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Infant mortality

Last Modified 20/11/2023 13:10:35 Share this page

Introduction

Infant mortality is an indicator of the general health of an entire population. It reflects the relationship between causes of infant mortality and upstream determinants of population health such as economic, social and environmental conditions. Deaths occurring during the first 28 days of life (the neonatal period) in particular, are considered to reflect the health and care of both mother and newborn.

Reducing infant mortality overall and the gap between the richest and poorest groups is part of the government's strategy for public health while one of NHS England's Outcomes Framework objectives is to prevent people from dying prematurely.1 An improvement area in the government's mandate to the NHS England for 2018-19 is to reduce the 2010 rate of stillbirths, neonatal deaths, maternal deaths and brain injuries in babies that occur during or soon after birth by 20% by 2020, demonstrating progress towards the national ambition to reduce rates by 50% by 2025.

Facts and figures

Blackpool experiences higher than average mortality rates for infants; however the actual number of deaths each year is small which means the rates are subject to large annual variation and need to be interpreted with caution.

In this case infants are defined as children under the age of 1 year. The data represents the crude rate of infant deaths per 1,000 live births, in Blackpool, the North West and England. The data in Figure 1 and 2 is grouped into three-year periods to mitigate for the small number of deaths in a single year. The Blackpool infant mortality rate increased from the early 2000s to the mid 2000s, declined to 2010-12 before rising again to a relatively flat rate since 2014-16. In the last three-year period (2019-21) there were 27 infant deaths in Blackpool, a rate of 6.0 per 1,000 live births, compared to the national average of 3.9 per 1,000. 

Figure 1: Trend in infant mortality, 2007-09 to 2019-21 (per 1,000 live births)

 2008-102009-112010-122011-132012-142013-152014-162015-172016-182017-192018-202019-21

England

4.6

4.4

4.3

4.1

4.0

3.9

3.9

3.9

3.9

3.9

3.9

3.9

North West

4.9

4.7

4.6

4.4

4.3

4.2

4.5

4.6

4.6

4.5

4.3

4.4

Blackpool

6.1

6.3

4.9

5.2

5.3

6.5

5.4

6.4

6.0

6.4

5.4

6.0

Blackpool (number)

32

33

26

27

28

34

28

32

30

31

25

27

Source: OHID, Child and Maternal Health Profile

Figure 2: Infant Mortality Trend, 2001-03 to 2019-21

 Chart showing infant mortality trends for Blackpool, North West and England. England's infant mortality rate is consistently higher than England and North West rates, though has remained relatively stable since 2015-17. The rate declined slightly in the last reported period of 2018-20.
 Source: OHID, Child and Maternal Health Profile

Figure 3 shows the infant mortality rate split by neonatal deaths (under 28 days) and post-neonatal deaths (between 28 days and 1 year). It can clearly be seen that deaths under 28 days make up the biggest proportion of infant mortality deaths in Blackpool and nationally, with Blackpool's neonatal mortality rate rising from 3.3 per 1,000 live births in 2014-16 to 4.8 in 2017-19 before reducing to 4.0 per 1,000 in 2019-21. The neonatal mortality rate for England in 2019-21 was 2.8 per 1,000 births.

Figure 3: Trend in infant mortality by neonatal and post-neonatal mortality, Blackpool and England, 2010-12 to 2019-21

 
Source: OHID, Child and Maternal Health Profile

Over the past 40 years infant mortality rates in England and Wales have declined from 12 deaths per 1,000 births in 1980 to 3.7 in 2021, a likely reflection of advances in medical care, particularly midwifery and neonatal intensive care.2

Immaturity-related conditions, such as respiratory and cardiovascular disorders, were the most common cause of infant deaths and neonatal deaths in 2021 (48% of all neonatal deaths). Congenital anomalies were another major cause group for infant deaths and neonatal deaths (33% of neonatal deaths). They also continued to account for the largest percentage of postneonatal deaths, followed by sudden infant deaths.

Risk factors

Several different factors are associated with increased risk of infant death and these vary according to age at death. For example, the effect of prematurity and low birthweight is greater in the first 28 days. Despite the downward trend in the infant mortality rate, evidence in the Marmot Review: Fair Society, Healthy Lives noted that factors, including births outside marriage, maternal age under 20 years and deprivation, were independently associated with an increased risk of infant mortality.

Risk factors for infant and child mortality include social factors such as:

    • Maternal age

    • Parents who are closely related to each other

    • Smoking or maternal substance misuse, including alcohol

    • Poor maternal nutrition or obesity

    • Domestic abuse

    • Social class and income deprivation

Additional medical factors also include:

    • Maternal mental illness and stress

    • Pre-existing medical conditions

    • History of problematic pregnancies

    • Parental exposure to environmental pollutants

    • Low birth weights

Child death overview panel

For the Blackpool, Lancashire and Blackburn with Darwen region, the deaths of all children under the age of 18 are reviewed by the Child Death Overview Panel (CDOP) which is administered through the Children’s Safeguarding Assurance Partnership. The main purpose of the panel is to identify lessons and prevent future child deaths. The Children's Safeguarding Assurance Partnership website has the most recent CDOP report.

National and local strategies

 [1] HM Government, Healthy Lives, Healthy People: Our Strategy for Public Health, November 2010

[2] ONS Child mortality in England and Wales: 2021, March 2023