Over the decade from 2014 to 2023, Mexico's infant death rate barely budged, suggesting the country hit a wall in saving babies' lives—even as official paperwork claimed that almost all babies had a medical professional present when they died.
That's among the findings of a new study co-led by Genny Carrillo , MD, a children's health expert with the Texas A&M University School of Public Health . She worked closely with colleagues from a Mexican hospital, university and national government agency to track what caused these deaths, where they happened and whether the families had access to medical care.
"A child's survival during the critical first year is a structural issue as well as a medical issue—it's a direct reflection of how a healthcare system treats mothers and newborns," Carrillo said. "We found that Mexico's disorganized and disconnected healthcare system from 2014 to 2023 made improvements difficult."
A deep-rooted issue
The issues behind infant mortality in Mexico are complex and deep-rooted. For example, while the team found that the infant death rates overall were higher in rural areas, the rates in some cities were just as bad as, or even worse than, those in rural areas.
"This is largely because of 'medical deserts'—poor, crowded or isolated neighborhoods that lack real access to care, even if there are large hospitals elsewhere in the city," Carrillo said. "These neighborhood-level issues are not apparent when looking only at national averages or hospital counts."
Digging into the data
For their retrospective study, the team analyzed the 224,212 deaths of infants under one year old in Mexico as recorded in a national database.
They compared the total number of infant deaths against the official number of live births each year to see how the death rate changed over time. They also looked at the medical codes listed on death certificates to identify the cause of each death and organized these causes into medical categories to help determine geographical patterns and which deaths might have been prevented with better, faster healthcare.
They included demographic factors, city of residence and social security insurance coverage ( IMSS , Mexico's main public health insurance, which is funded by workers, employers and the government to provide free medical care and typically has crowded facilities and long wait times).
In the case of infant deaths, they added whether a healthcare professional was present at the time of death, whether the infant died in a healthcare or other facility and whether an autopsy was performed.
"It's important to remember that having a medical worker present at the time of death does not mean that the care provided was timely, of high quality or complete," Carrillo said. "In some cases, the infant might be declared dead shortly after arrival, for example."
Uncovering the gaps
To determine the yearly infant death rate, the team counted how many babies out of every 1,000 born alive died before their first birthday across the country and for each of Mexico's 32 states from 2014 to 2023.
Their analysis revealed several key findings:
- Male infants accounted for a higher proportion of deaths than female infants. This pattern persisted after accounting for differences in the number of live births by sex and was steady consistently across years and across most causes of death.
- Most baby deaths occurred during the first month of life (the neonatal period) or right around birth (the perinatal period) and were caused by premature births, blood infections and other conditions affecting newborns. This suggests that many deaths could have been prevented with more medical attention during pregnancy, the delivery or right after birth.
- Babies in rural areas fared worse. Infants in smaller, rural towns had less access to medical care at the time of death and were far less likely to receive an autopsy. On the other hand, several smaller states did a better job of providing medical care at the time of death and performing autopsies than Mexico City.
- Autopsies in rural areas were less accurate. In smaller towns, infant deaths were more likely to be attributed to vague "external causes," which suggests dangerous environments as well as inconsistent medical investigations.
- Health insurance does not guarantee quality care. More pregnant women had health insurance, but poor and vulnerable populations, such as Indigenous women, still face major structural barriers and discrimination that results in inferior medical treatment.
- Better reporting. Doctors or medical staff reported attending to 99.5% of infant deaths by 2023—a major statistical increase from earlier years—but because the overall infant death rate did not go down, this likely resulted from changes in government modifications in paperwork and administrative processes.
"Infant death rates did not change based on the season or weather, indicating that babies were not dying simply because of short-term seasonal temperature spikes or flu outbreaks," Carrillo said. "The main culprits are structural problems like poverty and broken healthcare systems."
She added that real progress requires deep investments to improve the quality of care, better coordination between different clinics and honest investigations into why babies die.
The research team suggested that Mexico should follow the lead of several countries in South Asia and sub-Saharan Africa in lowering infant death rates through a chain of medical care that starts with early pregnancy checkups, moves through safe delivery and continues with support for the newborn.
Their study was published in Sage Open Pediatrics and was supported by IMSS-BIENESTAR, the Mexican Social Security Institute for Well-being.
Others involved in the study were Nina Mendez-Dominguez, MD, PhD, with the Regional Specialty Hospital of the Yucatan Peninsula; Hugo Azcorra, PhD, with Modelo University; and Amonario Olivera-Mar, PhD, and Adrian Perez-Navarrete, MD, with Mexico's General Directorate of Health Education.
By Ann Kellett, Texas A&M University School of Public Health
