Despite the trillions of dollars the U.S. spends every year on health care, an embarrassing fact persists: Among industrialized nations, the U.S. ranks among the worst in infant mortality.

For every 1,000 live U.S. births, 6.75 infants die within the first year of life, according to the Centers for Disease Control and Prevention. And in a ranking by the Central Intelligence Agency, the U.S. ranks behind 45 other countries.

Yet among African-Americans, the problem is particularly bad. Their infant mortality rate during the first year after birth is 13.3 deaths per 1,000, worse than the rate for Sri Lanka.

As The New York Times reports, there are no easy explanations.

“It is truly one of the most challenging issues because it is multifactorial,” said Dr. Garth Graham, who heads the Office of Minority Health at the U.S. Department of Health and Human Services. “And nationally, the disparity has remained despite our best efforts.”

Overall, infant mortality rates have dropped significantly since 1960, when the U.S. recorded 26 deaths for every 1,000 live births. However, that progress nationally has made it all the more frustrating for those working to improve the rate among African-Americans.

The Times highlighted the situation in Pittsburgh and surrounding parts of Allegheny County, where the infant mortality rate among black residents was 20.7 per 1,000 live births in 2009, worse than the rates in China or Mexico. In comparison, the rate among whites in the country was 4 per 1,000 live births.

According to recent studies, disparities in poverty, education, access to prenatal care, smoking rates and eating habits don’t fully explain the racial gap in infant mortality rates. Even black women with graduate degrees are more likely to lose a child in the first year of life than are white women who have not finished high school.

Budget constraints have prompted many federal and state programs to reduce their efforts to remedy the gap, however. In Pittsburgh, a federally funded nonprofit group, Healthy Start, has taken the lead in helping the most vulnerable pregnant women.

“As a city you want to be known for your football and baseball teams,” said Cheryl Squire Flint, who leads Healthy Start’s Pittsburgh branch, “but you don’t want to be known as a place where babies die.”

ROBERT T. NELSON

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