Infant mortality is a key public health indicator and remains disproportionately higher in rural regions of the United States, where limited healthcare access may contribute to adverse maternal and infant outcomes. Montana is a predominantly rural state with substantial geographic variation in healthcare access. This study aimed to evaluate county-level patterns of infant mortality and examine associations between healthcare access indicators and maternal or perinatal factors across Montana. A cross-sectional ecological analysis was conducted using publicly available Montana public health data. County-level variables included infant deaths, birth rates, timing of prenatal care initiation, birth facility type, maternal age at delivery, and causes of perinatal death. Healthcare access was assessed using Health Professional Shortage Area (HPSA) scores (range 5–22), with higher scores indicating greater provider shortages. Descriptive analyses evaluated geographic variation and potential relationships between healthcare access and infant mortality indicators. The statewide average birth rate was 10.29 per 1,000 population (range 4.58–21.19). Petroleum County had the highest birth rate (21.19) and one of the lowest HPSA scores (5). In 2022, 52 fetal deaths were reported statewide, with three counties reporting six infant deaths each. Approximately 95% of births occurred in hospital settings. The most common causes of perinatal death were associated with preterm birth, maternal infections, and complications of pregnancy, labor, or delivery. Infant deaths were geographically dispersed across the state, and small county-level numbers limit causal interpretation. Findings highlight the importance of improving early prenatal care access and maternal health services in rural communities.
