The infant mortality rate in the United States is approximately 5.5 deaths per 1,000 live births. In 2024, roughly 20,050 infants died before their first birthday, a rate that has held essentially steady since 2022. While the U.S. rate has dropped significantly over the past two decades, it remains well above the average for wealthy nations and varies dramatically depending on where you live and the race of the infant.
The Current Rate and Recent Trends
The 2024 infant mortality rate was 5.53 per 1,000 live births, statistically unchanged from the 2023 rate of 5.60. That number represents a reversal of what had been a long, encouraging decline. From 2002 to 2021, the U.S. infant mortality rate fell by 22%, reaching a low of 5.44 per 1,000. Then in 2022, the rate rose 3% in a single year, marking the first increase in two decades. It has remained at that slightly elevated level since.
To put the number in perspective, about 1 in every 180 babies born in the U.S. dies before turning one.
Leading Causes of Infant Death
The five leading causes, based on the most recent detailed data from 2022, are birth defects, preterm birth and low birth weight, sudden infant death syndrome (SIDS), unintentional injuries such as car crashes, and complications from the mother’s pregnancy. Birth defects and premature birth together account for the largest share of these deaths by a wide margin.
Most infant deaths happen very early. The neonatal mortality rate, covering deaths in the first 28 days of life, was 3.58 per 1,000 in 2022. The postneonatal rate, covering deaths from 28 days through the rest of the first year, was 2.02. That means nearly two-thirds of infant deaths occur in the first four weeks, often tied to conditions present at birth or extreme prematurity.
Racial and Ethnic Disparities
The national average obscures one of the starkest health disparities in the country. Black infants die at more than twice the rate of white infants. The 2021 figures break down like this:
- Black (non-Hispanic): 10.55 per 1,000
- American Indian or Alaska Native (non-Hispanic): 7.46 per 1,000
- Hispanic: 4.79 per 1,000
- White (non-Hispanic): 4.36 per 1,000
A Black infant born in the U.S. faces roughly the same mortality risk as an infant in many lower-income countries. This gap persists even after accounting for income and education, and researchers point to differences in access to quality prenatal care, chronic stress from discrimination, and higher rates of preterm birth among Black mothers as contributing factors.
Differences by State
Where a baby is born in the U.S. matters enormously. In 2023, the three states with the highest infant mortality rates were Mississippi (8.94 per 1,000), Arkansas (8.22), and Alabama (7.64). The three lowest were New Hampshire (2.93), Vermont (3.16), and Massachusetts (3.28). That means a baby born in Mississippi is roughly three times more likely to die in the first year than one born in New Hampshire.
The geographic pattern closely tracks poverty rates, access to maternal health services, and the availability of neonatal intensive care. States in the Deep South consistently rank at the top, while New England states cluster at the bottom. Rural areas in particular often lack the specialized hospital units that can save critically ill newborns.
How the U.S. Compares Internationally
Among wealthy nations, the U.S. performs poorly. The average infant mortality rate across OECD countries is 4.0 per 1,000 live births, meaning the U.S. rate sits roughly 40% above the peer-country average. Countries like Japan, Finland, and Norway consistently report rates below 2.0 per 1,000. Even after adjusting for differences in how countries register extremely premature births, the U.S. still lags behind most high-income nations.
Several factors help explain the gap. The U.S. has higher rates of preterm birth than most peer countries, partly driven by higher rates of chronic conditions like obesity and diabetes among women of childbearing age. Uneven access to prenatal care plays a role too. In countries with universal healthcare systems, pregnant women typically receive standardized prenatal monitoring regardless of income or geography.
Maternal Age and Prenatal Care
A mother’s age at the time of a first birth influences infant survival. Research across dozens of countries shows that first-time mothers in their late 20s have the lowest risk of infant death, with the optimal age around 28 to 29. Adolescent mothers, particularly those under 18, face significantly higher risks. The relationship is not strictly linear: risk is elevated at both ends of the age spectrum, though the increase for younger mothers is steeper.
Access to consistent prenatal care is one of the most modifiable factors in infant mortality. Early and regular prenatal visits allow providers to identify complications like preeclampsia, gestational diabetes, and signs of preterm labor before they become emergencies. Women who receive no prenatal care are several times more likely to experience an infant death than those who begin care in the first trimester.