Infant mortality, poverty and reproductive justice

Abstract

Infant mortality is a vital indicator of the overall health of a society. Judged by this metric, the United States (U.S.) has much room for improvement. Despite the highest health care spending of all industrialized countries, the U.S. ranks first in neonatal and infant as well as maternal mortality compared to the other top 10 highincome countries in the Organisation for Economic Co-operation and Development (OECD). At 4.0 and 5.8 deaths per 1000 live births, the U.S. neonatal and infant mortality rates are 50% higher than the other OECD nations. Even more alarming is the U.S. maternal mortality rate of 26.4 deaths/100,000 live births, over three times more than the OECD average of 8.4. The reasons for these high U.S. neonatal, infant, and maternal mortality rates are complex, intersecting with the social determinants of health including poverty, structural racism, and access to comprehensive reproductive services for women. When examining infant mortality rates and poverty, higher state-level poverty was associated with increasing state-level infant mortality rates (Fig. 1). Infant mortality is likely to be further impacted by decreased access to comprehensive reproductive health care for women, as measured by state-level access to Planned Parenthood Clinics (as a proxy for access to clinics providing comprehensive reproductive health care). Indeed, one of the important but frequently overlooked aspects of restrictive abortion laws is the bystander effect on the availability of comprehensive reproductive services, including essential prenatal care, for women. In fact, decreased access to Planned Parenthood (directly) and strictness of state abortion laws (inversely) are both associated with increasing infant mortality (Fig. 2). Thus, a multi-pronged approach with strategies focused on decreasing poverty, addressing structural racism, and increasing access to comprehensive reproductive services are