In the United States, neonatal and infant mortality have fallen dramatically over the last century, yet “significant racial disparities in mortality and other important outcomes have persisted.” Black infants, in particular, continue to die at far higher rates than White infants, even when born with similar levels of risk. In 2023, the Black infant mortality rate was more than double that of White infants, and rates for American Indian/Alaska Native and Native Hawaiian infants were also higher.
Researchers DeWayne M. Pursley and F. Sessions Cole argue that these gaps are not driven by biology but by “structural, institutional, individual, and internalized forces” that shape which families get high-quality care and which do not. Black and Hispanic infants are more likely to be born in “quality-challenged hospitals” with higher risk-standardized rates of death and serious complications, and to receive poorer care even within the same hospital. In New York City, the hospital of birth explained up to 40% of the Black–White disparity in outcomes for very preterm infants.
The review highlights that minoritized infants are disproportionately concentrated in safety-net NICUs with lower survival without major morbidity, and they face lower access to high-risk infant follow-up programs after discharge. Yet targeted quality improvement efforts have shown that racial gaps in mortality and complications can shrink when NICUs standardize evidence-based care, confront racism and bias, and fully engage families. The authors call infant health inequity “the legacy of systemic racism and structural disadvantages” and insist that hospitals, professional organizations, and policymakers share accountability for closing these deadly gaps.
See: “Improving infant health equity: what have we learned, what do we do” (December 12, 2025)
