Infant mortality declined more rapidly between 1989 and 1990 than in any year since 1977; the provisional 1990 rate, 9.1 per 1000 live births, was the lowest ever recorded. Absence of final 1989 data prevents updating sex and race differences, but in 1988 data the rate for black persons was more than twice for white. Most of the decline in 1990 was in the neonatal period with a substantial drop in perinatal categories involving respiration. Surfactant therapy earned deserved kudos for much of the decrease, but more attention is needed to the more cost-effective potential of preventive measures. Births increased in number and rate; there were more women in the childbearing years and they had higher fertility rates. Marriages and divorces both increased slightly. Deaths increased but the death rate decreased; the estimated age-adjusted death rate was the lowest ever. Excess of births over deaths added more than 2 million persons to the US population. Worldwide, 22 countries with more than 2 500 000 population had 1989 infant mortality rates less than 10, led by Japan at 4.4; the US, at 9.7, was 21st on the list. An additional 7 countries had rates less than 15 per 1000 live births.

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