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experienced a previous preterm birth. About 58 percent of these women use Medicaid as the main source of payment for the birth. Averting only 10 percent (106) of recurrent preterm births would create a cost savings for Alabama of almost nine million dollars.

The number of sleep related deaths (including SIDS) increased to 130 in 2016, from 108 in 2015. Sleep related death comprised 24 percent of the infant deaths and include accidental suffocations and strangulations in bed, SIDS, and unexpected ill-defined or unknown causes. The number of actual SIDS deaths decreased; however, the numbers were increased for accidental suffocation and strangulation in bed and for ill–defined and unknown causes.

Rates of infant deaths and numbers of infant deaths were examined for each county in the state, and during the three-year period from 2014-2016, twelve counties were identified which had infant death rates that were disproportionately high relative to their populations: Autauga, Colbert, Etowah, Jackson, Jefferson, Macon, Marion, Mobile, Montgomery, Russell, Tuscaloosa and Walker. These twelve counties accounted for 42.6% of all live births, but represented 49.7% of all infant deaths in Alabama from 2014-2016. The infant mortality rate for these twelve counties was 10.1 infant deaths per 1,000 live births for the period of 2014- 2016, while the infant mortality rate for the state of 8.7 infant deaths per 1,000 live births during that same period. This equates to about 105 excess infant deaths in these twelve counties from over these three years. Therefore, these geographic areas of focus can be targeted for infant mortality prevention efforts to decrease infant mortality in Alabama. The three leading causes of infant mortality in Alabama accounted for 47% of the infant deaths in 2016. Congenital anomalies are also known as birth defects, congenital disorders or congenital malformations. Although approximately 50% of all congenital anomalies cannot be linked to a specific cause, there are some known causes and/or risk factors, including genetic, environmental, socioeconomic, demographic and maternal health factors. Disorders related to short gestation and low birth weight are also known as prematurity, or being born too soon or too small. Racial and socioeconomic characteristics are strong predictors of prematurity. The highest risk for premature delivery occurs in a woman who has previously experienced a premature delivery. Sleep Related Deaths are infant deaths that include accidental suffocation and strangulation in bed, SIDS, and ill defined and/or unknown causes of mortality.

ALABAMA’S ACTION PLAN The Children’s Cabinet has adopted the recommendations of the working subcommittee to implement a pilot program to reduce infant mortality rates by at least 20% in three counties (Macon, Montgomery and Russell), within the next five years. Over 650 preterm births and 45 infant deaths occurred in these three counties in 2016. The pilot program will focus on immediate interventions that increase support to live born infants, medium-range programs that aim to reduce premature and low birth weight births, and long- term initiatives that address the social determinants of health to achieve health equity and eliminate disparities.