4 in 2017 to 244.0 in 2022, actually overtaking the American Indian/Alaska Native rate by the end of that period. Both groups experience these sleep-related deaths at rates far above the national average.
Safe sleep practices, like placing babies on their backs on a firm, flat surface with no loose bedding, reduce the risk significantly. But awareness campaigns have not reached all communities equally, and overcrowded housing or the absence of a separate crib can make safe sleep harder to practice consistently.
Why the Gap Exists
No single factor explains why Black and American Indian/Alaska Native infants die at higher rates. The causes are layered, spanning individual health, neighborhood conditions, and systemic barriers.
Chronic health conditions in mothers, including high blood pressure and diabetes, are more common in Black women and raise the risk of preterm delivery. But even after accounting for a mother’s personal health and education level, racial disparities in birth outcomes persist. This points to broader forces at work.
Neighborhood poverty is one of the strongest predictors. Research consistently links neighborhood-level factors like income, employment, housing stability, and access to healthy food with higher rates of preterm birth and infant death. Of 31 studies examining neighborhood socioeconomic status and birth outcomes, 21 found a significant connection. Residential segregation by race compounds the problem: nearly every ecological study on the topic has found that greater racial segregation correlates with higher infant mortality and preterm birth rates, independent of income.
Access to quality prenatal care matters too, though expanding insurance coverage alone hasn’t always improved outcomes. After Medicaid eligibility was broadened for pregnant women in the late 1980s and early 1990s, low birth weight rates dropped among white women with low incomes. But other studies found that simply giving uninsured women coverage or getting them into prenatal care earlier didn’t consistently lead to better births. The quality and continuity of care, not just having an insurance card, appears to be what makes the difference.
Unstable housing, lack of transportation, food insecurity, and economic inequality all create obstacles well before a woman reaches a doctor’s office. These social determinants of health disproportionately affect Black, American Indian, and Alaska Native communities, and they shape pregnancy outcomes in ways that no single medical intervention can fully counteract.
Programs That Are Narrowing the Gap
Several community-based models have shown promise. Centering Pregnancy, a national program, replaces traditional one-on-one prenatal visits with group care sessions where pregnant women receive health assessments, education, and peer support together. The idea is that women who build social connections during pregnancy are less isolated and more likely to adopt health-promoting behaviors.
Best Babies Zone, developed at the University of California, Berkeley, takes a neighborhood-level approach. Rather than focusing on individual patients, it brings together residents, community organizations, and local institutions in high-need neighborhoods to address the root causes of poor birth outcomes: economic development, early childhood education, healthcare access, and community systems all at once. The program launched in neighborhoods in Oakland, New Orleans, and Cincinnati where infant mortality was high but local resources were aligned for change.
The Baby-Friendly Hospital Initiative, established by the World Health Organization and UNICEF, promotes breastfeeding through a set of evidence-based hospital practices. Hospitals that follow the program’s guidelines have seen racial and ethnic gaps in breastfeeding rates shrink, and breastfeeding is associated with better infant survival.
These programs share a common thread: they go beyond the clinical encounter and address the conditions surrounding birth. Closing the infant mortality gap will likely require that same broader lens, tackling not just what happens in the delivery room but the months and years of health, stress, and access that precede it.