Infant Mortality

        Infant mortality is defined as the death of an infant less than one year old. Tennessee Department of Health calculates this metric as the number of deaths per 1,000 live births within one year. The infant mortality rate of the Unites States in 2017 was 5.8 deaths per 1,000 live births ranking it 55th in the world for highest infant mortality. Tennessee had a higher infant mortality rate than that of the Unites States averaging 7.2 deaths per 1,000 live births in 2018. This translated to one infant death every 15 hours in the states- ranking Tennessee 11th in the nation for highest rate of infant mortality. In Tennessee and across the United States, non-Hispanic black infants are at roughly twice the risk of infant mortality than white infants. This has been true for over a century, despite overall reductions in infant mortality of nearly 95% since 1915. 

        Over 22,000 infants died in the United States in 2017. Lead drivers of infant death included: birth defects, preterm birth, maternal pregnancy complications, sudden infant death syndrome, and injuries.  Similar issues emerge when looking at the drivers of infant mortality in Tennessee which include: birth defects, preterm birth and low birth weight, sleep-related death, and cardiovascular disease. 

        Infant mortality, in addition to giving us key information about maternal and infant health, is an important indicator of health care quality, socioeconomic status of a community and overall health of a population. It reflects the health status of mothers, the quality of and access to medical care, and the underlying social and economic conditions that powerfully influence health outcomes in communities. Factors associated with infant prematurity and death include a maternal history of previous preterm birth, sub-optimal maternal health prior to and during pregnancy (including chronic conditions like high blood pressure, obesity, and diabetes), short birth spacing, and chronic stress.  

        The major underlying medical cause of infant death is being born prematurely. Being born too early, and consequently too small, puts infants at risk for early death, medical complications, disability and chronic diseases later in life, and is associated with a significant societal economic burden. In Tennessee, the cost of infant mortality is $610 million annually. Such high costs indicate that infant mortality remains a significant public health challenge, especially in the state.  

        The burden of infant mortality is not shared equally among Tennessee infants. Social inequities in infant mortality have been marked, with the disadvantaged ethnic groups, socioeconomic groups, and geographical regions experiencing substantially increased risks of infant mortality despite the declining trend in mortality over time. In 2017, Tennessee infant mortality rates were highest for non-Hispanic black infants (12.9) compared to white infants (5.9).  Tennessee, among four other states, had the largest difference in infant mortality rates across maternal education levels. More specifically stated, infants were twice as likely to die as infants when born to less-educated mothers as opposed to more-educated mothers. A recent study published in 2017 showed that more than half of rural counties lack obstetric services. The disastrous aftermath of rural obstetric unit closures has resulted in less access to maternity and delivery services for females in these geographical areas—the least populated and most remote communities have been hit hardest.  

Vital Sign Actions Guide

The following are lists of intervention strategies that you, your health council, and other local stakeholders could use to address infant mortality in your community. 


1. Baby and Me Tobacco Free 

Baby and Me Tobacco Free is an evidence-based program based in Tennessee’s County Health Departments that helps pregnant women stop smoking tobacco during pregnancy and continue to remain tobacco-free post-partum. The program involves prenatal counseling sessions with trained healthcare providers, carbon monoxide monitoring and incentives for testing tobacco-free. Women who quit smoking may earn vouchers for diapers and baby wipes from the third pre-natal visit through twelve months postpartum. Promotion of this program at primary care facilities and businesses that serve pregnant women and new parents can help increase the number of women who enroll and quit smoking tobacco. 


2. Breastfeeding Support Groups and Peer Counseling 

Breastfeeding mothers benefit greatly from mother-to-mother sharing that occurs at support group meetings. Breastfeeding Counselors can set the stage for an effective meeting by selecting meeting topics and using discussion starters that put the participants at ease and encourage informative and supportive conversation. Support group meetings can include round table discussions, breastfeeding classes, or social events. Encouraging mothers to join or start a breastfeeding support group can help to destigmatize breastfeeding and educate mothers about the nutrition and health benefits of breastfeeding. 


3. Evidence-Based House Visiting 

Evidence Based Home Visiting (EBHV) programs are an early intervention strategy that aims to improve health outcomes for children in their first years of life. These programs improve family functioning and parenting skills, link families to social services, promote early learning, and help new parents provide safe, nurturing environments for their infants. In Tennessee, there are eleven EBHV local implementing agencies funded by the Tennessee Department of Health that operate in 51 counties, in addition to the CHANT program that operates in all health departments. For greater impact, EBHV programs can incorporate breastfeeding curriculum and support to enhance the health outcomes of children and further reduce infant mortality. 


4. Family Planning Clinics Promotion to Teens 

The Tennessee Department of Health offers family planning services in every county health department clinic. The staff are specially trained to provide education; counseling; medical histories; physical assessments and treatment, if needed; and comprehensive contraceptive options. Family planning services are provided on a sliding fee scale, based on family size and income, and they are free for persons below the federal poverty level. Clinics offer services for women, men and teens, and all information is kept private. Promoting these services, especially to teen boys and girls in high school and college settings, could help to prevent unintended pregnancies. 


5. Free child safety seats for low-income families 

Car crashes are one of the leading causes of death for children in the United States. Laws require that infants and children are restrained in car seats that are age and weight appropriate until children are 49 inches tall. By advertising that low-income families can get a free car seat from local agencies and educating families on proper car restraints for their children, infants are less likely to suffer fatal health outcomes in a car crash.


6. Free cribs for low-income families 

Low income families can receive free cribs from local agencies, including local health departments and first responders. Local health departments can receive cribs from the Tennessee Department of Health to distribute to their patients. Police departments, fire departments, EMS, parole officers, and coroners can partner with the Cribs for Kids organization to implement the National Public Safety Initiative to prevent unsafe sleep environments in homes.


7. March of Dimes Group Prenatal Care 

March of Dimes supportive pregnancy care enables expectant mothers to access prenatal care on a monthly basis in a group setting with women who are of similar gestational ages. During each visit, expectant mothers will have more time with their care providers than they would during their standard individual prenatal checkups, and benefit from prenatal care education and vital social and emotional support from other mothers. The Tennessee Department of Health supports March of Dimes by funding the implementation of this program in hospitals and clinics. The goal of this group prenatal care program is to see an increase in healthy birth weight babies and full term births for women who participate. 


1. March of Dimes 

Purpose: Grants given by the March of Dimes are primarily for programs addressing prenatal care, interconception education, quality improvement, and enhances prenatal care. 

Duration: One to three years 

Amount: $10,000- $25,000


2. Robert Wood Johnson 

Purpose: These grants are focused on health systems, “healthy children, healthy weight”, healthy communities and healthy leadership.

Duration: One to three years 

Amount: $100,000- $300,000


3. Tennessee Department of Children's Services 

Purpose: The Tennessee Department of Children’s Services has announced a funding opportunity for programs, project, and activities related to Tennessee’s Building Strong Brains initiative. This initiative aims to address Adverse Childhood Experiences (ACEs) by promoting safe, stable and nurturing relationships between infants/children and their care takers. ACEs are a strong predictor of adult health and prosperity later in life, including risk factors that threaten healthy pregnancies. 

Duration: One year, with opportunity to renew

Amount: Up to $20,000


4. The HCA Foundation 

Purpose: The HCA Foundation promotes health and wellbeing, childhood and youth development, and the arts in middle Tennessee communities through grant funding administration. Organizations must be 501(c)3 nonprofits in the Middle Tennessee area (see the website for eligible counties) to apply. 

Duration: Varies

Amount: Varies 


5. W.K. Kellogg  Foundation 

Purpose: Funding from the Kellogg Foundation is focused on educated kids, healthy kids, secure families, community and civic engagement, and racial equity. 

Duration: 6 months to 5 years

Amount: $10,000- $5 million


1. Breast Feeding Welcomed Here 

The Tennessee Department of Health recognizes businesses that support breastfeeding families through the “Breastfeeding Welcomed Here” campaign. Businesses can show their support for breastfeeding mothers by allowing and encouraging women to breastfeed their infants in the establishment and display a “Breastfeeding Welcomed Here” window decal to welcome these women. This program seeks to normalize breastfeeding in public.


2. Celebrate Day 366

Celebrate Day 366 is a campaign managed by the National Healthy Start Association that raises awareness for infant mortality. This campaign educates on the prevalence of infant mortality and how to prevent it. 


3. Community Baby Showers 

Community Baby Showers are one day events put on by local health departments, colleges, or other nonprofit organizations for pregnant women and new parents. These events teach young parents about how to keep their infants healthy through breastfeeding and nutrition, safe sleep practices, health insurance options, and other health related information. Parents are also given car seats, strollers, diapers, clothing and other infant supplies as door prizes. Local health departments can attend these events to gain opportunities to screen mothers and children for diseases, provide vaccinations, enroll parents and children in healthcare, and provide other essential health services and information. Community baby showers provide a space to educate mothers about healthy parenting practices. 


4. Distribute Safe Sleep Informational Material 

Information on safe sleep habits can help save the lives of infants by reducing the number of accidental injuries and suffocations that occur during sleep. Disseminating this information at retailers, community events, churches, daycares, or other entities that work directly with mothers helps to educate women on safe sleep. See the TDH and NIH “Safe to Sleep” campaign for informational texts to distribute. 


5. "Healthy Babies Are Worth The Wait" Full Term Birth Campaign 

The “Health Babies Are Worth The Wait” campaign was created by the March of Dimes to educate mothers who are considering an elective pre-term delivery (inducing labor before 39 weeks). Infants that are born before 39 weeks are more likely to have complications with breathing, body temperature and feeding. Informing providers and pregnant women about the benefits of delivering full-term may help to improve the health of the infant and the mother. The goal of this program is to eliminate early elective deliveries. 


6. National Breastfeeding Month 

National Breastfeeding Month is promoted in August each year by the United States Breastfeeding Committee. The month consists of social media advocacy and outreach campaigns inviting breastfeeding coalitions, partner organizations, and individuals to join the conversation to create a “landscape of breastfeeding support.” 


7. Prematurity Awareness Month 

Prematurity Awareness Month occurs each year in November. Preterm birth is one of the leading causes of infant death. This campaign serves as a way to reflect on the babies born preterm each year and advocate for ways to prevent future preterm births. The Prematurity Awareness Month campaign focuses on reducing teen pregnancies, which has the largest impact on reducing premature births, and addressing racial and ethnic disparities in preterm births (specifically those associated with African American women). 


8. Promote Breastfeeding Areas and Designated Breastfeeding Expert Services 

Community events are a great place to promote a breastfeeding area or room for mothers. Additionally, TN County Health Departments offer the services of a Designated Breastfeeding Expert. Promoting this free service to breastfeeding mothers encourages breastfeeding and can help to improve health outcomes for infants.


9. Promote the Poison Help Number 

The Poison Help number (1-800-222-1222) provides immediate expert answers in the case of a possible poisoning. If an infant is in distress, call 911. If an infant accidently ingested chemicals (cleaning solution, medication, etc) and is not having trouble breathing or difficult to awaken, parents can call the Poison Control Number for advice on how best to handle the situation. Parents also have the option of using the online help website. Advertising this free service to parents and child care workers could help decrease infant deaths due to accidental poisonings. 


10. Promote the Tennessee Breastfeeding Hotline Number 

The Tennessee Breastfeeding Hotline, staffed by International Board Certified Lactation Consultants (IBCLC) and Certified Lactation Counselors (CLC), is available to nursing mothers and  partners, their families, expectant mothers, and health care providers seeking breastfeeding support and information. The Hotline operates 7 days a week, 24 hours a day. The hotline number is 855-4BFMOMS and is available to mothers in more than 200 languages and to hearing-impaired callers. This service gives mothers the information and support they need to better breastfeed their infants.  


11. Sudden Infant Death Syndrome (SIDS) Awareness Month 

The CDC campaign SIDS Awareness Month occurs every October. The goal of SIDS Awareness Month is to inform the public about the prevalence and causes of SIDS, and educate parents about SIDS prevention, particularly safe sleep practices.


12. "Where's Baby? Look Before You Lock" Campaign 

The “Look Before You Lock” campaign reminds parents and care takers to check the back seats before leaving a vehicle. Infant deaths in hot cars are completely avoidable; most deaths occur in children under two years old and about half are caused by forgetting children in a hot car. The campaign encourages parents to leave a phone or shoe in the back seat as an extra reminder when a child is buckled into the seat. Furthermore, the campaign urges bystanders to take action by attempting to remove a child from an unattended hot car after calling 911—Tennessee’s Good Samaritan law protects those who have a reasonable belief that a child is in danger and who forcibly enter the locked vehicle for the sake of saving a life. 


13. World Breastfeeding Week 

World Breastfeeding Week occurs every year during the first week of August. This campaign aims to inform the public about the positive impacts of breastfeeding on infant health.  


1. Baby Friendly Workplace Policies 

In addition to a breastfeeding workplace policy, a family-friendly workplace policy gives new mothers and fathers the option to bring an infant to work for a specified period of time. These workplace policies allow parents to return to work sooner, decrease employee turnover due to a pregnancy or child birth, and improve health outcomes for infants. Click on the link for a sample workplace policy that can be implemented in local businesses


2. Breastfeeding Workplace Policies 

State and federal law require that all employers accommodate nursing mothers at work by allowing breaks for working mothers and make reasonable efforts to provide a breastfeeding space. In addition to these requirements, a breastfeeding policy in the workplace would encourage new mothers to breastfeed their infants after returning to work. See the source below for specific recommendations for a breastfeeding workplace policy. 


3. Gold Sneaker Initiative

The Gold Sneaker Initiative aims to enhance policy related to health and wellness within licensed child care facilities. Policies and recommendations target nutrition (including breastfeeding and breast milk use), physical activity and tobacco use. The goal of these policy changes is to enhance the health of infants and children in licensed child care facilities. 


4. Review all infant deaths in the community through a Child Fatality Review teams 

Child Fatality Reviews are a useful tool in determining a community's struggle with child deaths. These review boards identify common causes of death in order to address them as a community and prevent them in the future. 


1. Assess reproductive goals through use of PATH Frameworks in primary care provider settings 

PATH (“Parenthood/pregnancy Attitude, Timing, and How important is pregnancy prevention”) questions are designed to empower clients and help them understand their reproductive goals and how best to achieve them. The goal of the program is to reduce unintended pregnancies, which are shown to produce worse health outcomes for infants and mothers. 


2. Baby-Friendly Hospital Inititative/Ten Steps to Baby Friendly 

The Baby-Friendly Hospital Initiative was created by the World Health Organization as a compilation of policy and procedure recommendations for facilities serving pregnant women and infants. Ten Steps to Baby Friendly lays out the ten recommended steps to implementing services that support successful breastfeeding. 


3. BEST for Babies Award

The Tennessee Department of Health program promotes Breastfeeding, Early elective delivery elimination and Safe sleep for Tennessee babies (BEST) at hospitals caring for pregnant women and infants. The policy changes recommended by TDH ultimately aim to reduce infant mortality and increase positive health outcomes for newborns in Tennessee. The Tennessee Department of Health is also working toward partnering with more non-birthing hospitals to implement safe sleep policies. All Tennessee birthing hospitals, regardless of BEST status, receive “Sleep Baby, Safe and Snug” board books and “ABC’s of Safe Sleep” materials from TDH.


4. Comprehensive Contraceptive Counseling with same day access for all methods including LARCs

Contraception, including Long Acting Reversible Contraception (LARC), is supported by the American Academy of Pediatrics as a method to reduce the number of unintended pregnancies. Teen births often stem from unintended pregnancies and lead to increased risk of health problems for the mother and the baby. Further, the CDC states that 1 in 5 teen births are repeat births.  Policies in primary care settings should encourage a discussion between care providers and adolescents about their reproductive health and need for contraception. To minimize barriers, same-day access for all contraceptive methods including LARCs should be available. If the client is already pregnant, then access to immediate post-partum LARC can also help remove barriers for clients.  


5. Cover Kids Enrollment policies 

Tennessee’s CoverKids program is a part of the federally funded Children’s Health Insurance Program (CHIP) program that provides insurance to low-income pregnant women, infants, and children. By implementing policy to ensure that all uninsured pregnant women who are willing and financially eligible are enrolled in CoverKids at their first hospital visit, mothers and infants are more likely to receive adequate prenatal care. 


6. Cribs for Kids Hospital Certification 

The National Safe Sleep Hospital Certification Program awards recognition to hospitals that demonstrate a commitment to community leadership for best practices and education in infant sleep safety. The certification requires that infant sleep information is consistent among relevant hospital personnel, including medical, nursing, breastfeeding, child birth education, and nutritional staff. 


7. Immediate post-partum LARC Education 

Long Acting Reversible Contraception should be an option immediately postpartum for mothers who are both eligible and desiring. The Tennessee Initiative for Perinatal Quality Care aims to reduced unplanned pregnancies, NAS births, and improve pregnancy spacing in order to improve maternal and infant health by advocating for immediate postpartum LARC options for postpartum women.


8. Recommended vaccination during pregnancy 

The CDC’s Advisory Committee on Immunization Practices gives recommendations for which vaccines should be administered to pregnant women. By standardizing policy for vaccine recommendations and education, hospitals can help to prevent potentially fatal infections in infants and pregnant women.


9. Substance abuse policies for pregnant women 

The American College of Obstetricians and Gynecologists (ACOG) compiled recommendations for policy concerning pregnant women and opioid addiction. Implementing these policies in primary care settings may lead to early intervention and drug counseling, and reduce the rate of infant born with Neonatal Abstinence Syndrome (NAS). 


*State employees are prohibited from engaging in
political activity not directly a part of that person’s employment during any
period when the person should be conducting business of the state (Tenn. Code
Ann. § 2- 19-207). For further information on State Employee Political
Participation, please visit: 

This document is not a Department endorsement of legislative policy.