parent's should consult with their doctors to best manage any existing health conditions that they have to avoid complications of both their health as well as the fetus. obese people are at an increased risk of developing complications during pregnancy, including gestational diabetes or pre-eclampsia. additionally, they are more likely to experience a pre-term birth or have a child with birth defects. nutrition appropriate nutrition for newborns and infants can help keep them healthy and avoid health complications during early childhood. the american academy of pediatrics recommends exclusively breastfeeding infants for the first 6 months of life, following by a combination of breastfeeding and other sources of food through the next 6 months of life, up to 1 year of age. infants under 6 months of age who are exclusively breastfed have a lower risk of mortality compared to infants who receive a combination of breast milk and other food, as well as no breast milk at all. for this reason, breast feeding is favored over formula feeding by healthcare professionals. vaccinations the centers for disease control and prevention (cdc) defines infants as those 1 month of age to 1 year of age. for these infants, the cdc recommends the following vaccinations: hepatitis b (hepb), rotavirus (rv), haemophilus influenzae type b (hib), pneumococcal conjugate (pcv13), inactivated poliovirus (ipv < 18 yrs), influenza, varicella, measles, mumps, rubella (mmr), and diphtheria, tetanus, acellular pertussis (dtapp < 7yrs). each of these vaccinations are given at particular age ranges depending on the vaccination and are required to be done in a series of 1 to 3 doses over time depending on the vaccination. the efficacy of these vaccinations can be seen immediately following their introduction to society. following the advent of the pneumococcal conjugate vaccine (pcv13) in the united states in the year 2000, the world health organization (who) reports studies done in 2004 had shown a 57% decline invasive penicillin-resistant strains of diseases and a 59% reduction in multiple antibiotic resistant strains that could lead to mortality among infants. this reduction was even greater for children under 2 years of age with studies finding an 81% reduction in those same strains. as mentioned in a previous section, sudden infant death syndrome (sids) is the leading cause of infant mortality for those 1 month of age to 1 year of age. immunizations, when given in accordance to proper guidelines, have shown to reduce the risk of sids by 50%. for this reason, the american academy of pediatrics (aap) and the center for disease control (cdc) both recommend immunizations in accordance to their guidelines. socio-economic factors it has been well documented that increased education among mothers, communities, and local health workers results in better family planning, improvement on children's health, and lower rates of children's deaths. high-risk areas, such as sub-saharan africa, have demonstrated that an increase in women's education attainment leads to a reduction in infant mortality by about 35%. similarly, coordinated efforts to train community health workers in diagnosis, treatment, malnutrition prevention, reporting and referral services has reduced infant mortality in children under 5 as much as 38%. public health campaigns centered around the "first 1,000 days" of conception have been successful in providing cost-effective supplemental nutrition programs, as well as assisting young post-partum parent's in sanitation, hygiene and breastfeeding promotion. increased intake of nutrients and better sanitation habits have a positive impact on health, especially developing children. educational attainment and public health campaigns provide the knowledge and means to practice better habits and leads to better outcomes against infant mortality rates. awareness of health services, education, and economic opportunities provide means to sustain and increase chance of development and survival. a decrease in gdp, for example, results in increased rates of infant mortality. negative effects on household income reduces amount being spent on food and healthcare, affecting the quality of life and access to medical services to ensure full development and survival. on the contrary, increased household income translates to more access to nutrients and healthcare, reducing the risks associated with malnutrition and infant mortality. moreover, increased aggregate household incomes will produce better health facilities, water and sewer infrastructures for the entire community. differences in measurement infant mortality rate by region life expectancy at birth by region the infant mortality rate correlates very strongly with, and is among the best predictors of, state failure. imr is therefore also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index. however, the method of calculating imr often varies widely between countries and is based on how they define a live birth and how many premature infants are born in the country. reporting of infant mortality rates can be inconsistent, and may be understated, depending on a nation's live birth criterion, vital registration system, and reporting practices. the reported imr provides one statistic which reflects the standard of living in each nation. changes in the infant mortality rate reflect social and technical capacities of a nation's population. the world health organization (who) defines a live birth as any infant born demonstrating independent signs of life, including breathing, heartbeat, umbilical cord pulsation or definite movement of voluntary muscles. this definition is used in austria, for example. the who definition is also used in germany, but with one slight modification: muscle movement is not considered to be a sign of life. many countries, however, including certain european states (e.g. france) and japan, only count as live births cases where an infant breathes at birth, which makes their reported imr numbers somewhat lower and increases their rates of perinatal mortality. in the czech republic and bulgaria, for instance, requirements for live birth are even higher. although many countries have vital registration systems and certain reporting practices, there are many inaccuracies, particularly in undeveloped nations, in the statistics of the number of infants dying. studies have shown that comparing three information sources (official registries, household surveys, and popular reporters) that the "popular death reporters" are the most accurate. popular death reporters include midwives, gravediggers, coffin builders, priests, and others—essentially people who knew the most about the child's death. in developing nations, access to vital registries, and other government-run systems which record births and deaths, is difficult for poor families for several reasons. these struggles force stress on families, and make them take drastic measures in unofficial death ceremonies for their deceased infants. as a result, government statistics will inaccurately reflect a nation's infant mortality rate. popular death reporters have first-hand information, and provided this information can be collected and collated, can provide reliable data which provide a nation with accurate death counts and meaningful causes of deaths that can be measured/studied. unicef uses a statistical methodology to account for reporting differences among countries: unicef compiles infant mortality country estimates derived from all sources and methods of estimation obtained either from standard reports, direct estimation from micro data sets, or from unicef's yearly exercise. in order to sort out differences between estimates produced from different sources, with different methods, unicef developed, in coordination with who, the wb and unsd, an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official imr estimates used at the country level. however, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time. another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. this point is reinforced by the demographer ansley coale, who finds dubiously high ratios of reported stillbirths to infant deaths in hong kong and japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries. it suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths, but also that those countries do not follow who recommendations for the reporting of live births and infant deaths. another seemingly paradoxical finding, is that when countries with poor medical services introduce new medical centers and services, instead of declining, the reported imrs often increase for a time. this is mainly because improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. deaths that might have occurred in a remote or rural area, and not been reported to the government, might now be reported by the new medical personnel or facilities. thus, even if the new health services reduce the actual imr, the reported imr may increase. collecting the accurate statistics of infant mortality rate could be an issue in some rural communities in developing countries. in those communities, some other alternative methods for calculating infant mortality rate are emerged, for example, popular death reporting and household survey. the country-to-country variation in child mortality rates is huge, and growing wider despite the progress. among the world's roughly 200 nations, only somalia showed no decrease in the under-5 mortality rate over the past two decades. the lowest rate in 2011 was in singapore, which had 2.6 deaths of children under age 5 per 1,000 live births. the highest was in sierra leone, which had 185 child deaths per 1,000 births. the global rate is 51 deaths per 1,000 births. for the united states, the rate is eight per 1,000 births. infant mortality rate (imr) is not only a group of statistic but instead it is a reflection of the socioeconomic development and effectively represents the presence of medical services in the countries. imr is an effective resource for the health department to make decision on medical resources reallocation. imr also formulates the global health strategies and help evaluate the program success. the existence of imr helps solve the inadequacies of the other vital statistic systems for global health as most of the vital statistic systems usually neglect the infant mortality statistic number from the poor. there are certain amounts of unrecorded infant deaths in the rural area as they do not have information about infant mortality rate statistic or do not have the concept about reporting early infant death. europe and us requirements for reporting a live birth, united states and selected european countries, 2004 reporting requirement country all live birthsaustria, denmark, england and wales, finland, germany, hungary, italy, northern ireland, portugal, scotland, slovak republic, spain, sweden, united states live births at 12 weeks of gestation or morenorway live births at 500 grams birthweight or more, and less than 500 grams if the infant survives for 24 hoursczech republic live births at 22 weeks of gestation or more, or 500 grams birthweight or morefrance all live births for civil registration, births at 500 grams birthweight or more for the national perinatal registerireland live births at 22 weeks of gestation or more, 500 grams birthweight or more if gestational age is unknownnetherlands live births at 500 or more grams birthweightpoland the exclusion of any high-risk infants from the denominator or numerator in reported imrs can cause problems in making comparisons. many countries, including the united states, sweden and germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to united states some other countries differ in these practices. all of the countries named adopted the who definitions in the late 1980s or early 1990s, which are used throughout the european union. however, in 2009, the us cdc issued a report that stated that the american rates of infant mortality were affected by the united states' high rates of premature babies compared to european countries. it also outlined the differences in reporting requirements between the united states and europe, noting that france, the czech republic, ireland, the netherlands, and poland do not report all live births of babies under 500 g and/or 22 weeks of gestation. however, the differences in reporting are unlikely to be the primary explanation for the high