Editing Infant mortality (section)

==Prevention and outcomes==
To reduce infant mortality rates across the world, health practitioners, governments, and non-governmental organizations have worked to create institutions, programs, and policies to generate better health outcomes. Current efforts focus on the development of human resources, strengthening health information systems, health service delivery, etc. Improvements in such areas aim to increase regional health systems and aid efforts to reduce mortality rates.

===Policy===
Reductions in infant mortality are possible at any stage of a country's development.<ref name="Bishai" /> Rate reductions are evidence that a country is advancing in human knowledge, social [[institutions]], and [[physical capital]]. Governments can reduce mortality rates by addressing the combined need for education (such as [[universal primary education]]), nutrition, and access to basic maternal and infant health services. Focused policies has the potential to aid those most at risk for infant and childhood mortality, including rural, poor, and migrant populations.<ref>{{Cite journal |vauthors=Farahani M, Subramanian SV, Canning D |date=June 2009 |title=The effect of changes in health sector resources on infant mortality in the short-run and the long-run: a longitudinal econometric analysis |journal=Social Science & Medicine |volume=68 |issue=11 |pages=1918–25 |doi=10.1016/j.socscimed.2009.03.023 |pmid=19362762}}</ref>

Reducing the chances of babies being born at low birth weights and contracting pneumonia can be accomplished by improving air quality.{{citation needed|date=July 2023}} Improving [[hygiene]] can prevent infant mortality. Home-based technology to [[Water chlorination|chlorinate]], filter, and use [[solar disinfection]] for organic water pollution could reduce cases of diarrhea in children by up to 48%.<ref name="Andrews" /><ref name="Nussbaum" /><ref name="Jorgenson" /> Improvements in food supplies and [[sanitation]] have been shown to work for the most vulnerable populations in the US, including among African Americans.<ref name="Gortmaker 1997" />

Promoting [[Behaviour change (public health)|behavioral changes]], such as [[hand washing]] with soap, can significantly reduce the rate of infant mortality from respiratory and diarrheal diseases.<ref>{{Cite journal |vauthors=Curtis V, Cairncross S |date=May 2003 |title=Effect of washing hands with soap on diarrhoea risk in the community: a systematic review |journal=The Lancet. Infectious Diseases |volume=3 |issue=5 |pages=275–81 |doi=10.1016/S1473-3099(03)00606-6 |pmid=12726975}}</ref> According to UNICEF, hand washing with soap before eating and after using the [[toilet]] can save  children's lives by reducing deaths from diarrhea and acute respiratory infections.<ref>{{Cite web |title=The State of the World's Children 2008. Child Survival. UNICEF |url=https://www.unicef.org/media/84861/file/SOWC-2008.pdf |url-status=live |archive-url=https://web.archive.org/web/20230528174903/https://www.unicef.org/media/84861/file/SOWC-2008.pdf |archive-date=2023-05-28 |access-date=2023-08-15}}</ref>

Focusing on preventing preterm and low birth weight deliveries throughout all populations can help eliminate cases of infant mortality and decrease health care disparities within communities. In the United States, these two goals have decreased regional infant mortality rates, but there has yet to be further progress on a national level.<ref name="MacDorman 2009" />

Increasing human resources such as [[physicians]], [[nurses]], and other health professionals will increase the number of skilled attendants and the number of people able to give out immunizations against diseases such as measles. Increasing the number of skilled professionals is correlated with lower maternal, infant, and childhood mortality. With the addition of one physician per 10,000 people, there is a potential for 7.08 fewer infant deaths per 10,000.<ref>{{Cite journal |vauthors=Russo LX, Scott A, Sivey P, Dias J |date=2019-05-31 |title=Primary care physicians and infant mortality: Evidence from Brazil |journal=PLOS ONE |volume=14 |issue=5 |pages=e0217614 |bibcode=2019PLoSO..1417614R |doi=10.1371/journal.pone.0217614 |pmc=6544253 |pmid=31150468 |doi-access=free}}</ref>

In certain parts of the US, specific programs aim to reduce levels of infant mortality. One such program is the "Best Babies Zone" (BBZ), based at the [[University of California, Berkeley]]. The BBZ uses the [[life course approach]] to address the structural causes of poor birth outcomes and [[toxic stress]] in three US neighborhoods. By employing community-generated solutions, the Best Babies Zone's ultimate goal is to achieve health equity in communities that are disproportionately impacted by infant mortality.<ref>{{Cite web |title=Best Babies Zone - ACPHD |url=http://www.acphd.org/building-blocks/projects/bbz.aspx#:~:text=Best%20Babies%20Zone%20is%20a,to%20live%2015%20fewer%20years. |access-date=2020-08-03 |website=www.acphd.org}}</ref>

=== Prenatal care and maternal health ===
Certain steps can help to reduce the chance of complications during pregnancy. Attending regular [[prenatal care]] check-ups will help improve the baby's chances of being delivered in safer conditions and surviving.<ref>{{Cite journal |vauthors=Otundo Richard M |date=2019 |title=WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience in Kenya |journal=SSRN Working Paper Series |doi=10.2139/ssrn.3449460 |issn=1556-5068 |s2cid=219379303}}</ref> Additionally, taking supplementation, including [[Folate|folic acid]], can help reduce the chances of birth defects, a leading cause of infant mortality.<ref name="cdc-2020" /> Many countries have instituted mandatory folic acid supplementation in their food supply, which has significantly reduced the occurrence of a birth defect known as [[spina bifida]] in newborns.<ref>{{Cite journal |display-authors=6 |vauthors=Atta CA, Fiest KM, Frolkis AD, Jette N, Pringsheim T, St Germaine-Smith C, Rajapakse T, Kaplan GG, Metcalfe A |date=January 2016 |title=Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis |journal=American Journal of Public Health |volume=106 |issue=1 |pages=e24-34 |doi=10.2105/AJPH.2015.302902 |pmc=4695937 |pmid=26562127}}</ref> Similarly, the fortification of salt with iodine, called [[salt iodization]], has helped reduce negative birth outcomes associated with low iodine levels during pregnancy.<ref name="ramakrishnan-2012">{{Cite journal |vauthors=Ramakrishnan U, Grant F, Goldenberg T, Zongrone A, Martorell R |date=July 2012 |title=Effect of women's nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review |journal=Paediatric and Perinatal Epidemiology |volume=26 |issue=Suppl 1 |pages=285–301 |doi=10.1111/j.1365-3016.2012.01281.x |pmid=22742616 |doi-access=free}}</ref>

Abstinence from alcohol can also decrease the chances of harm to the fetus as drinking any amount of alcohol during pregnancy may lead to [[fetal alcohol spectrum disorder]]s (FASD) or other alcohol related birth defects.<ref>{{Cite journal |vauthors=Flak AL, Su S, Bertrand J, Denny CH, Kesmodel US, Cogswell ME |date=January 2014 |title=The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis |journal=Alcoholism: Clinical and Experimental Research |volume=38 |issue=1 |pages=214–26 |doi=10.1111/acer.12214 |pmid=23905882|doi-access=free }}</ref> Tobacco use during pregnancy has also been shown to significantly increase the risk of a preterm or low birth weight birth, both of which are leading causes of infant mortality.<ref>{{Cite journal |display-authors=6 |vauthors=Banderali G, Martelli A, Landi M, Moretti F, Betti F, Radaelli G, Lassandro C, Verduci E |date=October 2015 |title=Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review |journal=Journal of Translational Medicine |volume=13 |pages=327 |doi=10.1186/s12967-015-0690-y |pmc=4608184 |pmid=26472248 |doi-access=free }}</ref> Pregnant women should consult with their doctors to best manage any [[Pre-existing condition|pre-existing health conditions]] to avoid complications to both their health as well as the fetus's. Obese people are at an increased risk of developing complications during pregnancy, including [[gestational diabetes]] or pre-eclampsia. Additionally, they are more likely to experience a pre-term birth or have a child with birth defects.<ref>{{Cite journal |vauthors=Marchi J, Berg M, Dencker A, Olander EK, Begley C |date=August 2015 |title=Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews |url=http://openaccess.city.ac.uk/12304/1/Risks%20associated%20with%20obesity%20in%20pregnancy%20%28final%20accepted%20version%29.pdf |journal=Obesity Reviews |volume=16 |issue=8 |pages=621–38 |doi=10.1111/obr.12288 |pmid=26016557 |s2cid=206228471 |hdl-access=free |hdl=2262/75578}}</ref><ref name="ramakrishnan-2012" />

=== Nutrition ===
Appropriate nutrition for newborns and infants can help keep them healthy, and can help avoid health complications during early childhood. The [[American Academy of Pediatrics]] recommends exclusively [[breastfeeding]] infants for the first 6 months of life, and continuing breastfeeding as other sources of food are introduced through the next 6 months of life (up to 1 year of age).<ref>{{Cite journal |last1=Eidelman |first1=Arthur I. |last2=Schanler |first2=Richard J. |last3=Johnston |first3=Margreete |last4=Landers |first4=Susan |last5=Noble |first5=Larry |last6=Szucs |first6=Kinga |last7=Viehmann |first7=Laura |date=March 2012 |title=Breastfeeding and the use of human milk |journal=Pediatrics |volume=129 |issue=3 |pages=e827–e841 |doi=10.1542/peds.2011-3552 |pmid=22371471 |doi-access=free}}</ref> Infants under 6 months of age who are exclusively breastfed have a lower risk of mortality compared to infants who are breastfed part of the time or not at all.<ref>{{Cite journal |vauthors=Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, Bahl R |date=December 2015 |title=Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis |journal=Acta Paediatrica |volume=104 |issue=467 |pages=3–13 |doi=10.1111/apa.13147 |pmid=26249674 |s2cid=23206368 |hdl-access=free |hdl=1956/11852}}</ref> For this reason, breast feeding is favored over formula feeding by healthcare professionals.

=== Vaccinations ===
The [[Centers for Disease Control and Prevention]] (CDC) defines infants as those 1 month of age to 1 year of age.<ref>{{Cite web |date=4 February 2021 |title=Center of Disease Control and Development: Child Development |url=https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/infants.html |website=CDC.gov}}</ref> For these infants, the CDC recommends the following vaccinations: [[Hepatitis B]] (HepB), [[Rotavirus]] (RV), [[Haemophilus influenzae|Haemophilus Influenzae type B]] (HIB), [[Pneumococcal conjugate vaccine|Pneumococcal Conjugate]] (PCV13), [[Polio|Inactivated Poliovirus]] (IPV < 18 yrs), [[Influenza]], [[Chickenpox|Varicella]], [[Measles]], [[Mumps]], [[Rubella]] (MMR), and [[Diphtheria]], [[tetanus]], [[Whooping cough|acellular pertussis]] (DTapP < 7yrs).<ref name="cdcgov">{{Cite web |title=CDC Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020 |url=https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf |website=CDC.gov}}</ref> Each of these vaccinations are given at particular age ranges depending on the vaccination and are required to be done in a series of 1 to 3 doses over time depending on the vaccination.<ref name="cdcgov" />

The efficacy of these vaccinations can be seen immediately following their introduction to society.<ref name="who-2008">{{Cite web |title=WHO {{!}} Vaccination greatly reduces disease, disability, death and inequity worldwide |url=https://www.who.int/bulletin/volumes/86/2/07-040089/en/ |url-status=dead |archive-url=https://web.archive.org/web/20080227011328/http://www.who.int/bulletin/volumes/86/2/07-040089/en/ |archive-date=February 27, 2008 |access-date=2020-07-30 |website=WHO}}</ref> Following the advent of the [[Pneumococcal conjugate vaccine|Pneumococcal Conjugate vaccine]] (PCV13) in the United States in the year 2000, the [[World Health Organization|World Health Organization (WHO)]] reports studies done in 2004 had shown a 57% decline in invasive{{efn|Invasive meaning cultured from a normally sterile site}} penicillin resistant strains of the disease and a 59% reduction in [[multi drug resistant]] strains.<ref name="who-2008" /> This reduction was even greater for children under 2 years of age with studies finding an 81% reduction in those same strains.<ref name="who-2008" />

As mentioned in a previous section,{{efn|Causes: [[Infant mortality#Sudden infant death syndrome (SIDS)|SIDS]]}} [[SIDS|sudden infant death syndrome]] (SIDS) is the leading cause of infant mortality between 1 month and 1 year of age.<ref name="cdc.gov" /> Immunizations, when given in accordance to proper guidelines, have shown to reduce the risk of SIDS by 50%.<ref name="moon-2016" /><ref>{{Cite book |title=Immunization safety review measles-mumps-rubella vaccine and autism |vauthors=Stratton KR |date=2001 |publisher=National Academy Press |isbn=0-309-07447-9 |oclc=928430099}}</ref> For this reason, the [[American Academy of Pediatrics]] (AAP) and the [[Centers for Disease Control and Prevention|Center for Disease Control]] (CDC) both recommend immunizations in accordance to their guidelines.<ref name="moon-2016" /><ref>{{Cite web |title=Immunizations |url=http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Pages/Immunizations-home.aspx |access-date=2020-07-30 |website=AAP.org |language=en-US}}</ref>

===Socio-economic factors===
It has been well documented that increased education among mothers, communities, and local health workers results in better [[family planning]], improvement in children's health, and lower rates of children's deaths. High-risk areas, such as Sub-Saharan Africa, have demonstrated that an increase in women's educational attainment leads to a reduction in infant mortality by about 35%.<ref>{{Cite journal |vauthors=Shapiro D, Tenikue M |date=2017-09-13 |title=Women's education, infant and child mortality, and fertility decline in rural and urban sub-Saharan Africa |journal=Demographic Research |volume=37 |pages=669–708 |doi=10.4054/demres.2017.37.21 |issn=1435-9871 |doi-access=free}}</ref> Similarly, coordinated efforts to train community health workers in diagnosis, treatment, malnutrition prevention, reporting and referral services has reduced infant mortality in children under 5 by as much as 38%.<ref>{{Cite journal |display-authors=6 |vauthors=Mugeni C, Levine AC, Munyaneza RM, Mulindahabi E, Cockrell HC, Glavis-Bloom J, Nutt CT, Wagner CM, Gaju E, Rukundo A, Habimana JP, Karema C, Ngabo F, Binagwaho A |date=August 2014 |title=Nationwide implementation of integrated community case management of childhood illness in Rwanda |journal=Global Health: Science and Practice |volume=2 |issue=3 |pages=328–41 |doi=10.9745/GHSP-D-14-00080 |pmc=4168626 |pmid=25276592}}</ref> Public health campaigns centered around the [[First 1000 days]] of life have been successful in providing cost-effective supplemental nutrition programs, as well as assisting young mothers in sanitation, hygiene and breastfeeding.<ref>{{Cite journal |vauthors=Flood D, Chary A, Colom A, Rohloff P |date=June 2018 |title=Adolescent Rights and the "First 1,000 days" Global Nutrition Movement: A View from Guatemala |journal=Health and Human Rights |volume=20 |issue=1 |pages=295–301 |pmc=6039738 |pmid=30008571}}</ref> Increased intake of nutrients and better [[sanitation]] habits have a positive impact on health, especially for developing children. Educational attainment and public health campaigns provide the knowledge and means to practice better habits and lead to lower infant mortality rates.{{citation needed|date=July 2023}}

A decrease in [[GDP]] results in increased rates of infant mortality.<ref>{{Cite journal |vauthors=Baird S, Friedman J, Schady N |date=2011 |title=Aggregate Income Shocks and Infant Mortality in the Developing World |url=http://www.gwu.edu/~iiep/assets/docs/papers/Baird_IIEPWP2010-7.pdf |journal=The Review of Economics and Statistics |volume=93 |issue=3 |pages=847–856 |doi=10.1162/REST_a_00084 |jstor=23016081 |s2cid=57566653 |hdl=10986/4916}}</ref> A reduction in household income reduces the amount being spent on food and healthcare, affecting the quality of life, and reduces access to medical services that ensure full development and survival. Likewise, increased household income translates to more access to nutrients and healthcare, reducing the risks associated with malnutrition and infant mortality.<ref name="haddad-2003">{{Cite journal |vauthors=Haddad L, Alderman H, Appleton S, Song L, Yohannes Y |date=2003-06-01 |title=Reducing Child Malnutrition: How Far Does Income Growth Take Us? |journal=The World Bank Economic Review |volume=17 |issue=1 |pages=107–131 |doi=10.1093/wber/lhg012 |issn=0258-6770 |hdl-access=free |hdl=10419/81795}}</ref> Moreover, increased aggregate household incomes will produce better health facilities, water and [[Sewage treatment|sewer infrastructures]] for the entire community.<ref name="haddad-2003" />