Why Babies of Black Mothers Still Die More Often in Their First Year, and What Is Changing

A plain-language look at a 2026 JAMA Network Open study of 22 years of US birth and death records, from early birth to sudden unexpected infant death

In the United States, babies born to Black mothers are more than twice as likely to die before their first birthday as babies born to White mothers. A study of nearly 58 million births found that early birth still explains most of this difference, but a growing part, now about one-third, comes from higher risk among babies born at the same stage of pregnancy. Sudden unexpected infant deaths, many during sleep, were the biggest single reason for that growing part.

Why this question matters to families

Losing a baby is one of the hardest things a family can face, and the chance of it happening is not the same for every family in the United States. For many years, doctors have known that babies of Black mothers die in their first year more often than babies of White mothers. Knowing that a difference exists is only a first step. To do something about it, doctors, nurses and public health teams need to know where the difference comes from, so they can put their effort where it will help most.

How doctors have understood the gap until now

The researchers behind the new study, Alexander and colleagues [1], note that the gap between babies of Black and White mothers has lasted for decades. Recent national figures show how large it is: in 2022, about 11 of every 1,000 babies born to Black mothers died before age 1 (10.90 per 1,000), compared with about 4.5 of every 1,000 babies born to White mothers [2].

For a long time, the main explanation was that babies of Black mothers are more often born too small or too early. A 1992 study looked at babies whose parents had both been to college. Babies of Black parents in that group were still more likely to die, but once the smallest babies (those weighing under 2,500 grams, about 5.5 pounds) were set aside, the death rates of the two groups were the same [3]. Later, researchers at the US Centers for Disease Control and Prevention showed that about two-thirds of all baby deaths in the country happened to babies born "preterm", meaning before 37 weeks of pregnancy, and argued that lowering infant deaths would require a broad effort to find, test and use ways of preventing early birth [4]. In 2017, another team found that the extra deaths among babies of Black mothers had been shrinking but then started to grow again, and again pointed to preventing early birth as the most promising answer [5].

At the same time, another kind of loss was getting attention. Sudden unexpected infant death, often shortened to SUID, means a baby who seemed healthy dies suddenly, usually during sleep, and the cause is not obvious at first. It includes sudden infant death syndrome (SIDS), accidental suffocation or strangulation in bed, and deaths that remain unexplained even after investigation. The American Academy of Pediatrics, the main group of US children's doctors, estimates that about 3,500 babies die this way in the United States each year, and that the rate has barely changed since 2000 [6]. Government researchers saw these deaths rise among babies of Black mothers from 2019 to 2020 [7], and by 2022 babies of Black mothers were 2.9 times as likely to die of SUID as babies of White mothers, up from 2.2 times in 2017 [8]. What had not been measured over a long run of years, nationally, was how much of the overall gap comes from early birth and how much comes from something else.

How the researchers studied 22 years of records

The researchers, from the University of Toronto in Canada and the University of Colorado Boulder in the United States, used official national records that link each baby's birth certificate to the death certificate of any baby who died before age 1 [1]. These records cover almost every baby death in the whole country. They looked at every year from 2003 to 2024 and included 57,870,726 babies born to non-Hispanic Black or non-Hispanic White mothers, of whom 366,384 died before their first birthday. The mother's race was taken from the birth certificate.

They then used a well-known method from population science, first described in 1955, that splits a difference between two groups into two parts [9]. A simple way to picture it: imagine two classrooms with different average test scores. Part of the difference might be because one class has more younger children, and part might be because children of the same age score differently. Here, the "age" is how far along the pregnancy was at birth. The first part of the gap comes from babies of Black mothers being born early more often. The second part comes from babies of Black mothers having a higher risk of dying even when born at the same stage of pregnancy (the researchers grouped babies into seven ranges of weeks, such as 39 to 41 weeks). The researchers did this for every year and for each cause of death.

What the study found

Early birth was more common among Black mothers: about 17 of every 100 of their babies were born preterm (16.9%), compared with about 10 of every 100 babies of White mothers (10.5%) [1]. Death rates fell for both groups over the 22 years. In 2024, about 11 of every 1,000 babies of Black mothers died before age 1 (10.7), compared with about 4 of every 1,000 babies of White mothers (4.3). The difference had been shrinking until 2019, from 7.7 to 6.0 extra deaths per 1,000 births, but then grew again to 6.4 by 2024, because deaths among babies of Black mothers rose while those among babies of White mothers kept falling.

In every year, early birth explained most of the gap. Babies born extremely early, before 28 weeks of pregnancy, accounted for more than half of it on their own. But the second part, the higher risk at the same stage of pregnancy, grew from about one-fifth of the gap in 2003 to about one-third in 2024.

One finding may be meaningful for families of very premature babies. Among babies born before 28 weeks, the chance of dying in the first year was almost the same for both groups in 2024: about 356 of every 1,000 babies of Black mothers and about 364 of every 1,000 babies of White mothers. The higher risk at the same stage of pregnancy showed up mainly in babies born closer to their due date. Among babies born between 39 and 41 weeks, about 3.5 of every 1,000 babies of Black mothers died, compared with about 1.5 of every 1,000 babies of White mothers.

Sudden unexpected infant death: the part that grew fastest

Of all the causes of death, SUID added the most to the gap in 2024, about one and a half extra deaths per 1,000 births (1.56). Almost all of that (1.44 per 1,000) came from higher risk among babies born at the same stage of pregnancy, not from earlier birth [1]. SUID was also the cause whose share of the gap grew the most between 2020 and 2024. The type of SUID that increased most was deaths recorded as "ill-defined or unspecified". Earlier government research found that changes in how doctors and investigators label these deaths can move numbers from one SUID category to another [7], so the exact mix between the types should be read with some care.

The authors noted that the sharp 2020–2024 increase coincided with the coronavirus disease 2019 (COVID-19) pandemic, a time when a respiratory virus spread widely, and suggested this might point to a possible cause. Another national study found that SUID rose during the pandemic and that its monthly ups and downs in 2021 matched the pattern of hospital stays for respiratory syncytial virus (RSV), a common cold-like virus [10]. The authors also pointed out that deaths of mothers related to pregnancy rose unequally during the pandemic; a national study found that death rates among Black mothers were about three times those of White mothers throughout [11]. These are ideas to be tested, not proven causes.

What this means for your baby and family

These numbers describe large groups of families, not any one baby. Most babies of every background grow up healthy, and belonging to a group with a higher average rate does not decide what happens to an individual child.

The study does give families and care teams something practical to focus on. Many SUID deaths happen while a baby is sleeping, and there are simple steps that lower the risk. The American Academy of Pediatrics recommends that babies sleep on their backs, on a firm, flat surface that is not tilted, in the parents' room but not in the parents' bed, without soft bedding, and without getting too hot. Breast milk, keeping the baby away from cigarette smoke, alcohol, marijuana and other drugs, keeping up with vaccinations, and offering a pacifier also help [6]. If your baby has been in the neonatal intensive care unit (NICU), ask the team to show you safe sleep before you go home, and ask questions if anything at home makes these steps hard. Our article on safe-sleep teaching by text and video describes one way hospitals are helping families.

What researchers are working on next

The researchers want to look at other things that might matter, such as the mother's age, how many children she has had, and her education. They also note that babies of American Indian and Alaska Native mothers and of mothers of more than one race, who were not part of this study, also have high rates of infant death [1], and national SUID figures confirm high SUID rates in these groups [8]. Other important questions are whether the extra risk at full term shows up in the first weeks of life or later, and why it is happening, which this kind of study cannot answer on its own.

The bottom line

This study shows that preventing early birth still matters most for closing the gap between babies of Black and White mothers. But a growing part of the gap now comes from babies born at the same stage of pregnancy, often at full term, and sudden unexpected infant death is the biggest single reason. Both preventing early birth and supporting safe sleep and healthy first years at home are needed to give every baby the same chance.

References

  1. Alexander MJ, Alexander R, Root L. Decomposition of Black and White Infant Mortality Rates. JAMA Netw Open. 2026;9(9):e2635321. doi:10.1001/jamanetworkopen.2026.35321 ↩
  2. Ely DM, Driscoll AK. Infant Mortality in the United States, 2022: Data From the Period Linked Birth/Infant Death File. Natl Vital Stat Rep. 2024. doi:10.15620/cdc/157006 ↩
  3. Schoendorf KC, Hogue CJ, Kleinman JC, Rowley D. Mortality among infants of black as compared with white college-educated parents. N Engl J Med. 1992;326(23):1522-1526. doi:10.1056/NEJM199206043262303 ↩
  4. Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics. 2006;118(4):1566-1573. doi:10.1542/peds.2006-0860 ↩
  5. Riddell CA, Harper S, Kaufman JS. Trends in Differences in US Mortality Rates Between Black and White Infants. JAMA Pediatr. 2017;171(9):911-913. doi:10.1001/jamapediatrics.2017.1365 ↩
  6. Moon RY, Carlin RF, Hand I. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022;150(1):e2022057990. doi:10.1542/peds.2022-057990 ↩
  7. Shapiro-Mendoza CK, Woodworth KR, Cottengim CR, et al. Sudden Unexpected Infant Deaths: 2015-2020. Pediatrics. 2023;151(4):e2022058820. doi:10.1542/peds.2022-058820 ↩
  8. Shapiro-Mendoza CK, Cottengim CR, Erck Lambert AB, Geary S, Barfield WD, Parks SE. New Data on Sudden Unexpected Infant Deaths by Cause and Race and Ethnicity: 2015-2022. Pediatrics. 2025;156(1):e2024069558. doi:10.1542/peds.2024-069558 ↩
  9. Kitagawa EM. Components of a Difference Between Two Rates. Journal of the American Statistical Association.* 1955;50(272):1168-1194. doi:10.1080/01621459.1955.10501299 ↩
  10. Guare EG, Zhao R, Ssentongo P, Batra EK, Chinchilli VM, Paules CI. Rates of Sudden Unexpected Infant Death Before and During the COVID-19 Pandemic. JAMA Netw Open. 2024;7(9):e2435722. doi:10.1001/jamanetworkopen.2024.35722 ↩
  11. Park RY, Bilinski A, Parks RM, Flaxman S. Trends in Maternal, Fetal, and Infant Mortality in the US, 2000-2023. JAMA Pediatr. 2025;179(7):765-772. doi:10.1001/jamapediatrics.2025.0440 ↩