Border States CoIIN Resources

Technical Briefs

Infant Mortality in the Border Region

Infant mortality is an indicator of population health and a measure of health inequalities. US-Mexico Border States reveal significant disparities in infant mortality among subgroups that demonstrate these inequalities.

  • The infant mortality rates (IMR) for Native American populations in Arizona, California, New Mexico, and the United States overall surpass the national average (5.9 deaths per 1,000 live births) of all ethnicities combined.
  • In Arizona, California, Texas, and the United States as a whole, the IMR for African American populations surpass the national average (5.9 deaths per 1,000 live births) for all ethnicities combined.
  • In the Border States in 2015, there were 2,400 Hispanic infant deaths, (50% of all Hispanic infant deaths in the US that year); 1,427 non-Hispanic White infant deaths (13.9% of all non-Hispanic White infant deaths in the US); 937 African American (12.9% of all African Americans infant deaths in the US); and 94 Native American infant deaths (25.9% of all Native American infant deaths in the US).

More first birthdays

Why Early Prenatal Care (PNC)?

  • Early PNC is associated with improved birth weight and decreased risk of preterm delivery, both of which are important contributors to infant mortality.
  • Accessing early PNC increases the opportunity for mothers and families to access other supports (health, social, legal, environmental, etc.) that can impact the health of both mother and baby across the life course.
  • Access to early and adequate PNC is widely used as an indirect measure of access to health care in general.
  • Increasing the proportion of pregnant women who receive early PNC is a National Healthy People 2020 goal.



Social Determinants of Health factors in the Border States

Social determinants of health are conditions in which people are born and live that affect health, functioning, and quality-of-life outcomes and risks. By this logic, resources that enhance quality of life can have a significant influence on population health outcomes.


The Border States demonstrate significant challenges with the social determinants of health known to influence infant mortality (WHO, 2017). Some of these include:

  • Lower high school graduation rates (84% compared to 87.3% nationally)
  • Higher rates of poverty (18.2% compared to 15.5% nationally)
  • Higher rates of inadequate health insurance coverage among women of reproductive age (15-44 years) (84.6% compared to 88.3% nationally)
  • Higher proportions of foreign-born residents (17.25% compared to 13.2% nationally)
  • Twice as many non-English speaking residents (2.7% compared to 1.4% nationally)
  • Higher rates of unplanned pregnancies (48-62% compared to 45% nationally)
  • Higher rates of teen births (average 28.8 per 1,000 live births compared to 22.3 nationally)

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Border States IM CoIIN

In order to increase early entry to prenatal care by 10% over the next three years, the IM CoIIN will continue to build upon an active border-wide collective impact alliance forged with PCI’s backbone support and a strong existing infrastructure of all 12 HRSA-funded Healthy Start programs in the Border States organized around common benchmarks and strategies.

Border States IM CoIIN participants will draw upon the wealth of institutional and on-the-ground experiences of key state and regional partners, including all four Border State Title V Maternal and Child Health (MCH) Programs and their designated representatives; all 12 Healthy Start programs operating in the Border States; an Expert Resource Network of 5 experts in social determinants of health, prenatal care and health disparities, to be expanded through the project period as needed; and key state and local partners including health care systems, universities, and women and families themselves.


Strategic Objectives:

  1. Develop and maintain a strong, sustainable network of interstate, state and local impact site CoIINs committed to achieving measurable improvements in reducing IMR disparities by addressing social determinants of health through a culture of collaborative learning, innovation and quality improvement.
  2. Accelerate the development and/or discovery of improvement strategies and new evidence to increase utilization of early prenatal care and reduce IMR and disparities by addressing social determinants of health in local impact sites.
  3. Support dissemination, spread and scale of evidence-based improvement strategies to increase utilization of early prenatal care and reduce infant mortality and disparities by addressing social determinants of health to stakeholders in all states/jurisdictions.



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