Key facts on infant mortality

Infant mortality is defined as the death of a child in the first year of life. The infant mortality rate (IMR) is the number of babies born alive who die in the first year of life per 1,000 live births. There is a clear link between high levels of infant mortality, deprivation and poor health outcomes. It is therefore often used as a comparative measure of a nation’s health as well as a predictor of health inequalities.

In 2011, the IMR for England was 4.1 per 1,000 live births, compared with 4.9 in 2006 (ONS). IMRs show large socioeconomic and ethnic differences at national level. For example, IMRs for babies born to Pakistani and black Caribbean parents were 8.5 and 7.4 deaths per 1,000 live births respectively (2011, ONS). Explanations for variations in infant mortality between ethnic groups are complex, involving the interplay of deprivation, physiological, behavioural and cultural factors.1

Other groups at higher risk include babies born to: mothers with multiple births; mothers not born in the UK; single mothers and mothers who register their baby alone; mothers over 40 and less than 20; mothers who smoke; and mothers who are obese.

Birth weight is also a good indicator of long-term health for individuals and in communities. Low birth weight is often used as an important predictor of future health and mortality since a child with a low birth weight is more likely to die early or have poorer life outcomes.

Fortunately the numbers of infant deaths at a local level are too few to demonstrate this. However, reducing the variation in IMR is a key national target for tackling inequality and requires initiatives to improve maternal health, child health and the wider determinants of health, such as education and housing.

For the three years 2009 to 2011, Merton’s infant mortality rate was 4 per 1,000 live births and the borough was ranked 12th lowest out of the 32 boroughs of London. This means that for every 1,000 babies born alive, an average of 4 babies die in the first year of life. This was similar to London and England, which both had an IMR of 4.1 (2011, ONS).  

Infant mortality by London borough: 2009-11.

 

While the IMR has shown quite large variation, the overall reduction in IMR over the past two decades has been in line with the regional trend. The variation seen is likely to be a reflection of very small numbers.

Infant mortality trends 1990-92 to 2009-11.

Nationally, immaturity and congenital defects are the two commonest causes of death in infants and together account for about 75% of infant deaths. In Merton, the main cause of infant death was neonatal/prematurity (69%); congenital/inherited factor was the cause of 10% of deaths and factors related to the perinatal period the cause of 10% of deaths (ONS 2009-11).  

Infant mortality 2009-11.  

Source: Health & Social Care Information Centre

 

Evidence of what works and best practice

NICE provides guidance based on best available evidence and gives a range of advice and recommendations e.g. on effective interventions. NICE has produced guidance relevant to reducing infant mortality, including quitting smoking during pregnancy, weight management, sexually transmitted infections, and under-18 conceptions.

The guidance on helping pregnant women quit smoking during pregnancy and following childbirth (NICE PH26 2010) recommends:

  • identifying pregnant women who smoke, referring to NHS Stop Smoking Services, and providing ongoing support
  • using nicotine replacement therapy (NRT) and other pharmacological support
  • engaging with partners and others in the household who smoke
  • ensuring NHS Stop Smoking Services meet the needs of disadvantaged pregnant women who smoke
  • providing training for all professionals involved in the delivery of interventions.

For further information see NICE guidance

 

Guidance on weight management before, during and after pregnancy (NICE 2010) recommends:

  • weight management for women with a BMI 30 or more who are preparing for pregnancy
  • help for pregnant women to adopt healthy lifestyles during pregnancy especially those with BMI 30 or more
  • supporting women after childbirth at postnatal check-ups
  • community-based services
  • adequate skills for involved professionals.

For further information see NICE guidance

Guidance on maternal and child nutrition (NICE 2008) recommends:

  • providing women with information and advice on the benefits of taking vitamin D supplements in pregnancy, and breastfeeding
  • providing healthy start vitamins for eligible women (folic acid, vitamins C and D)
  • implementing a structured programme to encourage women to breastfeed, including training for health professionals
  • encouraging breastfeeding by providing information, practical advice, and ongoing support, including the help of breastfeeding peer supporters
  • promoting healthy weaning at aged 6 months.

For further information see NICE guidance

Key commissioning recommendations for reducing infant mortality

In order to improve maternal health and reduce infant mortality, commissioners should focus on the following:

  • improving the quality and accessibility of antenatal care and support during the first year of life, particularly in disadvantaged areas and among BME groups.
  • improving nutrition in pregnancy and infancy and access to affordable food
  • increasing the number of mothers who breastfeed, targeting areas of greatest need.
  • further reducing smoking in pregnancy
  • preventing teenage pregnancy and supporting teenage parents
  • improving housing conditions, especially for children in disadvantaged areas
  • developing culturally sensitive care for women and families.

While levels of infant mortality are similar to the regional average, there needs to be a continuing focus on key interventions, especially those where partnership working can make a significant difference, such as in reducing teenage pregnancy, improving housing conditions and improving the quality of and access to antenatal care, and breastfeeding rates.

Key facts on low birth weight

Birth weight is a good measure of infant health. Low birth weight (LBW) is strongly associated with poorer health and poorer life chances and is an important predictor of future infant, child and adult health. LBW babies are at greater risk of dying in their first year than heavier babies. LBW is defined as births under 2,500 gm; LBW is more common for babies born:

  • to mothers under the age of 20 and over the age of 40
  • in deprived areas
  • to parents in social classes IV and V
  • to lone mothers
  • to mothers born outside the UK.

Compared with the national profile, Merton overall has a lower level of LBW babies: 7.1% of babies were born with LBW in 2011 (ONS), which equates to 251 babies. This was lower compared with London (8%) and England (7.4%).

Since 2005, although the proportion of LBW babies has remained similar, there has been an overall increase in absolute numbers of LBW babies in line with the 40% increase in number of births.

Low Birth Weight 2005-2011.

 

At ward level, data is available for 2008-10 and indicates that within the borough there is variation: LBW births in Merton ranged from 3.9% in Wimbledon Park to 8.8% in Longthornton. However, none of the variation seen is statistically significant.  

In 2008-10, no wards in Merton had LBW rates that were significantly higher than the national average and two wards were significantly lower. Over the course of six years, eight wards have shown an increase in the proportion of LBW babies comparing 2008-10 to 2002-04 although none of the increases was significant. The increases seen were spread across both deprived and more affluent wards and may just be due to small numbers.

Low Birth Weight babies by ward 2006-10.

 

 

Ethnicity is also a key factor for infant mortality and LBW. Nationally, Pakistani and Caribbean groups have particularly high IMRs, 8.9 and 8.1 deaths per 1,000 live births respectively. This is more than double the rate of babies born in the white British group which was 3.7 deaths per 1,000 live births (ONS, 2010). This is of particular significance in Merton, where 35.2% of all women aged 15-44 are from black and minority ethnic (BME) groups,2and this is projected to rise to just under 40% by 2021.

Key commissioning recommendations for reducing LBW

If nothing changes and we take no action to reduce the levels of low and very low birth weight babies so the proportion stays the same (approximately 7% of all live births in Merton), then, because of the increase in the number of babies being born, there will be an absolute increase in numbers of children who are at risk of poor health and social outcomes; based on current live births for 2011 it is expected there will be around 250 babies with future special needs born in Merton per annum. Commissioners need to assess the implications for services, including:

  • Paediatric and neonatal services
  • Children’s centres, community health services, social care services
  • Mainstream and specialist education
  • Increased pressure on continuing care/short breaks budget.

See Vulnerable children and young people for more information.

Deprivation is linked to poor health and LBW. With higher numbers of children being born in deprived areas and with the country experiencing a significant recession there is a need to look at the impact of the recession on longer-term child health including long-term care and mental health needs.

Many of the measures to reduce LBW are the same as those to reduce infant mortality. It is recommended that commissioners consider relevant NICE guidance and ensure that action (services to prevent LBW) is focused on:

  • addressing the wider determinants of health, including reducing child and family poverty and housing needs
  • reducing maternal obesity; improving nutrition and access to affordable healthy food; and improving breastfeeding rates – targeted particularly within more disadvantaged areas
  • further reducing smoking in pregnancy – targeted particularly within more disadvantaged areas.
  • improving access to maternity care, ensuring pregnant women are assessed before 13 weeks of pregnancy, particularly in more deprived areas and BME groups
  • promoting folate supplements for pregnant women to reduce the risk of children being born with spina bifida.

References

1.^ Graya, R., Headley, J., Oakley, L., Kurinczuk, J., Brocklehurst, P. and Hollowell, J. from National Perinatal Epidemiology Unit, University of Oxford Department of Public Health, University of Oxford (2009). Inequalities in Infant Mortality Project Briefing Paper 3: Towards an understanding of variations in infant mortality rates between different ethnic groups in England and Wales.

2.^ GLA 2012 Round SHLAA EGPP custom age range creator. October 2013.