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Abstract 3

Introduction 4

FactorsInfluencing Infants death rate in West Virginia

Race 7

Neonataland Postnatal Mortality 9


Mother’sAge 11

EducationLevel and Occupation 12

MaritalStatus 13

Parent’sLifestyle (Substance Abuse) 14

Conclusion 15

References 16


Theaim of this report is to present statistics of a number of researchescarried out on West Virginia concerning infant death rates. It willgo through previous records and compare them presenting a systematicidea of the changes over time on the rates of infant mortality(Annual report 2011, 2013). Besides giving the records and the ratesover the last two decades, it will also present them in relation toraces in West Virginia broadly categorizing them in to two: Whitesand African Americans.

Itwill also look at the various causes of infant deaths mostly focusingon the leading ones and to which percentage they cause the deathsover the overall rate. This will help put in mind what needs to bedone to minimize the infant’s death rates. The rates will becalculated in every one thousand births.

Methodused: Tables, graphs and charts will be used to show various piecesof data grouping them by years over the two decades and race.

Keywords and Abbreviations:

IM:Infant mortality

IMR:Infants death/ mortality rate

SIDS:Sudden Infant Death Syndrome


WestVirginia a southern state in the United States of America bordered bystates like Ohio, Maryland, Pennsylvania and Kentucky. It is the 41stlargest state and 38thmost populous of the 50 United States with an estimated population ofabout 1,854,304 in 2013. The key test for any country or state’spopulation health is Infant Mortality. The number of deaths ofchildren below the age of 12 months per every 1,000 is always a clearindication of the health state of a certain population (ChildHealth USA 2013).

Infantmortality can be defined as the death of an infant before he or sheattains the age of twelve months. Infant mortality is used as the barthrough which a state or country’s health is assessed. From thestudies conducted, it is clear that the survival rate of children andmostly infants clearly depicts a clear picture of the country’smaternal health as well as healthcare and its quality. Looking at thenumber of infant deaths, determining their causes as well as theirpatterns – people affected, enables to tell, a country’s socialand economic dynamic and its a clear indicator of the gap betweendifferent classes of people in a certain nation. Dehydration, STD’s,congenital malformation, respiratory infections, drugs and alcoholand Sudden Infant Death Syndrome ( SIDS)are the main believed causesof infant deaths. Poor prenatal care, lifestyle, low income,poverty, race, mother’s marital status, substance abuse, airpollution and environmental factors are also attributed to the sameas causes.

Overthe years, the United States of America has seen a significantdecrease in number of infant deaths. The deaths have been very variedwith difference in race and class causing the variance. The last tenyears for example, have seen the infant mortality go down by a numberof percentages resulting from the measures employed over time (Annualreport 2011, 2013).

Medicaltechnology has been applied aid in reducing infant mortality in manycountries. The United States however, has not yet managed to enhancethis technology compared to other countries. The United States wasranked 32nd out of the nations (34) in the Organizationfor Economic Cooperation and Development in infant mortality in 2010.During the same period, its INFANTS DEATH/ MORTALITY RATE (IMR) hasbeen triple of that of countries like Iceland (2.2 per 1,000), Japan(2.3) and Finland (2.3). These countries had the lowest infantmortality rates and were rated well technology wise. Another study onpreterm births put the US at position 130 of the 184 participationcountries. This means that the US has a very high level of pretermbirths (12% of the births in the US are preterm) which explains thereason why the Infant mortality rates in the United States stillremain higher than the European countries

Apartfrom applying technology, the mortality rates can be reduced byaddressing all the contributing factors that are not naturallyoccurring such as maternal contributing factors. This includesfactors such as the mother’s education level, parent’s lifestyle,income level, race and class. Risk causing factors like prenatalsmoking, which is among the highest contributors to low birth weight,SUDDEN INFANT DEATH SYNDROME ( SIDS) and preterm delivery.

Figure1: Infants death rate in West Virginia over the last decade

Between2001and 2003, West Virginia was ranked 14thin overall INFANTS DEATH/ MORTALITY RATE (IMR) at 7.9, in comparisonto the national rate of 6.9. This was 1stamongthe 50 states in INFANTS DEATH/ MORTALITY RATE (IMR) among infantsborn to white mothers with the rate of 7.7, at that time the U.S.rate was 5.7. West Virginia’s rate of infant mortality amonginfants born to African American mothers stayed at 12.8, pushing thestate 39thand lower than the national rate of 13.6. This is according toNational Center for Health Statistics (NCHS).

Althoughthere has been a decline in the infant’s death rate in WestVirginia, the gap between black and white infant deaths has been verysignificant – the black-white gap is still evident. While theINFANTS DEATH/ MORTALITY RATE (IMR) for the infants for AfricanAmerican mothers has dropped by 41% over the decade, that of infantswith mothers of white origin has decreased by 21% (Mathews TJ, 2013).


Researchover the years has attributed the infant’s death rates to four maincauses. These are Sudden Infant Death Syndrome ( SIDS)(SUDDEN INFANTDEATH SYNDROME ( SIDS)), respiratory conditions, congenital anomaliesand low birth weight &amp short foetus development period (MathewsTJ,2013).. These conditions have been linked to about 66% of theinfant deaths. Other factors like pregnancy, placenta, membranescomplications and complication during birth are also infant mortalitycontributors but resulting to only about 5% of the deaths. Deathsresulting from congenital anomalies are most common in white motherswhile infants from African American mothers are lost through theother causes i.e. short foetus development period and low birthweight. While some of these deaths cannot be prevent, a significantnumber of lives can still be saved since the causes are avoidablebecause they are dependable on mothers behavioral and lifestylechoices. The government has a role that they need to play to enhancequality of healthcare and education as well as improve thelivelihoods of people living in the projects. Acquisition of infantmortality saving associated technology needs to be improved inhospitals and clinics where the mothers attend pre and post natalcare in West Virginia.

Figure3: Leading Causes of Infant Mortality by Race







Congenital anomalies



Sudden infant death syndrome



Respiratory disorders



Short foetus development period and low birth weight



Maternal pregnancy complications



Placenta, membranes and cord complication effects



Other causes




Theoverall annual death rate in West Virginia has been relative higherthan the National INFANTS DEATH/ MORTALITY RATE (IMR). While thenational INFANTS DEATH/ MORTALITY RATE (IMR) has been 6.7 per 1,000births, West Virginia has been at 7.4 annually. Comparing theinfant’s death rate by race (2001-2004), the number of deaths per1,000 of infants born by mothers of African American origin was ataround 10.6 deaths while that of the national population is 13.6. TheINFANTS DEATH/ MORTALITY RATE (IMR) for those born by White motherswas at 7.5 compared with the 5.6 for the entire United States (ChildHealth USA, 2013).

Thisis speculated to be as a result of socioeconomic status and racialassociated disadvantages. As the rates suggest, African Americans areexposed to poor health environments and poor healthcare compared tothe whites. People living in congested areas also show a rise ininfant mortality. These groups of people are often referred to as‘low class individuals’ and are mostly African Americans. Whiteshave good exposure to better healthcare when pregnant than AfricanAmerican does. Compared to whites, African Americans are most likelyto attend work when supposed to be at home during pregnancy due toeconomic pressures.

Figure2: Infants death rate in the United States of America by Race for theLast Twelve Years (2001-2012).

Althoughthe decline in death rate has been witnessed in all races, there hasbeen a very big difference in race deaths with a higher recorded rateof African American infants as compared to that of white infants(Theonen, 2006).

Figure4: Main Causes Of Infant Deaths on African American InfantsFigure5: Main Causes Of Infant Deaths from White MothersNEONATALAND POST NEONATAL MORTALITY

Researchalso indicated that different causes were likely to result to deathat different infant ages. Some were responsible for neonatalmortality and others common to post-neonatal mortality. Most of theinfant deaths in West Virginia happen before the first four weekscontributing to about 65.7% in white mothers of the overall infantdeaths. For the African American infants, 71.3% of the deaths occurat this neonatal period. Low birth weight and short foetusdevelopment period cause most deaths at the neonatal age in AfricanAmerican children (31.3%) while in White neonates, it results to16.9% of their deaths. 17.9% of deaths of African Americans resultedfrom congenital anomalies and 27.3% in white neonates.

Forpost neonatal deaths, SUDDEN INFANT DEATH SYNDROME ( SIDS) hasresulted to most deaths over the two previous decades in AfricanAmericans. 44.4% African American post neonatal infants were lostthrough complications resulting from SUDDEN INFANT DEATH SYNDROME (SIDS) while 35.9% were white dying from the same cause. Congenitalanomalies caused about 20.3% of the white post neonate deaths while11.1% were from African American mothers dying from congenitalanomalies.

Figure6: Main Courses of Neonatal Mortality (White Mothers)

Figure7: Main Courses of Neonatal Mortality (African American)

Figure8: Main Courses of Post-Neonatal Mortality (White Mothers)Figure9: Main Courses of Post-Neonatal Mortality (African American)MATERNALINFLUENCE ON INFANT MORTALITY

Thereare a number of aspects from the mother that influence an infant’ssurvival. These aspects include things like education, age, work,lifestyle, wealth/poverty, prenatal care and social behaviors havebeen known to course a variance on infants’ death rates.Comparatively, the infant’s death rates were high on infants fromlow class (poor) backgrounds than from wealthy (high-class)backgrounds. However, work seemed to control the rates too, workingmothers lost infants more than those who stayed at home duringpregnancy causing some sort of balance between wealthy and poorfamilies – infants from poor backgrounds were relatively highduring the last two decades.


Infant’sdeath rates decreased as the ages of mothers increased until aroundthe age of 35-39 where a rise in rate is noted. This applied to bothwhite and African Americans. Infants from white mothers of between30-35 years had greater chances of survival as the infant’s deathrate was at about 5.8 deaths in every 1000 births. African Americanborn infants from mothers of between 25-29 years had lowest INFANTSDEATH/ MORTALITY RATE (IMR) rates (9.4).

Asfigure 10 below shows, women below the teenage show a very high rateof deaths. This may be attributed to the fact that they arephysically immature increasing their risk of getting obstetriccomplications. Their bodies are not completely prepared to handlepregnancy and birth. A closer look at the patterns and records hasshown that premature births and low birth weights have been mostcommon in infants from mothers below the age of 13 and 25. Teenagersand women at this gap have also been seen to give improper prenatalcare. This has been associated to their wild lifestyles and poorknowledge of the importance of this care.

Anemia,malnutrition and damage to reproductive systems from early births arecommon in women at the age of between 35-45. These conditions andothers connected to this age are known to increase the possibility ofbearing a baby at risk of dying. Both in adolescents and over ageforty mothers, the rates are higher in places where these people havelow income and or are unemployed. Malnutrition is common to teenagemothers from these areas also which poses a greater chance of bearingan infant with low birth weight.

Whitemothers and mostly those at their teenage years are known to have thehighest smoking behaviours during pregnancy. Among PRAMSparticipants, West Virginia has gone on record as having a highernumber of respondents who did smoke during pregnancy and especiallythe last 3 months of pregnancy. This ignited the pressure to reducesmoking during pregnancy, which prompted West Virginia to launch the&quotTobacco Free Pregnancy Initiative&quot in 2009. This is amongthe measures that have been employed to control this infant mortalitydisaster.

Figure10: Infant Mortality In Relation To Age of MotherEDUCATIONLEVEL AND OCCUPATION

Workand education had the same effect on infant mortality on both whitesand African Americans. The rates decreased as the age of parentschanged from around 13-17 years. However, the rates start to increaseas the ages advance. This is due to the effect work on the fetaldevelopment period and prenatal care. Evidently, working mothersrisked death of their infants compared to those who stayed at home.

Populationdata records show that areas habited by people with high levels ofeducation had families with fewer numbers of children compared tothose who don’t get to higher education levels. Infant mortalityrecords in the same areas also showed high infant death rates. Thisindicates a big connection between education and infant mortality.Obviously, mothers who attended school have gone through a lesson ortwo on proper pregnancy care and dieting. They get to apply measurerequired during pregnancy. Poverty is also persistent in lowlyeducated areas, which contributed to improper care.


Theinfant’s death rate showed a difference depending on marital statuson white married mothers showing a rate of 6.6 deaths in every 1000births and 9.9 among the unmarried mothers. African American mothershowever, showed comparatively almost the same rate with the marriedat 12.4 and 13.0 for the single mothers (Heron,Scott, &amp Vera, 2008). Unmarried women do not afford proper carefor themselves and for the infants. They find themselves alwaysworking even during pregnancy.

Figure11: Relationship between Marital Status and Infant MortalityLIFESTYLE AND SUBSTANCE ABUSE

Infantmortality in non-smokers and non-drinkers was at 6.2 while indrinkers and smokers it was as high as 11.4 deaths in every 1000births. This was in both races. Alcohol and cigarettes hinder thecorrect and complete development of the unborn child. Apart from thelegal drugs, there are also the illegal ones that have even worseeffects. Areas in West Virginia known to have the highest drug uselevels have shown higher infant mortality rates in both white andAfrican Americans. These effects may sometime result to miscarriageand if the child is born, they are born either prematurely or withlow birth weights which are main causes of infant mortality. (Jaddoe,Verburg, Hofman, H. A., … &amp Witteman, 2007)

Figure12: Smoking and Alcohol Effects on Infant Death RateCONCLUSION

Fromthe research, it is obvious that infant mortality has a noticeableeffect on West Virginia’s population. A very significant percentageof the population is being lost, and more so, through things that canbe controlled. Good parenthood and government involvement can reallyhelp to reduce the number of infant deaths experienced every year.If proper prenatal and postnatal measures are taken, number of deathscan be reduced by more than half.

Alsoevident is the racial gap and its effect on human life in WestVirginia. African Americans are losing more lives than the whites,which imply that the bridge between the races has not yet broughtthem to an equal ground. Besides, the natural causes, more infantsare also lost through drug effects on the mother as mothers continueto drink and smoke even after conception.

About13.5 % born to African American women weigh less than 2,500 gramsduring birth and 8.4% weigh the same from white women. The risk ofpremature birth is less in white women at 11.8% compared to theAfrican Americans with 14.7%. Low birth weight and deaths caused byprematurity are the most useful determinants of infant mortality.From this data therefore, African American remain threatened as fromthe records, they are the most affected by deaths resulting fromthese factors.

Overthe past resent years, the government and governmental institutionshave focused on providing better conditions to both mothers and theirnew born babies. This has gone a long way into reducing the infantmortality rate. For instance, between 2007 and 2010, an average of63% of all the mothers who delivered babies within this periodreceived sufficient parental care. However, surveys show that thereare factors that are yet to be addressed. For instance, surveycarried out within the same period shows that parent’s educationlevels is still an issue. More than half mothers who gave birthbetween 2007 and 2010 were found to have education lower than highschool level. In addition, the medical staff especially thoseworking in the emergency department were reported to have a number ofmisdiagnosed pregnant mothers and infants, which led to increasednumber of complications that sometimes resulted to deaths. Some casesespecially those involving nausea, abdominal symptoms or vomiting areusually misdiagnosed (West Virginia infant and maternal reviewreport, 2012).

Ifcorrect measures were put in place, infant mortality would go downsignificantly. Mothers need to have access to proper diet as well asprenatal and postnatal care, both professional and personal. A changeof lifestyle is also called for during both the foetus developmentperiod and thought the pregnancy period if the infant mortality rateis to be reduced. Educating the masses on the needs and best infantcare practices as the government puts in measures to provide betterhealth care services to the poor as well as providing bettereducation, healthcare, counseling services on proper child andpregnancy practices to all mothers would also go a long way inreducing early deaths.


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EugeniaTheonen, (2006). Racial disparity in Infant mortality in WestVirginia, West Virginia Departmentof health and human resources.

Heron,M. P., Hoyert, D. L., Xu, J., Scott, C., &amp Tejada-Vera, B.(2008). Deaths: preliminary data for 2006. Nationalvital statistics reports,56(16),1-52.

JayBringman MD, West Virginia’s Infant Mortality Dilemma, Maternal andFetal Medicine Outpatient services

U.S.Department of Health and Human Services, Health Resources andServices Administration, Maternal and Child Health Bureau. ChildHealth USA 2013.Rockville, Maryland: U.S.&nbspDepartment of Health and HumanServices, 2013.

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Bureaufor Public Heath West Virginia Infant and Maternal Mortality ReviewTeam, (2012).WestVirginia Infant and Maternal mortality review report.State of West Virginia department of health and human resources,