Tennessee continues to struggle with infant mortality rates that exceed the national average, with Black families bearing a disproportionate share of the loss, according to a new report from the Tennessee Department of Health examining 2023 birth outcomes.
The state’s infant mortality rate stood at 6.5 deaths per 1,000 live births, more than 16% higher than the national average of 5.6. While Tennessee’s rate has declined modestly since 2019, health officials say progress has been uneven and racial disparities remain deeply entrenched.
Black infants in Tennessee are still dying at roughly twice the rate of white infants, a pattern that has remained stubbornly consistent in annual health reports. In many parts of the state, Black infants are 2.5 to three times more likely to die before their first birthday. In some counties, Black infant mortality rates exceed 10 to 12 deaths per 1,000 live births, compared to statewide averages that generally fall between six and seven.
The report found that most infant deaths in 2023 were linked to medical conditions, including preterm birth, low birth weight and congenital disease. Preterm and low-birth-weight deliveries remain the leading drivers of infant mortality, particularly among Black mothers, who experience higher rates of pregnancy-related complications such as hypertension and pre-eclampsia.
Sleep-related deaths also continue to be a major and preventable contributor. Unsafe sleep practices–such as placing babies on their stomachs, sleeping outside of cribs or bassinets, or sharing sleep spaces with blankets and stuffed animals–were responsible for a significant share of infant deaths.
Public health experts describe the disparity as the result of a “web of causation” rather than a single factor. Social determinants of health, including unstable housing, food insecurity and limited transportation, create chronic stress for expectant mothers, particularly in rural areas and segregated urban neighborhoods often described as “maternal deserts.”
Researchers also point to the “weathering” hypothesis, which links the cumulative stress of racial discrimination to earlier health deterioration in Black women, increasing the risk of premature birth.
Black infants in Hamilton County have historically died at rates nearly three times higher than white infants, with Black infant mortality frequently spiking into the 13 to 15 deaths per 1,000 live births range in certain years.
Those deaths are often concentrated in specific zip codes, including 37404, 37406 and 37411, areas characterized by limited access to pharmacies, nutritious food and primary care.
Former Hamilton County Health Department Director Becky Barnes addressed this gap in 2021 as she reflected on more than four decades of public health service.
“We see the statistics, but behind every number is a family and a tragedy,” Barnes said. “When we look at zip codes like 37406 or 37404, we aren’t just looking at health data; we are looking at the history of our city and where we have failed to invest in the well-being of our neighbors.”
That observation remains a core finding of the Hamilton County Health Department’s 2024 “A Picture of Our Health” report, which notes that medical excellence alone has not translated into equitable outcomes.
At the state level, the Department of Health’s latest report outlines several strategies aimed at reducing infant deaths, including expanded promotion of safe sleep practices, smoking cessation programs and increased awareness of prenatal services offered through local health departments. Health officials caution that reversing these disparity trends will require sustained investment and trust-building in communities that have historically been underserved. As one local leader recently put it during public meetings, the persistence of infant deaths in certain zip codes is not a failure of modern medicine, but a reflection of gaps in access, equity and support long before families ever reach a hospital door.