KOKOMO — Long one of the states with the highest infant mortality rates, Indiana has made improvements thanks to recent efforts and initiatives, but experts say there’s still work to be done.

Being in the top 10 of something is usually a good thing, but not when it comes to infant mortality.

Near the top of infant mortality rates per 1,000 births is where Indiana has historically been, though.

In 2017, the state’s 7.5 deaths per 1,000 births were the ninth-highest in the state. Infant mortality is defined as the death of an infant before the baby is 1 year old.

The rate per 1,000 has stayed in the 7s for most of the past decade — above the national average, which has hovered around 6 per 1,000 over the same time period and dropped to 5.6 per 1,000 in 2019.

Many factors, including a mother’s overall health, contribute to infant mortality rates. That said, Indiana’s historically high infant mortality rate is unsurprising, as the state was also the 12th-most obese state in the U.S. in 2017, according to CDC data, and 13.4% of pregnant Hoosier mothers smoke during their pregnancy, according to the ISDH.

Since 2017, though, the state’s infant mortality rate has been on a slight but steady decline.

In 2019, the Indiana State Department of Health reported an infant mortality rate of 6.5 deaths, the lowest rate in the state’s recorded history. In all, 527 babies died before their first birthday in 2019, down from 559 in 2018 and 602 in 2017. In the past five years, more than 2,900 infant lives in Indiana have been lost.

Perhaps most notably has been the decline in infant mortality among Black Hoosiers.

Over the past decade, the mortality rate for Black infants has been on a roller coaster ride, going down and back up since 2010. From 2017-2019, though, the infant mortality rate among Black infants has shown a steady decline, from a decade high of 15.4 per 1,000 in 2017 to a decade low of 11 in 2019.

That said, infant mortality for Black people in the state are still markedly higher than other races. Those racial disparities can be seen not only in Indiana but across the United States.

According to the ISDH, the mortality rate among white infants in Indiana was 6 per 1,000 in 2019. The mortality rate among Hispanic infants was 6.4 per 1,000 last year.

As a whole, though, the trend in the state is a positive one. Unsurprisingly, state officials last year expressed happiness over the most recent numbers.

“We are committed to ensuring the best chance for a healthy pregnancy and a strong start to life for Indiana’s newborns,” Gov. Eric Holcomb said in a written statement last fall. “While we celebrate these results, our work is far from finished, and we won’t rest as we work to protect our youngest.”

While the state’s infant mortality as a whole has declined in recent years, two of its regions saw an increase over the past five years.

The state’s eastern region — Howard, Tipton, Madison, Delaware counties and more — and the central southwestern region — Vigo, Vermillion, Clay counties and more — are seeing some of the highest infant mortality rates among the state’s 11 hospital regions, increasing 0.6% and 1.8%, respectively, from 2015 to 2019, according to a March ISDH presentation.

Perhaps more alarming, though, is the statewide increase in Sudden Unexpected Infant Death (SUID).

As the name suggests, SUID is the sudden, unexpected death of an infant under the age of 1, and it includes sudden infant death syndrome (SIDS), accidental suffocation in a sleeping environment and other deaths from unknown causes.

Unlike infant mortality, the SUID rate has been on the rise since 2010.

According to the ISDH, the state’s SUID rate per 100,000 live births was 69.2. In 2019, it was 122.4 — the highest it’s ever been since 2010. The state’s eastern and central southwest regions have the second- and third-highest SUID rate among the state’s 11 regions, with 156 deaths per 100,000 live births and 150.3 per 100,000, respectively.

While any infant death is tragic, local experts say SUID deaths are particularly tragic, as they’re almost always avoidable with proper education.

“We really think this is one of those preventable things,” said Barb Hilton, director of Prevent Child Abuse Howard County and member of the Infant Mortality Prevention Action Team of Howard County task force. “If people followed the different practices to reduce risk, we could eliminate these.”