Stillbirth and infant death rates are decreasing, but still vary widely across Europe

November 28, 2018, City University London
Credit: CC0 Public Domain

Rates of stillbirth and deaths in the first year of life have decreased in Europe over the five years 2010 to 2015. However, countries still vary widely, and differences persist in their populations and the maternity care provided.

This is according to a new report, co-authored by Professor Alison Macfarlane from City, University of London as part of the Euro-Peristat collaboration of over 100 contributors from all over Europe, including the four countries of the UK.

The report examined data about births and their context in all 28 current EU member states plus Norway, Iceland and Switzerland in 2015. It also examined changes between 2010 and 2015.

The report differs from other international comparisons of stillbirth and () rates by taking account of differences in the ways that statistics are compiled to make 'like for like' comparisons. Data about births before 22 weeks of pregnancy were excluded to improve consistency of reporting, as recommended by the World Health Organisation (WHO).

Key findings

Stillbirth rates

Stillbirth rates at or after 28 weeks of pregnancy ranged from below 2.3 per thousand total births (in Cyprus, Iceland, Denmark, Finland, and the Netherlands) to 3.4 or more (in Latvia, Ireland, Slovakia, Romania, Hungary, and Bulgaria). The rates for the countries of the United Kingdom came between these at 3.1 per 1,000 in England and Wales, 2.8 in Scotland and 2.6 in Northern Ireland.

Neonatal and infant death rates

Neonatal deaths are deaths in the first month after and infant deaths are deaths in the first year.

Neonatal death rates ranged from 0.7 per 1,000 live births in Slovenia to 4.4 in Bulgaria. The Czech Republic, Denmark, Estonia, Spain, Cyprus, Luxembourg, Austria, Slovenia, Finland, Sweden, Norway, Scotland and Iceland had rates below 2.0 per 1000 live births. In contrast, rates were over 3.0 per 1,000 in Bulgaria, Croatia, Malta, Romania and Northern Ireland.

The rate for England and Wales fell in between, at 2.2 per 1,000. Infant death rates showed similar patterns, ranging from 1.5 per 1,000 live births in Iceland to 7.4 in Romania and 7.6 in Bulgaria. Within the UK, Northern Ireland had the highest rate at 5.1 per 1,000 live births, while the rate was 3.2 in England and Wales and 2.9 in Scotland.

Multiple pregnancies

Babies from multiple births, mainly twins and triplets, are far more likely than singletons (single births) to be born early and so have higher rates of neonatal and infant death. Scotland and Northern Ireland were among the nine countries with fewer than 15 multiple births per thousand pregnancies. Five countries had rates of over 19 per thousand. England and Wales came in between with a rate of 16.1 per thousand pregnancies.

Age at childbirth

Since 2004, the average ages of women giving birth in Europe have risen. The countries of the UK are unusual in having relatively high proportions of both older and younger mothers. The percentage of mothers aged under 20 ranged from 0.8 per cent in Switzerland to 10.2 per cent in Bulgaria. Most countries, including the countries of the UK had under four per cent. The percentage of mothers aged 35 and over ranged from around 14 per cent in in Bulgaria, Poland and Romania to 36.3 per cent in Italy and 37.3 per cent in Spain. In each of the countries of the UK, just over a fifth of mothers were aged 35 or older.

Caesarean birth

Rising rates of caesarean birth (c-section) are a matter of concern internationally, and in six countries, rates reached over 35 per cent of all births in 2015. In contrast, not all rates rose and a quarter of countries had rates below 21 per cent. Iceland, Finland, Norway, and the Netherlands had the lowest rates, under 18 per cent.

The rates for the countries of the UK, although not the highest, were at the higher end of the range. Rates for Wales and Northern Ireland remained at 26.1 per cent and 29.9 per cent respectively, while the rate for England rose from 24.6 per cent in 2010 to 27.0 per cent in 2015, and the rate for Scotland rose from 27.8 per cent to 32.5 per cent.

Smoking and obesity

The report also identifies important gaps in data about two important subjects, smoking and obesity. In most countries with data, between five and eight per cent of women smoked during pregnancy, but in the countries of the UK, from 12 to 17 per cent did so. Only 12 countries had data about body mass index (BMI). These included the UK, where over a fifth of the women who gave in 2015 in each of England, Wales, Scotland and Northern Ireland were obese.

Professor Macfarlane, member of the Executive Board of Euro-Peristat and of its writing group and Professor of Perinatal Health at City, University of London, said:

"This new report confirms the findings of its predecessors, that when like is compared with like, the countries of the UK do not have the highest stillbirth and infant mortality rates in Europe. All the same they show that despite welcome decreases between 2010 and 2015, rates remain substantially above the low rates seen in the Nordic countries.

"The worrying increases in the already high caesarean rates for Scotland and England may well arise from initiatives to reduce stillbirth and infant mortality rates. However, the very much lower rates of caesarean section in the Nordic countries suggests that while good clinical care is important, a wider approach which also includes social and public health policies to improve the health of childbearing women is needed."

Explore further: Lack of consensus over best obstetric practice in EU, says report

Related Stories

Lack of consensus over best obstetric practice in EU, says report

March 10, 2015
Caesarean section rates vary widely across Europe with percentages of women giving birth by caesarean ranging from a high of 52% in Cyprus to a low of 14.8% in Iceland. This compares with around a quarter of births in the ...

True burden of stillbirths in Europe vastly underestimated

October 2, 2018
The burden of stillbirth has been underestimated by at least a third because of recommendations to report only stillbirths from 28 weeks' gestation in international comparisons, according to an observational study of 2.5 ...

CDC: infant mortality rate varies greatly among states

September 13, 2018
(HealthDay)—Infant mortality rates in the United States vary substantially by state, according to a QuickStats report published in the Aug. 24 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and ...

UK: More than eight out of ten newborn babies 'now start to breastfeed'

June 22, 2011
(Medical Xpress) -- The proportion of newborn babies in Britain breastfed by their mothers increased from six out of ten to eight out of ten between 1990 and 2010, according to new research by academics at the University ...

France leads EU fertility rates: agency

March 28, 2018
France and Sweden have the highest fertility rates in Europe but births across the EU are less than needed to replenish the population naturally, the bloc's statistics agency said Wednesday.

Report on stillbirth and neonatal death rates across the UK

June 22, 2017
Research published today shows that the stillbirth rate in the UK has reduced by almost 8% over the period 2013 to 2015. A current Government ambition is to halve the rates of stillbirth and neonatal death in England by 2030. ...

Recommended for you

Early postpartum opioids linked with persistent usage

December 14, 2018
Vanderbilt researchers have published findings indicating that regardless of whether a woman delivers a child by cesarean section or by vaginal birth, if they fill prescriptions for opioid pain medications early in the postpartum ...

Hysterectomy linked to memory deficit in an animal model

December 6, 2018
By age 60, one in three American women have had a hysterectomy. Though hysterectomy is a prevalent and routine surgery, the removal of the uterus before natural menopause might actually be problematic for cognitive processes ...

Obesity intervention needed before pregnancy

December 6, 2018
New research from the University of Adelaide's Robinson Research Institute supports the need for dietary and lifestyle interventions before overweight and obese women become pregnant.

First baby born via uterus transplanted from dead donor

December 5, 2018
In a medical first, a mother who received a uterus transplant from a dead donor gave birth to a healthy baby, researchers reported Wednesday.

Researchers find evidence of prenatal environment tuning genomic imprinting

December 5, 2018
A team of researchers from the U.S., Australia and Denmark has found evidence of the prenatal environment tuning genomic imprinting. In their paper published in Proceedings of the National Academy of Sciences, the group describes ...

RSV study reveals age when infants are most vulnerable to asthma

December 5, 2018
New research suggests a maternal vaccination against RSV should be augmented with active immunisation in a child's first two years to reduce the onset of asthma.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.