Half a million babies are born prematurely in the US each year. That equates to 1 out of 8, or 12% of all babies born every year. While the preterm birth rate in the US has been declining over the last few years, it still remains high. A 2012 report by the World Health Organization ranks the US 131st in the world in terms of its preterm birth rate, on par with Somalia, Thailand and Turkey.

Despite being the world leader in medical innovation with world class hospitals and state-of-the-art NICUs, the US doesn’t fare any better on infant mortality. This year, in the United States, more than 24,000 babies will take their last breath after only hours, days or months of life. That means 24,000 families will grieve the unfathomable loss of a child. This is what an infant mortality rate of 6 per 1,000 amounts to in a country with approximately 4 million babies born each year. While that may seem like a small number, consider that the US ranks 56th on infant mortality in comparison with other countries. In fact, babies born in the US have a lower chance of surviving their first year of life than babies born in Serbia, Cuba or Belarus. On a state level, Mississippi has an infant mortality rate on par with Botswana and worse than Sri Lanka and Uruguay, making it the state with the worst infant mortality rate in the US. Alabama, Louisiana and Tennessee aren’t much better.

The high infant mortality rate in the US is not because of a lack of specialists or facilities for newborns. On the contrary, America has more neonatologists and neonatal intensive care resources per person than Australia or Canada, but still has lower survival rates for infants of low birth weight. Racial, ethnic and socio-economic disparities in healthcare quality and access play a major role, but that’s only part of the story. While African-Americans have the highest preterm birth (16.5%) and infant mortality rates (11.5 per 1,000 births) of all racial groups, non-Hispanic white babies in the US die at a higher rate than in most other industrialized nations. Still, race and income-level are two of the leading factors that contribute to prematurity and infant mortality. Detroit, whose population is 84% black and where the poverty rate is three times that of the nation, has the highest preterm birth rate (18.2%) of any city in the US and has an infant mortality rate that is more than double the state and national average. The CIA’s latest world rankings indicate that an African-American baby would have a better chance of survival if born in China, Malaysia or Mexico than in the United States.

Why should we care about these statistics?
It is widely known that prematurity is the single largest cause of newborn death, so addressing prematurity could significantly improve our infant mortality figures. If the US could achieve an infant mortality rate at the level of Japan – the country that ranks best on this indicator – we could save more than 16,000 babies each year. For those babies that do survive prematurity, many of them suffer serious medical complications and lifelong challenges that cost the US economy $26 billion each year in medical care, educational costs and lost productivity.

What causes such poor health outcomes for American babies?
Among the factors contributing to these dismal statistics, and the reasons why minority babies are particularly at risk, include disparities in prenatal care, nutritional supplementation for pregnant women, and conditions that lead to unhealthy lifestyle choices such as smoking or unhealthy eating. Another factor is access to health insurance. Pregnant women without health insurance are less likely to receive prenatal care, and those who do not receive adequate prenatal care are more likely to suffer pregnancy complications, deliver preterm and have adverse outcomes after birth. In Mississippi, one of 26 states that have rejected the Medicaid expansion, 13% of its population is left without health insurance, and the majority of those affected are poor or are single mothers.

But, other factors beyond lifestyle choices and healthcare access also play a major role. These include education level, income, job security, working conditions, food insecurity, housing and the social safety net. Higher levels of stress for lower-income and minority women contribute to poor pregnancy outcomes, and for communities with high rates of teen pregnancy, preterm birth and infant mortality rates increase as well.

How can these outcomes be improved?
Some of the necessary changes are obvious. Increase access to early prenatal care, expand insurance coverage to the most vulnerable populations, and ensure mechanisms are in place to quickly get high-risk babies to the best medical facilities available with the proper resources and trained personnel to provide adequate care. All of these things are the role of governments and institutions to take care of. But, there are many things parents can do as well. Even in the most impoverished conditions, parents can ensure that their babies receive proper nutrition, that they keep their homes clean and free of smoke, that they practice safe sleep practices and that they learn how to recognize warning signs so that their babies can get the medical help they need in a timely manner.

That’s where Pebbles of Hope can help. We are developing multi-media materials to educate parents in low-resource areas on how to properly care for their preterm and low birth weight babies and to provide them with the information they need to make positive health choices for themselves and their children. As the wealthiest nation in the world, it’s our moral imperative to do more for our youngest citizens. All babies, regardless of where they are born, deserve a chance at a healthy life.