Mississippi has just declared a public health emergency involving an alarming rise in infant mortality rates. Between 2023 and 2024, deaths of children under age one rose to 9.7 per 1,000 live births from 8.9 per 1,000 in 2023. “Every single infant loss represents a family devastated, a community impacted and a future cut short,” State Health Officer Dan Edney said in a statement.
Public officials in Mississippi don’t seem to be paying enough attention to one of the most significant causes—maternal drug use. The spikes are happening in other states, too: Johns Hopkins researchers found that between 2021 and 2022, infant deaths in Texas rose from 1,985 to 2,240, a 12.9 percent increase.
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The data, in fact, suggest a national rather than merely regional problem. A recent study found that drug-related infant deaths more than doubled nationally between 2018 and 2022. Child and adolescent mortality rates nationally have also been rising—by 18.3 percent between 2019 and 2021, the largest such jump in at least half a century. National data show that the number of babies born with congenital syphilis—a leading cause of miscarriage and pre-term birth and strongly associated with maternal drug use—is ten times greater than a decade ago. What is happening?
Some have suggested that more restrictive abortion laws in the wake of the Supreme Court’s 2022 Dobbs decision have led women to give birth to unhealthy babies who would not previously have been counted as deaths, because they would have been aborted. This is possible in a limited number of cases. But the national rate rose to 5.6 infant deaths per 1,000 live births in 2022, up from 5.44 per 1,000 in 2021, largely before states implemented more restrictive abortion laws.
Others have suggested that maternal health more broadly may be at issue. Mississippi’s statement suggests partnering with local health departments to eliminate “OB [obstetrics] deserts,” areas where it’s harder to find providers. Some have even attributed rising mortality levels, particularly among some groups, to bias. “At the end of the day, the history of systemic racism in this country lies at the root of this tragedy by creating gaps in the social, economic and environmental conditions in which children are being raised,” claims one researcher.
The leading causes of infant mortality in Mississippi, however, point to drug abuse. The statement mentions “congenital malformations, preterm birth, low birth weight and Sudden Infant Death Syndrome (SIDS).” It does not mention that each of these conditions is strongly connected to—if not directly created by—parental substance use.
Prenatal alcohol and drug exposure is linked to congenital anomalies, impaired fetal growth, preterm delivery, and low birth weight. One largescale review found a fourfold increased risk of neonatal death and a nearly doubled risk of preterm birth among infants prenatally exposed to opioids. And while SIDS is often assumed to occur largely at random, a recent meta-analysis found that infants exposed to drugs in utero died of SIDS—or had deaths classified as SIDS—at seven times the rate of infants not exposed. In a prospective study of infants reported to Child Protective Services at or shortly after birth, the subsequent rate of SIDS/SUID (Sudden Unexpected Infant Death) was three times that of infants not reported, even after adjusting for other risk factors.
Over the past year, we have gathered data on child maltreatment fatalities for a project called Lives Cut Short. Using information from media reports and public records, we have pieced together some of the factors causing these disturbing trends. The first thing to note is that children under the age of one make up a disproportionate number of these tragedies. Of the 3,600 cases we have chronicled, 37 percent were in this youngest demographic.
Of those, substance abuse was a documented factor in more than a third of deaths. Some of the danger, of course, began before birth—the children were born with drugs already in their system. These vulnerable infants were often sent home with parents struggling with addiction. Indeed, in some states and at some hospitals, mothers of babies testing positive for drugs are merely offered literature on rehab programs, without mandatory follow up.
Some of these babies were then left unattended for hours or days at a time. Others did not receive proper medical care. Some died of unknown causes in horrific conditions. A shockingly high number were victims of unsafe-sleep deaths, in which a parent was intoxicated and may have rolled over onto a sleeping infant. Some accidentally ingested drugs left out in the open by an adult whose judgment was compromised. Some were the victims of car accidents or drowning when parents were drunk or high. Other infants died in homes with drugs and where their mothers were beaten.
Given the growing movement to legalize drugs and a culture that seems increasingly accepting of drug use, it is important to recognize the smallest victims of our addiction crisis. Rising infant-mortality rates in any country should be a cause for concern, but we cannot confront the problem unless we’re willing to name it.
Photo: imaginima / E+ via Getty Images