Stillbirths and neonatal and infant mortality

Background

Stillbirths, neonatal mortality, and infant mortality are common measures of healthcare quality and the safety of maternity services, but they are also influenced by social, economic and environmental factors.

Conditions relating to premature birth, such as respiratory and cardiovascular disorders, and congenital abnormalities, are common causes of infant deaths. The three major causes of neonatal deaths worldwide are infections, premature birth and suffocation.

Measures that reduce poverty and mitigate the impact of poverty on the health of women before and during pregnancy will have a significant impact on the risk of stillbirth and death during infancy. Policies that are directed at improving the health of pregnant women (such as Stop Smoking Services), and early intervention services such as health visiting and midwifery, are likely to reduce stillbirths and infant and neonatal mortality rates. 

For more information, see the explainer ’Understanding the health of babies and expectant mothers’ and the related blog, which asks: ‘Are the government's targets for reducing stillbirths and neonatal deaths achievable?’ See also the ‘International comparisons of health and wellbeing in early childhood’ report. If you are experiencing the loss of a child, refer to these resources by Tommy’s and Sands.

Infant, neonatal and stillbirth mortality rates

The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births, and the neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. The stillbirth rate is the number of stillbirths per 1,000 live births and stillbirths.

Between 1993 and 2013, the infant mortality rate and neonatal mortality rate decreased considerably in England. The infant mortality rate fell from 6.3 deaths per 1,000 live births in 1993 to 3.9 in 2013 and the neonatal mortality rate fell from 4.2 deaths per 1,000 live births to 2.7 over the same time period. However, since then progress has stalled and even worsened slightly. In 2021, the infant mortality rate was 4 deaths per 1,000 live births, 0.1 more than what it was in 2013. Similarly, the neonatal mortality rate was 2.9 deaths per 1,000 live births, slightly higher than 2013’s record low. This corresponds to 2,374 infant deaths and 1,701 neonatal deaths in 2021.

Between 1993 and 2005, the rate of stillbirth fluctuated around 5.7 stillbirths per 1,000 live births and stillbirths. Since then, stillbirth rates have generally fallen. However, in 2021 the stillbirth rate increased to 4.1 stillbirths per 1,000 live births and stillbirths, corresponding to 2,451 stillbirths. It may be difficult to unpack the reason for the increase since most stillbirths are unexplained and occur in the absence of an infection, placental issue, or foetal abnormality. That being said, disruption to maternity services during the pandemic has been suggested as a contributing factor to the increase in stillbirths. 

The government has a national ambition in England to achieve a 50% reduction in stillbirth and neonatal mortality by 2025, based on rates in 2010. Rates for both stillbirth and neonatal mortality will need to decrease considerably if this target is to be met. There is currently no national target for the infant mortality rate.

Infant mortality rates by ethnicity

When we compare infant mortality rates of different ethnic groups in England and Wales, the stark amount of variation is apparent. In 2021, the infant mortality rate among Black ethnic groups was 6.6 deaths per 1,000 live births—substantially higher than that of any other group. There was considerable difference between sub-groups, with Black Africans exhibiting a rate of 4.9 deaths per 1,000 live births, while for Black Caribbeans the rate was 3.3 deaths per 1,000 live births. Asian ethnic groups had the second highest infant mortality rate at 4.8 deaths per 1,000 live births. White ethnic groups consistently have the lowest infant mortality rates; in 2021, the rate was 3.0 deaths per 1,000 live births.

Although each group has seen an overall decrease in infant mortality rates since 2007, the Black ethnic group has only experienced a difference of 0.3 deaths per 1,000 live births, while the average decrease for the other ethnicities is 1.4. Levels of inequality between groups have remained consistent or have even grown. For example, there was a disparity of 2.9 deaths per 1,000 live births between White (4.0) and Black (6.9) people in 2007, compared with a disparity of 3.6 deaths per 1,000 live births between White (3.0) and Black (6.6) people in 2021.

As mentioned in our explainer on the health of babies and expectant mothers, more deprived areas see higher rates of infant mortality. Data published by the government in 2020 shows that, in England, those from minority ethnic groups are more likely to live in the most deprived 10% of neighbourhoods. Only 9% of White people live in these neighbourhoods, but for Black and Asian people, 15% and 16% of these groups live in such neighbourhoods, respectively

The infant mortality rate has been decreasing in all Organisation for Economic Co-operation and Development (OECD) countries since 2000. The UK has a relatively high rate of infant mortality compared with other countries presented here, with 4 deaths per 1,000 live births in 2021. The United States has the highest rate each year, while Japan and Finland have the lowest rates.

One of the United Nations Millennium Development Goals was to reduce child mortality by two-thirds between 1990 and 2015. According to this, the UK should have reduced the 1990 infant mortality rate of 7.9 deaths per 1,000 live births to 2.6 by 2015. The UK only managed to reduce its infant mortality rate by half, to 3.9 deaths per 1,000 live births, so did not meet this target. In 2015, the MDGs were replaced by the Sustainable Development Goals where maternal and child health remains key to Goal 3, "ensure healthy lives and promote well-being for all at all ages".