Arizona's infant mortality rate rose by 11% last year, new analysis says

Arizona's infant mortality rate has surpassed the U.S. level for the first time in at least a decade, signaling a problem that experts say could be improved with regular prenatal care and safer sleep environments.

The 11% increase in the state's infant mortality rate was a "substantial finding" in the Arizona Child Fatality Review Program's 30th annual report, said Dr. Mary Ellen Rimsza, a pediatrician and chair of the state's child fatality review program.

"It is disturbing if you look at the data. Although the national infant mortality rate went up, ours went up much more than the national," said Rimsza, who is also medical director of the child fatality program for the American Academy of Pediatrics' Arizona chapter. "There are certain racial and ethnic groups where there are unfortunately disparities and increased risk for infant mortality."

The latest annual child fatality report, released Nov. 15 by the Arizona Department of Health Services, analyzes the deaths of all 875 children ages 17 and younger who died in Arizona last year. The number of children who died was an 1.4% increase from the 863 children who died in 2021. Twenty-seven of the deaths last year involved children from out of state.

Arizona's child mortality rate in 2022 at 53.3 child deaths per 100,000 children ages 17 and younger showed little change from the 2021 rate. It was infant mortality — any death of an infant that occurs within the first year of life — that stood out.

Arizona's infant mortality rate in 2022 was six infant deaths for every 1,000 live births, while the U.S. rate that year was 5.6 infant deaths for every live births, provisional data from the U.S. Centers for Disease Control and Prevention says.

While a majority of the 479 infants who died in Arizona last year at less than 1 year of age were white or Hispanic, Black and American Indian infants have had consistently higher rates of infant mortality since 2013, the report found. Black babies in Arizona had an infant mortality rate of 12.2 deaths per every 1,000 live births last year, and American Indian and Alaska Native babies had a rate of 9.2 deaths per 1,000 live births.

Rimsza said it's unclear whether any of last year's infant deaths were connected with turmoil that happened last year after the U.S. Supreme Court's decision in June 2022 to overturn its landmark 1973 Roe v. Wade decision. The ruling meant that states could set their own abortion laws without any federal standard protecting abortion access. In Arizona, the result was confusion, a court battle and intermittent stops in abortion care.

Some studies have found that barriers to reproductive health care can have a negative effect on infant mortality. A December 2022 issue brief from the private New York-based Commonwealth Fund found that states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers and higher rates of maternal mortality and infant death, especially among women of color.

Unsafe sleep environments continue to kill Arizona babies

Authors of the report say encouraging regular prenatal care could reduce infant deaths, as could increasing the availability of affordable health insurance and awareness of the fact that the state's Medicaid program, known as the Arizona Health Care Cost Containment System, gives enrollees coverage up to one year after the birth of their baby.

Pregnant individuals should also avoid using drugs and alcohol during pregnancy because it increases the risk of preterm birth and other complications, the report says.

Another action that would improve Arizona's infant mortality rate includes getting medically accurate advice to families about safe sleeping environments for their babies, who can be suffocated if they are sleeping in a bed with adults, Rimsza said. Unsafe sleeping has been an ongoing cause of infant deaths in Arizona, in spite of education campaigns and assistance programs.

"We now know that virtually every hospital in the state provides education to new parents when their babies are born about safe sleep. So they are getting the message," Rimsza said. "But unfortunately there's a lot of conflicting messaging on the internet and in certain subcultures that believe that in putting babies in bed with you is okay, and we're competing against that."

Sudden Unexpected Infant Death, SUID, is the death of a healthy infant who is not initially found to have any underlying medical condition that could have caused their death. There were 74 SUID deaths in Arizona in 2022, up 13% from 2021. In a vast majority of those deaths, the infant was sleeping in an unsafe environment, the report says.

Parents and caregivers need more education about the dangers of sleep products that are not specifically marketed for infant sleep, Rimsza said. Infants should be placed on their backs for every sleep on a firm, flat, non-inclined sleep surface. Alone, on my Back, in a Crib (ABCs) is the safest sleeping practice for an infant until one year of age, and infants should always sleep on a separate surface, she said.

"There are a lot of commercial products on the market that really shouldn't be there and are being used while babies sleep," Rimsza said. "They may be marketed for activity use while the child is awake, but they are actually being used during sleep and many of them shouldn't even be on the market."

Babies should not be left unsupervised in any product not designed for safe sleeping, including rockers, gliders, soothers or swings, the Consumer Product Safety Commission says. Caregivers should remove soft bedding suffocation hazards including blankets, pillows and stuffed toys, from a baby’s sleep space, and also be on the alert for product recalls, the commission says.

Motor vehicle crashes were the top cause of preventable deaths

Three hundred and ninety Arizona children died preventable deaths in 2022, and motor vehicle crashes were the number one cause. Eighty-one children in Arizona died in motor vehicle crashes last year, which was an 11% increase over 2021.

The other leading causes of preventable deaths were suffocation, firearm injury, poisoning and drowning, according to the report.

As with other years, children of color died preventable deaths at a disproportionate rate compared with white children.

Drowning deaths among Arizona children dropped 33% last year to 30 deaths but drowning remains a problem and was the leading cause of death for Arizona children ages one through four years of age. The report's authors recommend caregivers provide constant supervision of young children around pools and that Arizona increase the availability of affordable swim lessons for children.

Fentanyl killed eight Arizona children younger than five

The number of Arizona children who died from fentanyl, a powerful synthetic opioid that has been increasingly infiltrating the illicit drug market, declined from 44 in 2021 to 34 last year.

Eight of the children who died from fentanyl poisoning last year were under the age of five, a number that is "huge" compared with previous years, Rimsza said. In the past, any deaths of children under five from fentanyl were rare enough that the data was suppressed and not included in the child fatality report. Authors of the report say they don't report specific death counts that amount to less than six to protect privacy.

"Parents need to be warned that if they are using drugs, make sure the child can't get them ... They don't come in childproof packaging when you buy this stuff on the street," she said. "One pill will kill a child."

The report found that of drugs or alcohol caused or contributed to Arizona one in every five child deaths in 2022.

Parental substance use history was a risk factor in slightly more than two-thirds of the 146 cases where Arizona children died of abuse and/or neglect last year and poverty was the second most common risk factor for abuse and neglect. The neglect/abuse death rate among children last year was a 12% increase from 2021, the report says.

Neglect was more common than abuse, Rimsza said.

"We need to be investing in the kids if we want to prevent child deaths," Rimsza said. "And keep kids out of foster care. Some kids end up in foster care just because the parents are poor. ... And that's terrible, to have children removed from their homes just because the parents are too poor to be able to provide a safe place for them to live."

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on X formerly known as Twitter @stephanieinnes.

This article originally appeared on Arizona Republic: Infant mortality in Arizona has surpassed national rate, report says