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The good news is that infant mortality rates (deaths/1,000 live births in 1st year) declined by 80% between 1950 and 2000, from 35 to just 7 and have declined an additional 14% to a little less than 6 by 2018.

• United States: infant mortality rate 1935-2020 | Statista

Infant Mortality Rate for the United States (SPDYNIMRTINUSA) | FRED | St. Louis Fed (stlouisfed.org)

The main CDC page highlights the 5 main causes of death, the significant state differences (higher rates in the south central states, Ohio and WV, and differences by race. Black infant mortality rates (IMR) remain more than twice as high as non-Hispanic Whites. Asians have lower rates than Whites. Hispanic White infant mortality rates are “close” to the White rates.

Infant Mortality | Maternal and Infant Health | Reproductive Health | CDC

The Petersen-KFF website provides clear summaries of the main dimensions of this public health area. About 2/3rds of deaths occur in the first month and are termed neonatal. The remainder in the first year of life are termed postnatal. Both neonatal and postnatal death rates have declined in the last 20 years.

Petersen provides more details on state level death rates, showing that the Great Lakes states have high rates similar to the southern states (7), while much of the country has much lower rates (5).

Births for mothers under 20 show death rates almost twice as high as those in their twenties and thirties.

Ten factors account for two-thirds of deaths, lead by congenital defects and early delivery/low birth weight which account for one-third.

The US mortality rate (5.8) is 75% higher than other countries with similar income levels (3.5). The world-class results in Japan and Finland come in at 2. Details in the way the US reports its figures may account for one-third of the difference versus comparable countries. While the US rate has declined from 7 to 5.8 in the last 20 years, the comparable group reduced its rate from 4.6 to 3.3. Various sources propose that socioeconomic inequality, racial differences and health care system differences account for the US’s poor performance.

What do we know about infant mortality in the U.S. and comparable countries? – Peterson-KFF Health System Tracker

Health status – Infant mortality rates – OECD Data

The racial disparities in infant mortality rates are addressed in various ways.

The very different rates by state seem to show that differing health care policies matter greatly.

Regional variation in Black infant mortality: The contribution of contextual factors (plos.org)

Socioeconomic and racial differences at the county level can be clearly seen in Indiana.

Infant mortality in Indiana | County Health Rankings & Roadmaps

The US Health & Human Services website highlights black-white differences in birth weights, SIDS occurrence, early births/low birth rates and causes of death.

Infant Mortality and African Americans – The Office of Minority Health (hhs.gov)

The statistical analyses to disentangle socioeconomic status and race are very complicated. Most show that socioeconomic status accounts for half of differences, but not nearly 100%. This study found that maternal education, maternal marital status and maternal age “explained” much of the racial differences. Of course, the authors then point to poverty and income differences as underlying factors.

Racial and Ethnic Infant Mortality Gaps and the Role of Socio-Economic Status (nih.gov)

Several more recent studies point to systematic racism working through a large number of lifetime events which impact the mother’s health as the primary cause of racial differences in infant mortality rates.

Exploring African Americans’ High Maternal and Infant Death Rates – Center for American Progress

Eliminating Racial Disparities in Maternal and Infant Mortality – Center for American Progress

One study of Florida births indicated that having a black doctor reduced deaths by 40% for black infant births. White infant mortality was not effected by the race of the doctor.

Black newborns 3 times more likely to die when looked after by White doctors – CNN

In summary, great progress has been made since WW II and continues to be made in the US. However, the reduction in death rates has slowed down. The US death rates are much higher than in other higher income nations and death rates in Europe and Japan have declined faster than in the US. US state death rates range widely, from 4 to 8. Black death rates are twice as high as white death rates.

There remains room for significant progress. World class 2 deaths per 1,000 versus 4.7 for American whites, 11 for American blacks, 4.2 for Californians, 4.6 for New Yorkers, 6.1 for Illinoisans and Floridians, 7.2 for Buckeyes, Hoosiers and Georgians, more than 8 for Mississippians and Arkansans.