Babylost: Racism, Survival, and the Quiet Politics of Infant Mortality, from A to Z

By Monica J. Casper

The U.S. infant mortality rate is among the highest in the industrialized world, and Black babies are far more likely than white babies to die in their first year of life. Maternal mortality rates are also very high. Though the infant mortality rate overall has improved over the past century with public health interventions, racial disparities have not. Racism, poverty, lack of access to health care, and other causes of death have been identified, but not yet adequately addressed. The tragedy is twofold: it is undoubtedly tragic that babies die in their first year of life, and it is both tragic and unacceptable that most of these deaths are preventable. Despite the urgency of the problem, there has been little public discussion of infant loss. The question this book takes up is not why babies die; we already have many answers to this question. It is, rather, who cares that babies, mostly but not only Black and Native American babies, are dying before their first birthdays? More importantly, what are we willing to do about it? This book tracks social and cultural dimensions of infant death through 58 alphabetical entries, from Absence to ZIP Code. It centers women’s loss and grief, while also drawing attention to dimensions of infant death not often examined. It is simultaneously a sociological study of infant death, an archive of loss and grief, and a clarion call for social change.

• Language: English
• Publisher: Rutgers University Press
• Release date: Mar 18, 2022
• ISBN: 9781978825963

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Cover Page for Babylost

Babylost

Babylost

Racism, Survival, and the Quiet Politics of Infant Mortality, from A to Z

MONICA J. CASPER

RUTGERS UNIVERSITY PRESS

NEW BRUNSWICK, CAMDEN, AND NEWARK, NEW JERSEY, AND LONDON

Library of Congress Cataloging-in-Publication Data

Names: Casper, Monica J., 1966– author.

Title: Babylost: racism, survival, and the quiet politics of infant mortality, from A to Z / Monica J. Casper.

Description: New Brunswick: Rutgers University Press, [2022] | Includes bibliographical references and index.

Identifiers: LCCN 2021023672 | ISBN 9781978825949 (paperback; alk. paper) | ISBN 9781978825956 (hardback; alk. paper) | ISBN 9781978825963 (epub) | ISBN 9781978825970 (mobi) | ISBN 9781978825987 (pdf)

Subjects: LCSH: Infants—Mortality—United States. | African American infants—Health and hygiene. | Indian infants—Health and hygiene—United States. | Maternal health services—United States. | Discrimination in medical care—United States. | Racism—Health aspects—United States. | Maternal and infant welfare—United States.

Classification: LCC HB1323.I42 U6336 2022 | DDC 304.6/4083—dc23

LC record available at https://lccn.loc.gov/2021023672

A British Cataloging-in-Publication record for this book is available from the British Library.

Copyright © 2022 by Monica J. Casper

All rights reserved

No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, or by any information storage and retrieval system, without written permission from the publisher. Please contact Rutgers University Press, 106 Somerset Street, New Brunswick, NJ 08901. The only exception to this prohibition is fair use as defined by U.S. copyright law.

References to internet websites (URLs) were accurate at the time of writing. Neither the author nor Rutgers University Press is responsible for URLs that may have expired or changed since the manuscript was prepared.

www.rutgersuniversitypress.org

Manufactured in the United States of America

For all the babies, and those who mourn them.

When I get to the Capitol after much difficulty and begin to state the case for the Children’s Bureau, I discover a serious handicap. Those men in Congress are really just as fond of children as I am. They are fond of their own children and their friends’ children, but they are usually not familiar with what is happening to many American children, and they usually lack the imagination to translate the facts and figures which are presented to them in terms of actual children.

—Grace Abbott, 1931

I thought stillbirth was a thing of history, and then it happened to me, and yet now when I hear of a baby dying I’m just as incredulous. You mean they still haven’t figured this out? I want to hear about every dead baby, everywhere in the world. I want to know their names, Christopher, Strick, Jonathan. I want their mothers to know about Pudding.

—Elizabeth McCracken, 2008

My daughter. Say it—hold it in your mouth, look at the words: born dead.

To be told there is no pulse at the precise threshold of birth—water breaking. To be told to deliver anyway. Death.

—Lidia Yuknavitch, 2015

I had never seen a dead body before. My baby was my first.

—Kate Inglis, 2018

In many ways, for the mothers and families who lost these babies, the inability and lack of public space to talk about them are a second death. The silence makes us feel as if there is something fundamentally wrong with wanting and needing to remember our children no matter how short their lives may have been.

—Shannon Gibney and Kao Kalia Yang, 2019

I cannot express how little I care that you hate the photos. How little I care that it’s something you wouldn’t have done. I lived it, I chose to do it, and more than anything, those photos aren’t for anyone but the people who have lived this or are curious enough to wonder what something like this is like. These photos are only for the people who need them. The thoughts of others do not matter to me.

—Chrissy Teigen, 2020

Contents

Introduction

A. Absence

Abuse

Angel Babies

Awareness

B. Babyland

Black Infant Mortality

Blame

Breastfeeding

C. Children’s Rights

CIA’s World Factbook

Congressional Black Caucus

Cuba

D. Dads

Deprivation

Disability

Doulas

E. Emptiness

Envy

Epigenetics

F. Folic Acid

Fracking

Frankenstein

G. Grief

Guilt

H. Hope

I. Infant Mortality Rate

Infanticide

J. Japan

K. Kangaroo Care

L. Life Expectancy

M. Maternal Mortality

Medicaid

Memphis

Midwives

Mother’s Day

N. Neonatology

Nurses

O. Obstetric Violence

Ohio

P. Placenta

Prematurity

Prenatal Care

Q. Quiet

R. Racism

Rainbow Baby

Reproductive Justice

S. Stillbirth

Survival

T. Tahlequah

Trauma

U. Urgency

V. Vulnerability

W. Washington, D.C.

Weathering

Women’s Health

X. Xenophobia

Y. Yearning

Z. Zip Code

Acknowledgments

References

Index

About the Author

Introduction

Babies matter. And they matter to most, if not all, people on our planet, though in many different ways.

When I was a child, I gradually understood that my grandmother and aunt each had lost a baby. I did not know precise details but recall my mom mentioning it more than once. This knowledge made me sad. I understood that my cousin, Walker Aaron, who died at birth after being strangled on his way through the birth canal, would have been one month older than me. Instead, I was a year older than my next closest cousin, Tim, born fourteen months after his brother’s death. Later, tragically and unexpectedly, my aunt lost another child, Chad, at age five. We never met him as they did not live near us then. It was many years before we were able to visit the family gravesite to offer our respects. But we talked to my aunt on the telephone just after her second son died, and I remember—like it was yesterday—the fatigue and sorrow in her usually cheerful voice.

As I grew older, I learned of other lost babies and children. A friend of my sister, married to her high school sweetheart, suffered a stillbirth. Another friend gave birth to a beautiful little girl who died a few days later from a rare illness. Another lost first one twin in utero and then the other a few days later, a ghastly roller coaster of despair, hope, and more despair. Friends and colleagues suffered miscarriages—too many to count. A friend of a friend experienced a late-term miscarriage and had to deliver her stillborn baby. And these were just people I knew personally. I also had read about infant deaths in novels such as Betty Smith’s A Tree Grows in Brooklyn, Toni Morrison’s Beloved, and Bobbie Ann Mason’s Feather Crowns.

Babies everywhere, it seemed, were dying, though few were speaking of these losses publicly.

I have long been fascinated with babies, specifically the practices and politics of imagining, preventing, carrying, delivering, nurturing, fixing, and grieving them. I knew as early as college that I would focus my professional attention on reproduction—my senior thesis was on midwifery—and I also hoped that I would have my own babies someday. And yet, because reproductive loss was a branch of my family tree, I knew that reproduction was fraught. Indeed, in the United States, few issues are as weighted with social and cultural expectations or as heavily politicized. But I was already too invested to be scared away, in large part because reproduction—which is both embodied and deeply consequential for our species—is where politics come out to play, often in deadly ways, especially for women and their babies.

Nearly thirty years ago, while in graduate school, I began a project on fetal surgery, a relatively new boutique procedure for operating on the so-called unborn patient. In addition to interviewing surgeons, nurses, social workers, and others, I observed fetal surgical operations, which prepared me for eventually watching my own (second) cesarean section. That research became my dissertation, then later my first book, The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery. In it, I offered an innovative sociological analysis of fetal interventions, drawing attention to significant ethical issues such as the clinical erasure of pregnant women alongside the emergence of fetal personhood. I also situated fetal surgery in historical and contemporary contexts, including vociferous and sometimes violent abortion politics in the United States and elsewhere.

What I did not discuss in the book, but which was very much on my mind, was the high infant mortality rate in African American communities in Oakland, just across the bay from where I had researched fetal surgery at Capital Hospital. I was struck by the juxtaposition between an expensive, high tech, experimental intervention on a handful of singular, mostly white fetuses, while nearby, Black babies were dying at two to three times the rate of white babies, decimating families and communities. This disparity was made more poignant by the abundance of media coverage fawning over every successful fetal surgery (Look what we did!), in contrast with the stark absence of stories about reproductive loss. I was witnessing firsthand what anthropologist Shellee Colen called stratified reproduction.

Though the current project was germinated years ago, while I was immersed in fetal surgery research, I did not launch it in earnest until I was living in Nashville, Tennessee, teaching at Vanderbilt University. There, two related events caused me to dive more fully into studying infant mortality. First, in 2006, I attended a conference on infant death called Why Our Babies Die, organized by Vanderbilt and Meharry Medical College, one of the nation’s oldest historically Black educational institutions. And second, I stumbled across data on high infant mortality rates in nearby Memphis, Tennessee, representative of dire health outcomes across the U.S. South. Together, these suggested there could—and should—be sociological investigations into infant death and racism. The data made it obvious that Black communities were especially negatively impacted. But outside of demography and epidemiology, few scholars were paying attention to infant death. I wanted to pick up where sociologist David Armstrong left off in his radical 1986 study of the invention of infant mortality.

When I began to excavate the practices and politics of infant death, the most pressing and useful question I found myself asking was Who cares? That is, in a pragmatist sociological sense, who cares about and is willing to act on commitments to reduce infant mortality rates? This broad question led to other, more pointed questions: Who cares about babies, dead or alive? Who invests in infant survival in the United States, including research to explain and ameliorate health disparities? Who cares about pregnant people, and which pregnant people? Who cares about women’s health, and which women? Who cares about mothers, especially those with few resources and little power? Who cares about persistent racial inequalities in the United States that continue to result year after year in premature, preventable death? Who cares about fetuses, abortion, prenatal interventions, and perinatal death, and what do these concerns have to do with the politics of infant and maternal survival? Equally significantly, who cares little or not at all about infant mortality—where are the gaps, elisions, and spaces of disregard? And finally, how do we talk about infant loss—in which registers, in whose voices, and with what consequences for human flourishing?

I started with the basics—framing infant mortality as a social problem, just as physician George Newman did more than a century ago.

Every day, small persons die in their first year of life, often quietly and invisibly. They perish from a variety of causes: low birth weight, birth anomalies, genetic diseases, failure to thrive, inadequate nutrition, violence, stillbirth, poverty, prematurity, and lack of access to care. They die at different ages, some without taking a first breath, others at day 1 or 2 or 6 or 137, and some just shy of their first birthday. These deaths are routine, often preventable tragedies, tiny fissures in the fabric of human evolution. Each death, singly, is an acute loss—a local, specific occasion for grief and commemoration. Infant deaths—like miscarriages, perinatal losses, and stillbirths—are publicly unremarked and largely unrecognized by others beyond grieving parents and perhaps other family members and close friends gathered in private spaces.

Yet taken together, these local misfortunes—Walker, Amelia, Parker, Tyan, Kiara, Malik, Elena, Sophie—are transformed into something greater. One solitary baby’s premature death is combined with another and then another and so on, until these excess deaths become a social phenomenon, a collective pattern, a vital statistic. We describe infant loss in the aggregate as infant mortality, an arithmetical measure referencing the death of a baby in the first year of life. (The World Health Organization defines child mortality as death under age five.) Through population-level quantification, we seek to know how and why babies die. And we seek to understand what these premature deaths mean for families and also for cities, states, and nations tasked with the governance of life and death. Consider, for example, the nature of headlines such as U.S. Reports New Low in Infant Mortality and [Millennium Development Goals] Target on Infant Mortality Not Met.

Infant mortality is political in the fullest sense of the term, connected historically both to quantities of death and their measurements and also to qualities of life. Yet in relying on infant mortality as a conceptual and practical framework for understanding infant death, we move away from grief and loss to a different, more technical register. One that attends not to the emptiness inside a pregnant person’s body, the hollow around which they achingly wrap their arms, but rather to numbers, databases, archives, and registries. We move from profound losses experienced affectively to presumably objective statistical rates and from cherished unique babies with gravestones to considering the aggregate, the group, the population, the state. We leave the realm of my baby died, and it hurts—expressed privately and intimately—to infant mortality as a public health problem, firmly transplanting us from hearts, homes, and cemeteries to larger biopolitical worlds of risk, prevention, intervention, governance, and the health status of nations.

Numeric language is preferred, indeed required, by clinicians, governments, the World Health Organization, the World Bank, public health experts, nongovernmental organizations (NGOs), and mass media. Infant mortality tells us not about the texture and circumstances of each baby’s brief life and death but about frequencies, geographic concentrations, and correlations. Death clusters, and quantitative methodologies help us recognize and chart these. The infant mortality rate (IMR) offers a standardized language that enables communication in and across recognizable categories: race, ethnicity, socioeconomic status (SES), gender, city, county, state, nation, globe. Thus rates ultimately help providers, organizations, and states—but not necessarily grieving parents and their families—to communicate and work to assess the situation and formulate possible solutions.

Patterns and aggregates can helpfully allow us to see social phenomena. And if we pay attention, we can notice that poor babies and nonwhite babies die more frequently in the United States and globally. We can notice that the United States has more first-day newborn deaths than all other industrial nations combined. We can notice that African American and Native American babies die at more than twice the rate of white babies and that some powerful groups in the United States worry less about this tragedy and more about declining birth rates among white people. We can notice that babies in some communities, cities, and regions die so often that infant mortality is an established fact of life there, like racial profiling. And we can notice that in other communities, cities, and regions—those that are whiter and those with more economic privilege—the death of an infant is so very rare that it is unexpected and thus especially shocking. Perinatal and infant death, tragically routine in some contexts, in others interrupts the privilege of believing all is right in the world.

My initial aim for this project was to produce a book about the politics of quantification, focusing on how numeric framings of infant death—infant mortality rates—distract us from loss itself. Counting deaths, it seemed to me, minimized lived experiences of grief and loss. Following economist Marilyn Waring, I wanted to know: Where are the women? Both dead babies and the people who birthed them—primarily women, but also trans men and genderqueer people—were (and still are) invisible in most discussions of infant mortality. What was highly visible were rates, useful for clinical, governmental, and policy purposes. Yet as visible as the shifting rates have been across time, they have not translated into interventions lessening racial disparities in infant mortality. Nor have they inspired many public conversations about the persistent problem of infant death. The numbers, I have found, drain the emotion from loss and fail to inspire care and concern.

As I was working on an earlier version of the book, my beloved stepfather died, quite unexpectedly. After a routine knee replacement, he developed an infection and was dead two weeks later, at age sixty-seven. This was both devastating and life-changing, as my mother suddenly became a widow, and my siblings and I had to figure out how to navigate a world without our dad in it. Grieving, I did not touch the infant mortality project for two years; I could not look at loss and death without weeping. It didn’t help that my other projects were also focused on trauma and death, including the harms of gender-based violence. Though it was quite different, I imagined, to lose a beloved parent than a cherished newborn, my dad’s death underscored all the ways death is never merely a statistic. It is always relational, affective, grief-inducing, and dreadfully permanent.

I understood that it was an immense privilege to be able to step away from infant loss in ways that babylost parents—those who have lost babies through miscarriage, stillbirth, or infant death—could never do. I eventually returned to my infant mortality research but now with a very different project in mind, one that would not unnecessarily create abstractions from lived experiences. This is the book you now hold in your hands (or are viewing on-screen). It is clearly not the standard academic book I originally intended to write, nor does it follow conventional representations of data. Borrowing from the genre of creative nonfiction, I have aimed for accessibility and impact. This book is primarily for babylost parents and those who care for and about them, but also for most anyone interested in babies and their survival and well-being.

Over the past fifteen years, extensive research for this project has included interviews with a wide range of people working on and around infant mortality; participation in workshops and conferences; analysis of clinical, public health, and scientific literature; analysis of memoirs, films, novels, and other cultural depictions of infant loss; conversations with women who have lost babies and the people who have cared for these women; analysis of websites, especially those devoted to babyloss; media analysis, specifically of news coverage of infant mortality; and analysis of government documents both historical and present-day. When a project takes as long as this one has, it is difficult to ignore new material, whether in the form of epidemiological studies, which are frequent, or memoirs, of which there are too few. What I have learned, sadly, is that there will always be new material until we fix the enduring problem of infant mortality.

To write for a popular audience, I explored a number of forms. I felt an alphabet book could be the right vehicle. For one, alphabet books are a tender reminder of what babylost parents do not get to share with their deceased children. I read many alphabet books to my own girls, and they were critical parts of their early childhood development. To be denied a baby is, ultimately, to be denied the chance to read to and play with that child, to parent that child. I also chose the alphabet book format because it allowed me to usefully organize themes that had emerged from my years of research. Each of the book’s fifty-eight entries can be read as a keyword that makes sense of some aspect of infant mortality, primarily in the United States. Ranging from Absence to Zip Code, the entries offer a picture—inevitably incomplete, as not every aspect can be included in one volume—of how infant death moves through and is shaped by various social and cultural factors.

Analytically, I selected entries that in my view most trouble our preconceived ideas about infant mortality. What haven’t we thought about, talked about, or written about? What aspects of infant death and babyloss have not appeared publicly or been taken up by policymakers? What hidden crevices of infant loss are in dire need of sunlight? What populations have been overlooked? Whose stories are never told or are told only in ways that advantage those in power? Where do pregnant people and parents enter into accounts of infant loss, as those most impacted? How does this book interrupt the formal, numeric register of infant mortality rates to make new spaces for affective considerations of grief and loss? For feelings rather than statistical responses to infant death?

You may ask, How will I read this book?

My answer is, Any way you choose.

Some readers will move through the entries sequentially, as one might when reading to a child or oneself. Others will start with entries that most interest them; the table of contents will be helpful in this regard. Babylost may also function as a kind of (partial) encyclopedia or archive, a reference text for activists, caregivers, scholars, and others interested in a specific topic or concern. People who have lost babies may read some entries and skip over others, finding them too close to the bone. And still others may mine this book for ideas about future projects related to infant mortality. I hope this is the case. I would be honored if this book inspired a few dissertations or other studies of the many woefully understudied aspects of infant loss, from the relationship between capitalism and infant mortality, to transgender pregnancy and birth outcomes, to infant mortality and pandemics, and well beyond.

The book’s underlying argument is this: infant mortality has been, for far too long, ignored. Those who study rates and measures, seeking causes in everything from race to socioeconomic status to a father’s educational level, will likely disagree with me. But what I mean is this: we have ignored those facets of infant death that might deepen our collective understanding and promote different and better interventions. Because it is not enough to simply measure death; we must also be willing to shift practices and structures that will foster deeper understanding and survival. To do so, we must make visible the babies who die and the babylost families who grieve them. If we cannot see infant mortality as a human problem, a matter of trauma and loss, and not simply as a statistical conundrum, then we cannot address it at the roots. We must allow ourselves to be haunted by all the lost babies rather than comforted by or preoccupied with abstractions.

There is another assertion, too, at once poignant and political. It has been the book’s pulse, urging me forward even when my own heart was too undone to continue. It is this:

That babies die is a sad fact of life.

That babies die prematurely, from preventable causes, is shameful.

We can and must do more, especially for the most marginalized among us.

Babylost is my modest offering.

A

ABSENCE

In historian Elizabeth Heineman’s memoir of babyloss, Ghostbelly, she writes, This is what I want to do. . . . To take that moment, in which Thor will not grow six hours older, and inhabit it fully. . . . And because this is so important, other things can wait. Like crying. Like thinking about Thor’s absence. . . . [It] will not last just a moment, not even a stretched-out moment. It will occupy time. First he will be dead a day, then a week, then a month, then a year. I will have the rest of my life to explore it, and its exploration will require the rest of my life.

This passage deftly and painfully captures the ways in which babyloss shapes and is sculpted by time and space. The desolation of absence is strangely flush with the remembrance of presence. For pregnant people, a baby is a solid being inside the womb: moving, kicking, rolling, and otherwise making her presence known. The thingness of babies and the corporeal reality of pregnancy—nausea, aches and pains, elasticized joints, weight gain, swollen breasts, penguin-like ungainliness—situate babies as recognizable beings in pregnant bodies and in communal life. A baby felt—quickened to use the old-fashioned term—is an anticipated member of the human community.

Babies of a certain gestational age, usually after the first trimester, have heft, names, legacies, and futures. They become tender repositories for the hopes and fears of expectant parents and their families and communities. During pregnancy, women may cradle their bellies with their arms, rest their hands or perhaps a teacup on them as if on a curved shelf, or gaze in wonder (or sometimes dismay) at their silhouettes revealed in full-length mirrors, evidence of fertility in their plump stomachs.

I did all these things, and more.

When my own daughters were born, I immediately desired to touch them. Instinctual or learned behavior: Who knew? It felt primal, and I wanted nothing more than to hold their tiny bodies close to my skin, to lick their downy heads. I was fortunate. Despite a terrifying emergency cesarean delivery of my first daughter, more than two weeks past her due date, and a cesarean delivery of my second child after thirty-six hours of labor in an attempted vaginal delivery, I held and nursed my babies soon after their births. Their warm, supple matter was breathtakingly familiar and intoxicating.

Empty crib. Photo credit: Gary Roebuck / Alamy Stock Photo.

Some people are not so lucky.

Stillbirth is an especially cruel fate, one that affects 1 in 160 pregnancies in the United States each year. Here, laboring women deliver not-living babies, often unexpectedly—there may be no warning, even with prenatal monitoring. These babies become present in the world as flesh and soft bone; they can be held and caressed, even photographed, by those expecting them. They have names and birth stories, no matter how abbreviated their lives. And yet, these tiny humans are absent consciousness, personhood, and futurity; they are dead on arrival.

Kelly Kittel, author of the memoir Breathe, writes, There is nothing sadder in this world than a dead baby. There is nothing more heartbreaking for a mother than to deliver a baby into this world knowing he is no longer of this world, knowing that it is only a token gesture, like closing the cage door after the dove has flown away.

In her 2008 memoir, An Exact Replica of a Figment of My Imagination, novelist Elizabeth McCracken writes, The first thing we did back at Savary was dismantle the future. That is, Edward broke down the portable crib that had been waiting for a few weeks on my side of the bed. I threw out all my maternity clothes, just threw them away, along with the single package of diapers I’d obediently bought. . . . We tossed out the stuffed hippopotamus from Edward’s sister and any other toylike object.

After death, hope seeps away along with the toys and diapers, and absence settles in to supplant physical presence. Since he died, McCracken laments, I’ve never had a dream of him alive.

In Nadia’s Story, Ana Todorović writes wrenchingly of her daughter’s stillbirth, including the agonizing decision to let Nadia die in utero rather than to ‘put her to sleep’ with a needle to the heart, after which her birth would be induced and it would be all over. Todorović, a neuroscientist and experimental psychologist, reflects, "My mind will try to build some meaning around her because my feelings take me in that direction, but the idea of a child that almost was is something too elusive to be carefully taken apart and then mentally rebuilt. It’s just a gaping hole, a hollow, aching absence. One I’m told will grow more comfortable over time."

In stillbirth, a lost baby is barely known to those who mourn him, more a figment of the imagination, to echo McCracken’s wistful phrasing. A baby who is born alive but dies within the first year of her life is a different species of being, one who accumulates personality, gestures, familiarity, and prospects as time passes. Babies born alive can be, already are, somebody. Into the abandoned space after such a loss creep specific memories of a life lived, however briefly. Grieving parents may recount weight and matter, the curl of a baby in their arms, but also a particular facial expression, a first giggle, the silkiness of growing curls, gurgles and coos, a milky scent. Or they may feel nothing at all, numb and confused.

A baby who dies during her first year may live for days, weeks, or even months, and the ripple effects of loss—moments lived and shared, history laid down like small footprints—magnify the eventual permanent absence. An abandoned crib, discarded toys, an empty high chair at the kitchen table, a drawer full of carefully folded onesies, a binky still in its package, silence.

To be clear: there is no better or worse way to lose a baby, no optimal time or age or circumstance. There are no Olympic games to measure or reward the grief and suffering of moms and dads and other family members. Each loss is achingly unique, and there is ample mourning to be distributed and shared. And yet, while parents are enmeshed in an intricate choreography of presence and absence in the wake of babyloss, infant death as loss is still largely absent from public conversation. There is increasing discussion of adult death in hospitals, in hospices, at home, by choice. But infant death is still met with silence.

Instead, a focus on numbers—the infant mortality rate—invites and makes possible abstraction and standardization. Vital statistics are useful, to be sure. But clinical and bureaucratic detachment obscure lived experiences, the messiness of stories. Numbers, rates, charts, and tables hide the fleshiness of loss, the steady pulse of grief, the tears of all the babylost parents and those who love them.

Dead babies are doubly absent, then: they no longer inhabit pregnant bodies and daily lives, nor are they much present in public discourse. They are missing bodies, figments of the imagination, tiny occasions for monumental grief. And their ghostly disappearance is registered in empty cribs and broken hearts.

ABUSE

Sometimes babies die because people hurt them, malevolently or accidentally but nonetheless fatally.

In the United States each year, approximately seven hundred thousand children are abused. Seven percent of infant deaths are caused by injuries and violence, including abuse and neglect. Murder is the cause of one in five injury-related deaths in infants under one year of age.

More often than not—78 percent of the time—the abuser is a parent.

In their first week of life, infants are statistically at greater risk from their mothers; after this period, they are more at risk from male family members, usually a father or stepfather. Homicide risk is highest during a child’s first month of life—more than at any other time before age eighteen.

Parents who have abused their infants often report frustration stemming from the baby’s inconsolable crying. Shaken baby syndrome, which can cause severe brain damage and death, is one—albeit horrific and inappropriate—response to a child in distress.

Parenting, especially mothering, is taxing. An anthropologist friend once shared with me her surprise that exhausted, confused, undervalued, and unsupported mothers do not kill their infants more often.

But sometimes, parents who harm are not frustrated and overtired; they are simply cruel.

Infant abuse may be unfathomable to parents who have lost desperately wanted babies, whom they had hoped to nurture and protect for the entirety of their lives, from cradle to adulthood.

They, and we, might ask: Why would anyone deliberately harm their defenseless baby, especially a tiny, fragile newborn entirely dependent on others for its survival?

Though we can sociologically identify reasons for infant harm, the why is sadly rhetorical; it allows us to pose a question about an unspeakable act for which there is no reasonable answer, especially for babylost parents.

ANGEL BABIES

This sweet term of remembrance and endearment designates some babies who have died at birth or during their first year of life. Influenced by religious iconography, angel babies are believed to inhabit both heaven and earth. Their presence brings peace and comfort to the people left behind to mourn them, especially parents.

Many babylost parents, particularly mothers, report that when asked how many children they have, they list their living children and angel babies. Some bereaved women share stories of communicating with their angel babies through dreams and conversations.

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