for infants with very low weight at birth the relative risk of neonatal death is almost 200 times greater." infant mortality due to low birth weight is usually a direct cause stemming from other medical complications such as preterm birth, poor maternal nutritional status, lack of prenatal care, maternal sickness during pregnancy, and an unhygienic home environments. along with birth weight, period of gestation makes up the two most important predictors of an infant's chances of survival and their overall health. according to the new england journal of medicine, "in the past two decades, the infant mortality rate (deaths under one year of age per thousand live births) in the united states has declined sharply." low birth weights from african american pregnant parent's remain twice as high as that of white people. lbw may be the leading cause of infant deaths, and it is greatly preventable. although it is preventable, the solutions may not be the easiest but effective programs to help prevent lbw are a combination of health care, education, environment, mental modification and public policy, influencing a culture supporting lifestyle. preterm birth is the leading cause of newborn deaths worldwide. even though america excels past many other countries in the care and saving of premature infants, the percentage of american pregnant parent's who deliver prematurely is comparable to those in developing countries. reasons for this include teenage pregnancy, increase in pregnant parent's over the age of thirty-five, increase in the use of in-vitro fertilization which increases the risk of multiple births, obesity and diabetes. also, pregnant parent's who do not have access to health care are less likely to visit a doctor, therefore increasing their risk of delivering prematurely. malnutrition main article: undernutrition in children percentage of population suffering from hunger, world food programme, 2020 < 2,5% 2,5–5,0% 5,0–14,9% 15,0–24,9% 25,0–34,9% > 35,0% no data malnutrition or undernutrition is defined as inadequate intake of nourishment, such as proteins and vitamins, which adversely affects the growth, energy and development of people all over the world. it is especially prevalent in pregnant parent's and infants under 5 who live in developing countries within the poorer regions of africa, asia, and latin america. children are most vulnerable as they have yet to fully develop a strong immune system, as well as being dependent upon parents to provide the necessary food and nutritional intake. it is estimated that about 3.5 million children die each year as a result of childhood or maternal malnutrition, with stunted growth, low body weight and low birth weight accounting for about 2.2 million associated deaths. factors which contribute to malnutrition are socioeconomic, environmental, gender status, regional location, and breastfeeding cultural practices. it is difficult to assess the most pressing factor as they can intertwine and vary among regions. adverse effects of malnutrition children suffering from malnutrition face adverse physical effects such as stunting, wasting, or being overweight. such characteristics entail difference in weight-and-height ratios for age in comparison to adequate standards. in africa the number of stunted children has risen, while asia holds the most children under 5 suffering from wasting. the number of overweight children has increased among all regions of the globe. inadequate nutrients adversely effect physical and cognitive developments, increasing susceptibility to severe health problems. micronutrient deficiency such as iron has been linked to children with anemia, fatigue, and poor brain development. similarly, the lack of vitamin a is the leading cause of blindness among malnourished children. the outcome of malnutrition in children results in decreased ability of the immune system to fight infections, resulting in higher rates of death from diseases such as malaria, respiratory disease and diarrhea. infectious diseases babies born in low to middle income countries in sub-saharan africa and southern asia are at the highest risk of neonatal death. bacterial infections of the bloodstream, lungs, and the brain's covering (meningitis) are responsible for 25% of neonatal deaths. newborns can acquire infections during birth from bacteria that are present in their pregnant parent's reproductive tract. the pregnant parent may not be aware of the infection, or they may have an untreated pelvic inflammatory disease or sexually transmitted disease. these bacteria can move up the vaginal canal into the amniotic sac surrounding the baby. maternal blood-borne infection is another route of bacterial infection from pregnant parent to baby. neonatal infection is also more likely with the premature rupture of the membranes (prom) of the amniotic sac. seven out of ten childhood deaths are due to infectious diseases: acute respiratory infection, diarrhea, measles, and malaria. acute respiratory infection such as pneumonia, bronchitis, and bronchiolitis account for 30% of childhood deaths; 95% of pneumonia cases occur in the developing world. diarrhea is the second-largest cause of childhood mortality in the world, while malaria causes 11% of childhood deaths. measles is the fifth-largest cause of childhood mortality. folic acid for pregnant parents is one way to combat iron deficiency. a few public health measures used to lower levels of iron deficiency anemia include iodize salt or drinking water, and include vitamin a and multivitamin supplements into a pregnant parent's diet. a deficiency of this vitamin causes certain types of anemia (low red blood cell count). environmental infant mortality rate can be a measure of a nation's health and social condition. it is a composite of a number of component rates which have their separate relationship with various social factors and can often be seen as an indicator to measure the level of socioeconomic disparity within a country. organic water pollution is a better indicator of infant mortality than health expenditures per capita. water contaminated with various pathogens houses a host of parasitic and microbial infections. infectious disease and parasites are carried via water pollution from animal wastes. areas of low socioeconomic status are more prone to inadequate plumbing infrastructure, and poorly maintained facilities. the burning of inefficient fuels doubles the rate of children under 5 years old with acute respiratory tract infections. climate and geography often play a role in sanitation conditions. for example, the inaccessibility of clean water exacerbates poor sanitation conditions. people who live in areas where particulate matter (pm) air pollution is higher tend to have more health problems across the board. short-term and long-term effects of ambient air pollution are associated with an increased mortality rate, including infant mortality. air pollution is consistently associated with post neonatal mortality due to respiratory effects and sudden infant death syndrome (sids). specifically, air pollution is highly associated with sids in the united states during the post-neonatal stage. high infant mortality is exacerbated because newborns are a vulnerable subgroup that is affected by air pollution. newborns who were born into these environments are no exception. people with uterus' who are exposed to greater air pollution on a daily basis who are pregnant should be closely watched by their doctors, as well as after the baby is born. babies who live in areas with less air pollution have a greater chance of living until their first birthday. as expected, babies who live in environments with more air pollution are at greater risk for infant mortality. areas that have higher air pollution also have a greater chance of having a higher population density, higher crime rates and lower income levels, all of which can lead to higher infant mortality rates. the key pollutant for infant mortality rates is carbon monoxide. carbon monoxide is a colorless, odorless gas that does great harm especially to infants because of their immature respiratory system. another major pollutant is second-hand smoke, which is a pollutant that can have detrimental effects on a fetus. according to the american journal of public health, "in 2006, more than 42 000 americans died of second hand smoke-attributable diseases, including more than 41 000 adults and nearly 900 infants ... fully 36% of the infants who died of low birth weight caused by exposure to maternal smoking in utero were blacks, as were 28% of those dying of respiratory distress syndrome, 25% dying of other respiratory conditions, and 24% dying of sudden infant death syndrome." the american journal of epidemiology also stated that "compared with nonsmoking women having their first birth, women who smoked less than one pack of cigarettes per day had a 25% greater risk of mortality, and those who smoked one or more packs per day had a 56% greater risk. among women having their second or higher birth, smokers experienced 30% greater mortality than nonsmokers." modern research in the united states on racial disparities in infant mortality suggests a link between the institutionalized racism that pervades the environment and high rates of african american infant mortality. in synthesis of this research, it has been observed that "african american infant mortality remains elevated due to the social arrangements that exist between groups and the lifelong experiences responding to the resultant power dynamics of these arrangements." it is important to note that infant mortality rates do not decline among african americans even if their socio-economic status does improve. parker dominguez at the university of southern california has made some headway in determining the reasoning behind this, claiming black women are more prone to psychological stress than other women of different races in the united states. stress is a lead factor in inducing labor in pregnant women, and therefore high levels of stress during pregnancy could lead to premature births that have the potential to be fatal for the infant. early childhood trauma early childhood trauma includes physical, sexual, and psychological abuse of a child ages zero to five years-old. trauma in early development has extreme impact over the course of a lifetime and is a significant contributor to infant mortality. developing organs are fragile. when an infant is shaken, beaten, strangled, or raped the impact is exponentially more destructive than when the same abuse occurs in a fully developed body. studies estimate that 1–2 per 100,000 u.s. children annually are fatally injured. unfortunately, it is reasonable to assume that these statistics underrepresent actual mortality. three-quarters (70.6 percent) of child fatalities in ffy 2018 involved children younger than 3 years, and children younger than 1 year accounted for 49.4 percent of all fatalities. in particular, correctly identifying deaths due to neglect is problematic, and children with sudden unexpected death or those with what appear to be unintentional causes on the surface often have preventable risk factors which are substantially similar to those in families with maltreatment. there is a direct relationship between age of maltreatment/injury and risk for death. the younger an infant is, the more dangerous the maltreatment. family configuration, child gender, social isolation, lack of support, maternal youth, marital status, poverty, parental aces, and parenting practices are thought to contribute to increased risk. socio-economic factors infant mortality rates are higher in countries with higher economic inequality. social class is a major factor in infant mortality, both historically and today. between 1912 and 1915, the children's bureau in the united states examined data across eight cities and nearly 23,000 live births. they discovered that lower incomes tend to correlate with higher infant mortality. in cases where the father had no income, the rate of infant mortality was 357% more than that for the highest income earners ($1,250+). differences between races were also apparent. african-american mothers experience infant mortality at a rate 44% higher than average; however, research indicates that socio-economic factors do not totally account for the racial disparities in infant mortality. while infant mortality is normally negatively correlated with gdp, there may indeed be some opposing short-term effects from a recession. a recent study by the economist showed that economic slowdowns reduce the amount of air pollution, which results in a lower infant mortality rate. in the late 1970s and early 1980s, the recession's impact on air quality is estimated to have saved around 1,300 us babies. it is only during deep recessions that infant mortality increases. according to norbert schady and marc-françois smitz, recessions when gdp per capita drops by 15% or more increase infant mortality. social class dictates which medical services are available to an individual. disparities due to socioeconomic factors have been exacerbated by advances in medical technology. developed countries, most notably the united states, have seen a divergence between those living in poverty who cannot afford medical advanced resources, leading to an increased chance of infant mortality, and