Editing Infant mortality (section)

===Environmental===
The infant mortality rate is one measure of a nation's health and social conditions. Its causes are a composite of a number rates that each have their own separate relationships with each other and with various other social factors. As such, IMR can often be seen as an indicator to measure the level of socioeconomic disparity within a country.<ref name="MacDorman 2009">{{Cite journal |vauthors=MacDorman MF, Mathews TJ |year=2009 |title=The challenge of infant mortality: have we reached a plateau? |doi-access=free |journal=Public Health Reports |volume=124 |issue=5 |pages=670–81 |doi=10.1177/003335490912400509 |pmc=2728659 |pmid=19753945}}</ref><ref name="Gortmaker 1997">{{Cite journal |vauthors=Gortmaker SL, Wise PH |year=1997 |title=The first injustice: socioeconomic disparities, health services technology, and infant mortality |journal=Annual Review of Sociology |volume=23 |pages=147–70 |doi=10.1146/annurev.soc.23.1.147 |pmid=12348279}}</ref>

Organic [[water pollution]] is a better indicator of infant mortality than health expenditures per capita. Water contaminated by animal waste houses various [[pathogens]] including a host of [[parasitic]] and [[microbial]] infections.<ref name="Jorgenson">{{Cite journal |vauthors=Jorgenson AK |year=2004 |title=Global inequality, water pollution, and infant mortality |journal=The Social Science Journal |volume=41 |issue=2 |pages=279–288 |doi=10.1016/j.soscij.2004.01.008 |s2cid=154147986}}</ref> Areas of low [[socioeconomic status]] are more prone to inadequate plumbing infrastructure and poorly maintained facilities.<ref name="Andrews" /> Climate and geography often play a role in sanitation conditions. For example, the inaccessibility of clean water exacerbates poor sanitation conditions.<ref name="Jorgenson" />

The burning of inefficient fuels doubles the rate of acute respiratory tract infections in children under 5 years old.<ref name="Andrews" /> People who live in areas where [[particulate matter]] air pollution is higher tend to have more health problems regardless of age. The short and long-term effects of [[air pollution]] are associated with an increased mortality rate, including infant mortality. Air pollution is consistently associated with postnatal mortality due to respiratory effects and sudden infant death syndrome (SIDS). Specifically, air pollution is highly associated with SIDS in the United States during the post-neonatal stage.<ref>{{Cite journal |vauthors=Woodruff TJ, Darrow LA, Parker JD |date=January 2008 |title=Air pollution and postneonatal infant mortality in the United States, 1999-2002 |journal=Environmental Health Perspectives |volume=116 |issue=1 |pages=110–5 |doi=10.1289/ehp.10370 |pmc=2199284 |pmid=18197308|bibcode=2008EnvHP.116..110W }}</ref> High infant mortality is exacerbated because newborns are a vulnerable subgroup that is affected by air pollution.<ref>{{Cite journal |vauthors=Glinianaia SV, Rankin J, Bell R, Pless-Mulloli T, Howel D |date=October 2004 |title=Does particulate air pollution contribute to infant death? A systematic review |journal=Environmental Health Perspectives |volume=112 |issue=14 |pages=1365–71 |doi=10.1289/ehp.6857 |pmc=1247561 |pmid=15471726|bibcode=2004EnvHP.112.1365G }}</ref> Newborns who were born into these environments are no exception, and pregnant women exposed to greater air pollution on a daily basis should be closely watched by their doctors, including after the baby is born. Babies who live in areas with less air pollution have a greater chance of living until their first birthday, meaning babies who live in environments with more air pollution are at greater risk for infant mortality. Areas that have higher air pollution also have a greater chance of having a higher population density, higher crime rates, and lower income levels, all of which can lead to higher infant mortality rates.<ref>{{Cite web |title=Infant Mortality: Reducing Infant Deaths. |url=http://www.nichd.nih.gov/news/resources/advances/2005/infant.cfm |url-status=dead |archive-url=https://web.archive.org/web/20111012190945/http://www.nichd.nih.gov/news/resources/advances/2005/infant.cfm |archive-date=12 October 2011 |publisher=[[Eunice Kennedy Shriver National Institute of Child Health and Human Development]]}}</ref>

A key pollutant in infant mortality rates is [[carbon monoxide]]. Carbon monoxide is a colorless, odorless gas that can kill, and is especially dangerous to infants because of their immature respiratory systems.<ref>{{Cite journal |vauthors=Benjamin DK |date=Winter 2006 |title=Air Pollution and Infant Mortality |url=http://perc.org/articles/air-pollution-and-infant-mortality |journal=Property and Environmental Research Center Report |volume=24 |issue=4}}</ref>
Another major pollutant that can have detrimental effects on a fetus is second-hand smoke.

{{Blockquote|source=''American Journal of Public Health''|text=[I]n 2006, more than 42,000 Americans died of secondhand smoke-attributable diseases, including more than 41,000 adults and nearly 900 infants. Fully 36% of the infants who died of low birth weight caused by exposure to maternal smoking in utero were black, as were 28% of those dying of respiratory distress syndrome, 25% dying of other respiratory conditions, and 24% dying of sudden infant death syndrome.}}

{{Blockquote|source=''The American Journal of Epidemiology''|text=Compared with nonsmoking women having their first birth, women who smoked less than one pack of cigarettes per day had a 25% greater risk of mortality, and those who smoked one or more packs per day had a 56% greater risk. Among women having their second or higher birth, smokers experienced 30% greater mortality than nonsmokers.}}

Modern research in the United States into racial disparities in infant mortality suggests a link between [[institutionalized racism]] and high rates of African American infant mortality. In synthesis{{Synthesis inline|date=July 2023}} of this research, it has been observed that "African American infant mortality remains elevated due to the social arrangements that exist between groups and the lifelong experiences responding to the resultant power dynamics of these arrangements."<ref name="Osel2008" />

It is important to note that infant mortality rates do not decline among African Americans if their socio-economic status improves. Parker Dominguez at the University of Southern California<ref>{{Cite web |title=Tyan Parker Dominguez {{!}} USC Social Work |url=https://dworakpeck.usc.edu/academics/faculty-directory/tyan-parker-dominguez |access-date=2024-03-16 |website=dworakpeck.usc.edu |language=en}}</ref> has made some headway in determining the reasons behind this, claiming black women in the US are more prone to psychological stress than women of other races. Stress is a leading factor in the start of labor, and therefore, high levels of stress during pregnancy could lead to premature births that have the potential to be fatal for the infant.<ref>{{Cite news |date=2014-03-03 |title=Why do black infants die so much more often than white infants? |work=Southern California Public Radio |url=http://www.scpr.org/news/2014/03/03/42483/why-do-black-infants-die-so-much-more-often-than-w/ |access-date=2017-02-07}}</ref>

====Early childhood trauma====
[[Early childhood trauma]] includes physical, sexual, and psychological abuse of a child from birth to five years old. [[Childhood trauma|Trauma]] in early childhood has an extreme impact over the course of a lifetime and is a significant contributor to infant mortality. Developing organs are fragile, when an infant is shaken, beaten, strangled, or raped, the impact is exponentially more destructive than when the same abuse occurs to a fully developed body.{{Fact or opinion|date=July 2023}} Studies estimate that 1–2 per 100,000 U.S. children are fatally injured annually, and it is reasonable to assume that these statistics underrepresent actual mortality.<ref name="child welfare">{{Cite book |last=Child Welfare Information Gateway |url=https://www.childwelfare.gov/pubpdfs/fatality.pdf |title=Child Abuse and Neglect Fatalities 2018: Statistics and Interventions |date=2020 |publisher=Children's Bureau, U.S. Department of Health and Human Services |location=Washington, DC |access-date=22 October 2020 |archive-date=16 October 2020 |archive-url=https://web.archive.org/web/20201016192931/https://www.childwelfare.gov/pubPDFs/fatality.pdf |url-status=dead }}</ref><ref>{{Cite journal |vauthors=Palusci VJ, Covington TM |date=January 2014 |title=Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System |journal=Child Abuse & Neglect |volume=38 |issue=1 |pages=25–36 |doi=10.1016/j.chiabu.2013.08.014 |pmid=24094272}}</ref> Almost three-quarters (70.6%) of child fatalities in [[Fiscal year|FFY]] 2018 involved children younger than 3 years, and children younger than 1 year accounted for half (49.4%) of all fatalities.<ref name="child welfare" /> In particular, correctly identifying deaths due to neglect is problematic, and children with sudden, unexpected deaths or deaths from apparently unintentional causes often have preventable risk factors that are substantially similar to those in families with maltreatment.{{citation needed|date=August 2023}}

There is a direct relationship between the age at which maltreatment or injury occurs and the risk of death. The younger an infant is, the more dangerous the maltreatment.<ref>{{Cite journal |vauthors=Imamura JH, Troster EJ, Oliveira CA |date=September 2012 |title=What types of unintentional injuries kill our children? Do infants die of the same types of injuries? A systematic review |journal=Clinics |volume=67 |issue=9 |pages=1107–16 |doi=10.6061/clinics/2012(09)20 |pmc=3438254 |pmid=23018311}}</ref>{{Failed verification|date=July 2023|reason=Improper synthesis?}}

Family configuration,<ref>{{Cite journal |vauthors=Smith-Greenaway E, Trinitapoli J |date=April 2014 |title=Polygynous contexts, family structure, and infant mortality in sub-saharan Africa |journal=Demography |volume=51 |issue=2 |pages=341–66 |doi=10.1007/s13524-013-0262-9 |pmc=3974908 |pmid=24402794}}</ref><ref>{{Cite web |title=Child Maltreatment: Risk and Protective Factors |url=https://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html |url-status=dead |archive-url=https://web.archive.org/web/20100306061203/https://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html |archive-date=6 March 2010 |website=Centers for Disease Control and Prevention}}</ref> child gender, social isolation, lack of support, maternal youth, marital status, [[poverty]], parental [[Adverse Childhood Experiences Study|adverse childhood experiences]], and parenting practices<ref>{{Cite journal |vauthors=Leventhal JM, Garber RB, Brady CA |date=March 1989 |title=Identification during the postpartum period of infants who are at high risk of child maltreatment |journal=The Journal of Pediatrics |volume=114 |issue=3 |pages=481–7 |doi=10.1016/S0022-3476(89)80580-3 |pmid=2921696}}</ref> are all thought to contribute to increased risk.<ref name="child welfare" />

====Socio-economic factors====
[[File:Infant mortality rates are higher in more unequal countries.jpg|thumb|Infant mortality rates are higher in countries with higher [[economic inequality]].]]
[[Social class]] is a major factor in infant mortality, both historically and today. Between 1912 and 1915, the Children's Bureau in the United States examined data across eight cities and nearly 23,000 live births. They discovered that lower [[income]]s tended to [[correlation|correlate]] with higher infant mortality. In cases where the father had no income, the rate of infant mortality was 357% higher than that for the highest income earners ($1,250+).<ref name="ReferenceA" />{{rp|5}} Differences between [[race (classification of humans)|races]] were also apparent. African-American mothers experience infant mortality at a rate 44% higher than average;<ref name="ReferenceA">{{Cite journal |vauthors=Haines MR |year=2011 |title=Inequality and infant and childhood mortality in the United States in the twentieth century |url=http://www.nber.org/papers/w16133.pdf |journal=Explorations in Economic History |volume=48 |issue=3 |pages=418–28 |doi=10.1016/j.eeh.2011.05.009 |s2cid=154583453 |ssrn=1630138}}</ref> however, research indicates that socio-economic factors do not totally account for the racial disparities in infant mortality.<ref name="Osel2008" />

[[File:Countries by GDP (nominal) per capita in 2019.svg|thumb|left|270x270px|Countries by 2019 [[List of countries by GDP (nominal) per capita|GDP (nominal) per capita]]{{efn|Data from the [[United Nations]] is used.}}]]

While infant mortality is normally negatively correlated with GDP, there may be some beneficial short-term effects from a recession. A 2009 study in ''[[The Economist]]'' showed that economic slowdowns reduce air pollution, which results in a lower infant mortality rate. In the late 1970s and early 1980s, the recession's impact on air quality was estimated to have saved around 1,300 US babies.<ref>{{Cite news |date=2009-06-01 |title=A recession breathes life |newspaper=The Economist |url=http://www.economist.com/research/articlesBySubject/displaystory.cfm?subjectid=7933604&story_id=13764868 |archive-url=https://web.archive.org/web/20090725034036/http://www.economist.com/research/articlesBySubject/displaystory.cfm?subjectid=7933604&story_id=13764868 |archive-date=2009-07-25}}</ref> It is only during deep recessions that infant mortality increases. According to Norbert Schady and Marc-François Smitz, recessions when [[per capita GDP]] drops by 15% or more increase IMR.<ref>{{Cite web |last1=Schady |first1=Norbert |last2=Smitz |first2=Marc |date=August 2009 |title=Aggregate Economic Shocks and Infant Mortality: New Evidence for Middle-Income Countries |url=http://siteresources.worldbank.org/INTAFRICA/Resources/SchadySmitz_080509.pdf |website=The World Bank}}</ref>

Social class dictates which medical services are available to an individual. Disparities due to [[socioeconomic]] factors have been highlighted by advances in medical [[technology]]. Developed countries, most notably the United States, have seen a divergence in IMR between those living in poverty who cannot afford medically advanced resources, and those who can.<ref name="Gortmaker 1997" />

Developing nations with democratic governments tend to be more responsive to public opinion, [[social movements]], and [[special interest groups]] on issues like infant mortality. In contrast, non-democratic governments are more interested in corporate issues than in health issues. Democratic status affects the dependency a nation has on its economic state via exports, investments from multinational corporations, and international lending institutions.<ref name="Shandra">{{Cite journal |vauthors=Shandra JM, Nobles J, London B, Williamson JB |date=July 2004 |title=Dependency, democracy, and infant mortality: a quantitative, cross-national analysis of less developed countries |url=http://www.escholarship.org/uc/item/1wm303dg |journal=Social Science & Medicine |volume=59 |issue=2 |pages=321–333 |doi=10.1016/j.socscimed.2003.10.022 |pmid=15110423 |s2cid=616916}}</ref>

Levels of socioeconomic development and global integration are inversely related to a nation's infant mortality rate, meaning that as they increase, IMR decreases.<ref name="Andrews" /><ref name="Fuse">{{Cite journal |vauthors=Fuse K, Crenshaw EM |date=January 2006 |title=Gender imbalance in infant mortality: a cross-national study of social structure and female infanticide |journal=Social Science & Medicine |volume=62 |issue=2 |pages=360–74 |doi=10.1016/j.socscimed.2005.06.006 |pmid=16046041}}</ref> A nation's internal impact is highly influenced by its position in the global economy, which has adverse effects on the survival of children in developing countries.<ref name="Jorgenson" /> Countries can experience disproportionate effects from [[trade]] and stratification within the global system,<ref>{{Cite journal |vauthors=Moore S, Teixeira AC, Shiell A |date=July 2006 |title=The health of nations in a global context: trade, global stratification, and infant mortality rates |url=https://www.researchgate.net/publication/7316172 |journal=Social Science & Medicine |volume=63 |issue=1 |pages=165–78 |doi=10.1016/j.socscimed.2005.12.009 |pmid=16457924}}</ref> which contributes to the global [[division of labor]], and distorts the [[domestic economy|domestic economies]] of developing nations. The dependency of developing nations can reduce the rate of economic growth, increase income inequality inter- and intra-nationally, and adversely affect the wellbeing of a nation's population. Collective cooperation between  countries plays a role in development policies in the poorer countries of the world.<ref name="Shandra" />{{Explain|date=July 2023|reason=Jargon heavy paragraph is hard to follow for the non-economist.}}

These economic factors present challenges to governments' public [[health policy|health policies]].<ref name="Jorgenson" /> If the nation's ability to raise its own revenues is compromised, governments will lose funding for their health service programs, including those that aim to decrease infant mortality rates.<ref name="Shandra" /> Less developed countries face higher levels of vulnerability to the possible negative effects of globalization and trade in relation to more developed countries.<ref name="Jorgenson" />

Even with a strong economy and economic growth (measured by a country's [[gross national product]]), the advances of medical technologies may not be felt by everyone, increasing social disparities.<ref name="Gortmaker 1997" /> In England, from 2014 to 2017, a rise in infant mortality was disproportionately experienced by the poorest regions, where the previously declining trend was reversed and an additional 24 infant deaths per 100,000 live births occurred annually.<ref>{{Cite journal |display-authors=6 |vauthors=Taylor-Robinson D, Lai ET, Wickham S, Rose T, Norman P, Bambra C, Whitehead M, Barr B |date=October 2019 |title=Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000-2017: time trend analysis |journal=BMJ Open |volume=9 |issue=10 |pages=e029424 |doi=10.1136/bmjopen-2019-029424 |pmc=6954495 |pmid=31578197}}</ref>

====War====
Infant mortality rates correlate with [[war]], political unrest, and [[government corruption]].<ref name="Andrews" /> In most cases, war-affected areas will experience a significant increase in infant mortality rates. Having a war take place when planning pregnancy is not only stressful on the mother and fetus but also has several detrimental effects.<ref>{{Cite journal |last=Abouharb |first=M. Rodwan |date=2023-03-16 |title=War and infant mortality rates |url=https://www.tandfonline.com/doi/full/10.1080/14754835.2022.2122786 |journal=[[PLOS Medicine]] |volume=22 |issue=2 |pages=135-157 |doi=10.1080/14754835.2022.2122786 |issn=1475-4835 |via=[[Taylor & Francis Online]]}}</ref><ref>{{Cite journal |last1=Jawad |first1=Mohammed |last2=Hone |first2=Thomas |last3=Vamos |first3=Eszter P. |last4=Cetorelli |first4=Valeria |last5=Millett |first5=Christopher |date=2021-09-28 |title=Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000–2019 |journal=PLOS Medicine |language=en |volume=18 |issue=9 |pages=e1003810 |doi=10.1371/journal.pmed.1003810 |doi-access=free |issn=1549-1676 |pmc=8478221 |pmid=34582455}}</ref>

Many other significant factors influence infant mortality rates in war-torn areas. Health care systems in developing countries in the midst of war often collapse, and obtaining basic medical supplies and care becomes increasingly difficult. During the [[Yugoslav Wars]] in the 1990s, Bosnia experienced a 60% decrease in child immunizations. Preventable diseases can quickly become epidemics during war.<ref name="Krug_2002">{{Cite book |url=https://www.who.int/violence_injury_prevention/violence/world_report/en/ |title=World Report on Violence and Health |vauthors=Krug E |publisher=Geneva WHO |year=2002 |location=Geneva}}</ref>

Many developing countries rely on foreign aid for basic nutrition, and transport of aid becomes significantly more difficult in times of war. In most situations, the average weight of a population will drop substantially.<ref>{{Cite journal |vauthors=Toole MJ, Galson S, Brady W |date=May 1993 |title=Are war and public health compatible? |url=https://zenodo.org/record/1258317 |journal=Lancet |volume=341 |issue=8854 |pages=1193–6 |doi=10.1016/0140-6736(93)91013-C |pmid=8098086 |s2cid=7743798}}</ref> Expectant mothers are affected even more by a lack of access to food and water. During the Yugoslav Wars in Bosnia, the number of premature babies born increased and the average birth weight decreased.<ref name="Krug_2002" />

There have been several instances in recent years of systematic rape as a weapon of war. People who become pregnant as a result of war rape face even more significant challenges in bearing a healthy child. Studies suggest that people who experience sexual violence before or during pregnancy are more likely to experience infant death.<ref>{{Cite journal |vauthors=Asling-Monemi K, Peña R, Ellsberg MC, Persson LA |year=2003 |title=Violence against women increases the risk of infant and child mortality: a case-referent study in Nicaragua |journal=Bulletin of the World Health Organization |volume=81 |issue=1 |pages=10–6 |pmc=2572309 |pmid=12640470}}</ref><ref>{{Cite journal |vauthors=Emenike E, Lawoko S, Dalal K |date=March 2008 |title=Intimate partner violence and reproductive health of women in Kenya |journal=International Nursing Review |volume=55 |issue=1 |pages=97–102 |doi=10.1111/j.1466-7657.2007.00580.x |pmid=18275542}}</ref><ref>{{Cite journal |vauthors=Jejeebhoy SJ |date=September 1998 |title=Associations between wife-beating and fetal and infant death: impressions from a survey in rural India |journal=Studies in Family Planning |volume=29 |issue=3 |pages=300–8 |doi=10.2307/172276 |jstor=172276 |pmid=9789323}}</ref> Causes of infant mortality after abuse during pregnancy range from physical side effects of the initial trauma to psychological effects that lead to poor adjustment to society.<ref>{{Cite journal |vauthors=Fisher SK |date=October 1996 |title=Occupation of the Womb: Forced Impregnation as Genocide |url=https://scholarship.law.duke.edu/dlj/vol46/iss1/4 |journal=Duke Law Journal |volume=46 |issue=1 |pages=91–133 |doi=10.2307/1372967 |jstor=1372967}}</ref> Many people who became pregnant by rape in Bosnia were isolated from their hometowns, making life after childbirth exponentially more difficult.<ref>{{Cite journal |last=Theidon |first=Kimberly |date=1 December 2015 |title=Hidden in Plain Sight |url=https://www.journals.uchicago.edu/doi/10.1086/683301 |journal=Current Anthropology |volume=56 |issue=S12 |pages=S191–S200 |doi=10.1086/683301 |issn=0011-3204}}</ref>