West Virginia’s Fatality and Mortality Review Team (FMRT) recently published their 2025 annual report, which offers the latest available data and insights into the causes of infant and maternal deaths in the state. These measures serve as two key indicators of overall health in the state.
Infant mortality measures the number of children under one year old who die per 1,000 live births. The 2025 annual report covers infant deaths between 2017 and 2022, breaking them out to show trends before and after the COVID-19 pandemic started. The overall and white infant mortality rates remained relatively flat, reaching their lowest point that data exists for between 2020 and 2022. Over the same period, the Black infant mortality rate decreased. As of the most recently available data, Black infants are still more than twice as likely to die within their first year of life compared to their white counterparts.
Over the period covered in this data, West Virginia had a higher infant mortality rate than the United States overall.
The report also provided data about causes of infant deaths and their level of preventability. Nearly 70 percent of deaths were medical in nature, with top causes including congenital abnormalities, prematurity, and other medical and perinatal conditions. Fewer than five percent of these medical deaths were deemed preventable. The FMRT panel could not determine the cause of death for 20 percent of infant deaths, which was the next largest category; however, 90 percent of deaths in this category were related to an unsafe sleep environment. Of these, 72 percent were deemed preventable. Overall, about 25 percent of infant deaths between 2017 and 2022 were determined preventable.
Two in three infant deaths happened during the neonatal period, which comprises the first 28 days of life. And while 15 percent of infant deaths were caused by prematurity (born before 37 weeks of gestation), preterm babies made up two in three overall deaths. While prematurity was not the primary cause of death in most cases, its prevalence reflects research outlining the additional risks that premature babies face.
Other risk factors that were prevalent in many cases, but not always the primary cause of infant deaths, were related to unsafe sleep environments, maternal smoking, and a lack of prenatal care. As previously stated, most undetermined infant deaths were sleep-related, including sleeping outside a crib or bassinet and having unsafe materials like pillows and blankets in the sleeping area.
There was a significant overlap between unsafe sleep environments and maternal smoking. In fact, 60 percent of sleep-related infant deaths had documentation of secondhand smoke exposure. One study explains that infants’ airways are most compromised during sleep. Another reason is that tobacco exposure at any stage impacts development and makes babies more vulnerable to death in the first place, including within unsafe sleep environments. West Virginia has one of the highest rates of tobacco use in the country across populations, including among pregnant and postpartum people. Between 2017 and 2022, one in five mothers reported smoking at some point during pregnancy, which is four times higher than the national average. These parents were twice as likely to experience the death of their infants than nonsmokers.
Lastly, researchers found that babies whose parents received no prenatal care were over three times as likely to die within their first year of life, with a mortality rate of 20.2 per 1,000. Prenatal care allows medical professionals to monitor the health of pregnant people and their babies, treat abnormalities and prevent them from progressing, and educate families about best practices—including around smoking and safe sleep—during a vulnerable time. It is imperative that families have access to prenatal care to reduce infant deaths.
The FMRT annual report also included updated data on maternal mortality in the state and has aggregated it between 2017 and 2023. The maternal mortality rate is the number of pregnancy-related deaths per 100,000 live births during pregnancy or within a year of giving birth. While infant deaths remained stable or fell between 2020 and 2023, the rate of maternal deaths in West Virginia nearly doubled over the same period.
One-third of maternal deaths occurred one to six weeks postpartum, followed by 28 percent during pregnancy. The leading causes of maternal deaths during this period included infections (including COVID-19), mental health conditions, hemorrhages, embolisms, and cardiovascular conditions. Nearly 70 percent of maternal deaths were deemed preventable by the review team.
The COVID-19 pandemic disrupted health outcomes in many ways, from decreased access to the health care system to increased isolation which played a major role in maternal health outcomes. The Kaiser Family Foundation conducted a study finding that the COVID-19 pandemic had a direct relationship with worsened mental health and increased substance use. Further, the review team found that one in five maternal deaths since 2020 have been due to COVID-19 infections.
While substance use disorders caused 12 percent of maternal deaths, they were a contributing factor in 40 percent of cases, indicating the continued prevalence of the opioid epidemic in West Virginia communities. These deaths followed the overall trend of opioid deaths in the state; as opioid deaths in the state rose and fell, so did those among pregnant and postpartum people. Another eight percent of deaths were caused by depression and other mental health conditions, though they were present in one in five maternal deaths. Providing care for mental health crises in the state, including substance use disorders, must be a priority to reduce maternal deaths in West Virginia.
For the first time, the review panel included some racial data on maternal deaths. Previously, small sample sizes prevented the panel from sharing this data. They found that while Black women comprised just 3.6 percent of live births in the state between 2017 and 2023, they represented eight percent of pregnancy-related deaths. While this ratio is lower than the national average (between 2021 and 2023, Black women made up 14 percent of live births but roughly 50 percent of maternal deaths), Black women are dying at a disproportionate rate in West Virginia, highlighting an important racial disparity previously unknown publicly in the state.
The review team had several recommendations to address infant and maternal deaths. Chief among these is increasing access to health care and improving access to resources such as safe sleep education, mental health services, and substance use disorder treatment. And yet, access to health care and resources are disappearing for families in several ways across the state.
Since 2006, West Virginia has seen half of its labor and delivery units close, with just 18 left of the 35 that existed two decades ago.[1] Several factors, including hospital consolidation, have contributed to the increase in maternal care deserts, especially in rural areas of the state.
As previously highlighted, there is a direct relationship between a lack of prenatal visits and infant deaths, with infants who received no prenatal care dying at three times the overall rate. Health care access goes beyond access to health insurance; this map indicates long distances between where a person may live and where they may receive care, preventing even people with health insurance from receiving necessary services. Other factors like access to transportation, time off work, child care, and more can reduce a person’s ability to seek prenatal health care. Doulas and midwives offer one means of addressing these barriers and improving birthing outcomes while reducing health care costs.
In July 2025, the United States passed HR 1 (“One Big Beautiful Bill Act”), a sweeping bill that significantly reduces access to the social safety net, including Medicaid and the ACA Marketplace, SNAP, and other programs that many families rely on. This legislation will further decrease West Virginians’ access to health care in several ways, including for pregnant and postpartum populations meant to be excluded from these cuts. Make no mistake, these health care and other cuts will cost West Virginia the lives of infants and mothers. This policy puts state decision-makers in a difficult position wherein they must generate and dedicate more state dollars to federal programs to keep them afloat. Lawmakers and administrators in West Virginia must prioritize mitigating the impact of these policies, as well as making up for lost federal funds through the state budget.
[1] Email correspondence between author and representative at Perinatal Partnership, May 22, 2025.
