State of South Dakota's Child: 2022.

In 2021, South Dakota observed an increase in the number of births from 2020 when the state experienced its lowest historic birth rate. Nonetheless, this increase represented a 3.7 percent decrease from the state's previous five year (2016-2020) mean of live births. This growth in the 2021 cohort of newborns was seen almost entirely among its white population. Further, South Dakota's current rate of birth remains slightly higher than that observed nationally. Over recent years, the racial diversity of South Dakota's newborns became similar to that observed nation-wide with nearly one quarter being American Indian, Black or Other races (AIBO). This trended down in 2021 with 22 percent of the state's newborns AIBO. Further, in South Dakota, the percent of all AIBO newborns who are American Indian is decreasing. Currently, 60 percent of the AIBO population is American Indian compared to more than 90 percent in 1980. During the pandemic years of 2020 and 2021, racial disparities in perinatal outcome occurring during previous years continued to be observed but the onset of prenatal care in the first trimester for both white or AIBO pregnant women did not change. There were 71 infant deaths in 2021 yielding a decrease in South Dakota's infant mortality rate (IMR) from 7.4 to 6.3 (higher than the 5.4 IMR for 2020 for the U.S.). Though there was a decrease in the state's 2021 IMR to 6.3, the reduced rate from its previous five year mean of 6.5 is not statistically significant. The state's 2021 neonatal mortality rate (NMR = 0 to 27 days per 1,000 live births) and post neonatal mortality rate (PNMR=28 to 364 days per 1,000 live births) dropped for the white population and increased for the AIBO population, though the actual number of AIBO deaths associated with these rate increases were low. Between 2017- 2021, the South Dakota rates of death for AIBO compared to white newborns was significantly higher for perinatal causes, sudden unexpected death (SUID), and other causes. Compared to the U.S.' 2020 rates of infant mortality, South Dakota's comparable 2017-21 rates were significantly higher for congenital anomalies. In 2021 there were 15 deaths in the state due to SUID; a decrease from the previous year, yet little overall improvement in decreasing the rate of this cause of death has not been achieved. Between 2017 and 2021, SUIDs comprised 22 percent of infant deaths for both white and AIBO infants. A discussion of strategies to prevent these persisting tragedies is presented.