Baby death rates are higher than the national average in every authority area in the Black Country, Staffordshire and Birmingham - with Sandwell and Birmingham both having rates that are nearly double that of England as a whole.
And the rate of death has remained “stubbornly static” across the West Midlands despite a national drop.
Councillors in Birmingham have now agreed a goal to halve the area's rate of infant mortality after being shown that 100 babies die in the city every year before their first birthday.
The only area with a higher infant mortality rate than Sandwell (7.1 per 1,000 live births) and Birmingham (7.0) is Stoke-on-Trent (7.5).
Walsall is fourth on the list (6.8) and Wolverhampton is 11th (5.7). The rates in Staffordshire (4.8) and Dudley (4.1) are significantly lower but still above the countrywide average. These figures are based on the latest Public Health England data, for 2017-19, when the rate across England was 3.9 deaths per 1,000 live births.
Rates are highest in deprived areas of the West Midlands and are also higher among Black African, Black British, Pakistani, Bangladeshi heritage families, a full meeting of Birmingham City Council was told.
Risk factors include babies born prematurely, low birth-weight babies and lifestyle factors including smoking, obesity and living conditions.
Genes can be a factor and that in some cases infant mortality can be attributed to marriage between close blood relatives, the meeting heard.
The council agreed recommendations in the health and social care overview and scrutiny committee’s report to form a taskforce to address the issue and set a goal to halve infant mortality in the city by 2025.
Councillor Rob Pocock, chair of the committee said: “Seven out of every 1,000 babies in our city will not live to see their first birthday. This is a tragedy that can and must be reduced.
“There are other cities with high levels of infant mortality and in our report we have quoted them.
“But none of these has an infant mortality rate as high as Birmingham. So, something is going wrong. We need to act to put it right.”
Addressing the main risk factors, he said: “All these conspire to create risk factors that produce the problem we have in this city.
“The encouraging part of this is these are modifiable factors, things we can influence to reduce infant mortality.
“We can reduce premature births by better maternal and antenatal care. We can reduce low birth-weight babies by early detection.
“We can improve healthy lifestyles of mothers and families by health promotion and support in those communities.”
The meeting heard factors also include genetic disorders, in some case due to marriages between close blood relatives.
Councillor Pocock said: “This is actually a common practice around the world. It doubles the risk of congenital disorders and the consequent risk of infant mortality. In our report we have not sought to exaggerate this issue. We have also not sought to ignore it.
“It is part and parcel of the range of complex factors we face when attempting to deal with the problems of infant mortality.”
Councillor Peter Fowler seconded the motion and said the subject of marriages between close family members was one he was initially “fearful of making any comments on”.
He said councillors from a range of backgrounds have said to the committee “yes this is a problem within the Pakistani and Bangladeshi community” but that it is happening less among younger people.
Councillor Mohammed Idrees added: “Infant mortality rates among Pakistani and Bangladeshi communities are far higher compared to other ethnic groups.
“One of the reasons seen as contributing to this is cousin marriages.
“Our observation is in the last ten to 15 years, as more and more girls and boys are going to colleges and universities, there is a trend that they are not marrying each other as it used to be.
“So in the next five years if the infant mortality rate amongst these two communities is not coming down, then we will have to look at what other factors could be causing this.”
Councillor Paulette Hamilton, cabinet member for health and social care, said she was “committed” to reversing the situation in Birmingham.
She said: “More work is also needed with women from ethnic minorities in relation to drug and substance misuse and obesity while maintaining good mental health, physical health and using stress reduction strategies before becoming pregnant to increase their chances of giving birth to a healthy baby.”
Referencing unions between close relatives, she said: “It is a sensitive issue. There is awareness within communities on the significance of consanguineous abnormalities and genetics that is significantly higher in close unions.
“We need to do much more to promote access and a greater use of services that are already available such as genetic services.”
Councillor Morriam Jan said: “A number of factors suggest the UK is not providing optimal conditions for children to survive and thrive.
“Firstly, the UK performs poorly on several measures of child health and wellbeing including mortality compared with other European countries.
“Secondly, there are stark inequalities in survival chances between rich and poor children in the UK.
“Finally, many children’s deaths are potentially preventable although it is difficult to measure avoidability on a population basis.
“Comparing how children fare in different countries shows that Britain’s children unfortunately are amongst the more deprived in Western Europe.”