THE DEATH of an infant is devastating on the family unit. Infant mortality (IM) is the death of an infant before his or her first birthday. Infant mortality rate (IMR) is the number of babies who die in the first year of life per 1000 live births. Leading causes of death include birth defects, preterm birth, injuries, sudden infant death syndrome, and maternal pregnancy complications. The current IMR for the United States (US) in 2019 was 5.6 deaths per 1000 live births.1 While the general regression is celebrated, a closer look shows that the benefits are not reaching African Americans to the extent it has for other races. It was reported that African Americans have 2.3 times the IMR as non-Hispanic whites. African American infants are 4 times as likely to die from complications related to low birth weight as compared with non-Hispanic white infants. African Americans have more than twice the sudden infant death syndrome mortality rate as non-Hispanic whites. Also, African American mothers are 2 times more likely than non-Hispanic white mothers to receive late or no prenatal care.2 Social determinants of health are the conditions in the places where people live that affect health risks and quality-of-life outcomes.3 Social determinants of health are correlated with the health of African Americans and have been identified as maternal risk factors associated with IM. Racial inequities, health and access to health care, socioeconomic disadvantage, contextual disparities within education levels, and stress result in poorer infant health outcomes of African American than of whites.4 With the use of an applicable model focusing on the life course, we provide recommendations on how a health promotion focus can bring about the needed change of healthier outcomes for infants. The Life Course Perspectives (LCP) model focuses on biological, psychosocial, and environmental factors throughout one's life. The 5 key principles include life span development, timing, human agency, interlinked lives, and historical time and place.5 Life span development states that health is a lifelong process that is influenced by lived experiences. The timing principle considers when individuals were exposed to important periods of development. Human agency encompasses behaviors during health and illness. The “interlinked lives” pillar considers the influences of networks. Historical time and place consider factors influencing environmental and social determinants of health over the life span.6 Epidemiologists, developmental biologists, behavioral scientists, and pediatricians alike accept the LCP with its strengths that include being able to work within structural (emphasis on socioeconomic position, social identity, life span exposures) and developmental (understanding human plasticity in response to environmental and social influences) perspectives.7 This article focuses on 6 recommendations to use with a health promotion plan that encompasses the 5 principles used within the LCP with a focus on IM: life span development, health behaviors including safe sleep, nutrition and breastfeeding, and networking involving community and faith engagement. Determinants of health and stress reduction are also included. These 6 recommendations are thought to be foundational for initial change. The LCP conceptualizes birth outcomes as the culmination of not only pregnancy but also the entire life course of the mother. LIFE SPAN CARE Significant life events, experiences, and transitions in a person's life from birth to death have an effect on outcomes. Individual lives are interdependent, and the family is the crucial arena for experiencing and interpreting broader historical, cultural, and social experiences. It is known that sociodemographic and socioeconomic factors have a prominent effect on IMRs.8 If socioeconomic status and poverty are a cause of health disparities and individuals and their family are not socially mobile, we could expect ongoing health problems within their life spans. Low-income African American women face many barriers when trying to access suitable care. As to how to overcome these issues involves recommendations that include access to transportation, insurance, overcoming negative attitudes, and improved perception of care. All individuals need culturally appropriate care, trusting relationships, and respect from providers. SAFE SLEEP Behaviors such as unsafe sleep practices for infants can result in sleep-related deaths such as sudden infant death syndrome and accidental suffocation. The most common unsafe sleep practices are infants sleeping in a nonsupine position, bed-sharing, and using soft bedding. When considering racial differences, placing infants in nonsupine sleep position was highest among non-Hispanic Blacks.9 We recommend culturally specific education as an effective way to reduce deaths in infants. A study conducted by Nurse Family Partnership developed a safe sleep program to identify why African American mothers did not follow or sustain the recommendations. The team identified 14 concepts divided into 3 categories to frame the message: It's Just Easier; Can't Fight Culture and Grandma; and Effectively Teaching Mother. The messaging was effective, and the multifaceted learning revealed shared patterns of cultural beliefs and learning that would be discussed at every appointment and with every family member.10 NUTRITION AND HEALTH Nutritional behaviors of mothers are another factor to consider when taking a holistic approach to IM. Body mass index (BMI) is an important consideration. It was found that the high prepregnancy BMI is related to increased IMR.11 While the issue of obesity and appropriate nutrition affects all pregnant women, African American women may be inexplicably affected because of systemic racism. As an example, the disproportionate amount of food deserts in many African American communities can influence nutritional capacity. Food deserts tend to have worse health outcomes including higher rates of obesity, cardiovascular disease, and diabetes.12 To address how this can be improved, we recommend culturally specific programs designed to address health perceptions at the individual- (ie, self-esteem and resilience training), interpersonal- (ie, reducing stigma), community- (ie, reducing residential segregation), and system-level health (ie, reducing unemployment) to facilitate long-term, sustainable improvements in health of African Americans.13 BREASTFEEDING The latency of when an infant is first breastfed after birth is associated with IM. Compared with infants breastfed within an hour of birth, those who waited 2 to 23 hours had a 33% greater risk of IM and those who waited even longer (>24 hours) had a 2.19-fold risk of IM. Breastfeeding practices after the first day of a newborn's life are also important to consider. It was found that during the first 23 months of infants' life, they are significantly less likely to risk all-cause mortality if they are exclusively breastfed than predominantly, partially, or nonbreastfed groups.14 Evidence abounds on the many benefits of breastfeeding, although African American women are less likely to breastfeed their infants than other races.15 Higher rates of breastfeeding could contribute to the better-quality health of the African American population by decreasing rates of IM. At the same time, higher rates of breastfeeding could foster maternal-child bonding and could contribute to building stronger families. Recommendations for how change can occur include overcoming hindrances to breastfeeding that include an increase of breastfeeding role models and/or support networks to normalize breastfeeding, undoing social pressures to introduce formula-feeding, overcoming feelings of dependency on care, and allowing increased leave from employment. COMMUNITY AND FAITH ENGAGEMENT In the early 1900s, the heavy emphasis on large structural interventions played a significant role in reducing IMRs in the US. Changes were brought about by mobilized resources, technical expertise, and community groups.16 The moral ethos that religious institutions create provides real-world effects on population health. As an example, it has been found that within the environment of religions focused on faith healing, a collective suspicion toward medical interventions leads to a lack of community support for prenatal or postpartum care. Perhaps, medical interventions in the face of complications are collectively defined as a demonstrated lack of faith in God. However, at the same time, it was found that religious service attendance is a buffer to depressive symptoms and psychological distress.17 Recommendations on how change might occur include a committed understanding and focus on IM awareness and education in religious/cultural associations within communities. STRESS REDUCTION Negative stress has the potential for unwanted side effects throughout life. Exposure to maternal prenatal stress can affect fetal brain development, decrease fetal heart rate coupling, and program the risk for emotional dysregulation and mental disorders over the course of a lifetime. And, in the third trimester, it has been revealed that elevated stress leads to premature birth.18 When considering the life span in relation to stressful life events, allostatic load (AL) warrants consideration. AL refers to the accumulative affliction of chronic stress and life incidents on an individual's health status. When environmental challenges exceed an individual's capability to cope, then AL develops. When AL progresses, an alteration occurs to the severe state where the stress response systems are repetitively activated and protective factors are not sufficient.19 Moreover, the concept of “weathering” points to how socially organized, recurring stress can accumulate and proliferate disease susceptibility. The notion of weathering focuses on the significance of internalized/interpersonal racism as a driver of racial outcomes inequalities for African Americans. Furthermore, ethnicity is associated with AL, with Black African Americans displaying higher levels of AL than whites. Furthermore, higher AL is displayed by individuals reporting greater perceived racial discrimination and racial hostility.20 We recommend further assessment and evaluation of the social determinants of health and the impact of health and health inequities over the life span. Social factors are paramount for improving primary and secondary prevention related to the delivery and outcomes of health care. CONCLUSION IM among African Americans in the US needs targeted health promotion measures to circumvent the harsh realities of current disparities. Overall, we recommend community awareness with an interdisciplinary focus operating within an innovative, comprehensive approach using the LCP is a useful endeavor to allow understanding both structurally and developmentally. With social determinants of health affecting the health outcomes of African Americans, maternal demographic risk factors associated with IM need to be specifically targeted. As a nation, we recommend addressing this issue at the level of health promotion by overcoming barriers, establishing trusting relationships, and strengthening family and community systems to establish a lasting effect. Focusing on reproductive health within an historical lens and ensuring the application of culturally applicable programs will possibly move public health toward realizing health equality, which will benefit the health of African American women and their children.