Child health experts call on new government to urgently address inequalities in rising infant mortality

More babies are dying before their first birthday, with those in deprived areas, the North of England and Black and Asian ethnic groups the worst affected, according to new analysis.

The analysis—by experts from the Child of the North research group, including Professor Kate Pickett from the University of York—looked at national figures on infant deaths in 2022 and has revealed that, after a brief hiatus, infant mortality is rising once again, exposing stark inequalities across society.

The increase in infant mortality rates (IMR) has been linked to risk factors such as prematurity, congenital anomalies, low birthweight, ethnicity, maternal age, deprivation, poverty and inequality.

Urgent priority

The findings have prompted calls from leading child health academics for a serious investigation into the underlying drivers of higher IMR among the most deprived populations and for the new government to commit to reducing health inequalities as an urgent priority.

The latest data released by the Office of National Statistics (ONS) reveals that 2,240 infants died before their first birthday in 2022 in England, a rise from 2,209 in 2021, corresponding to 3.9 infant deaths per 1,000 live births.

IMR in the North of England in 2022 was 4.6 per 1,000 live births—compared to 3.3 per 1,000 in London and 3.8 per 1,000 in the rest of England.

Regionally, West Midlands had the highest rate (at 5.6 per 1,000 live births), followed by Yorkshire and the Humber (5.1 per 1,000) and the North West (4.4 per 1,000), the East Midlands and North East both had 4.3 and 3.9 per 1,000 live births respectively.

Shocking

Professor Kate Pickett from the Department of Health Sciences at the University of York, said, "It is shocking that a country such as the U.K. continues to lag so far behind similar high income countries when it comes to infant mortality rates. Our research highlights an alarming inequality gap that needs serious investigation into the underlying drivers of higher IMR.

"All babies deserve to have the same life chances regardless of where they are born or their ethnicity. Yet, these figures show that isn't the case and that more needs to be done urgently. I urge the new government to prioritize reducing health inequalities with specific targets to address infant mortality."

Key findings

Key findings of the analysis by the Child of the North Group (a collaboration between the virtual institute Health Equity North and N8 Research Partnership formed of the eight most research intensive universities in the north of England) also include:

• Inequalities in infant mortality between the most and least deprived local authorities are the same as in 2008, highlighting 14 years of stagnation.
• In 2022, the IMR in local authorities in the most deprived areas of the country was 4.7 deaths per 1,000 live births, compared to 2.8 deaths per 1,000 live births in the least deprived areas.
• IMR was highest for babies from the Black ethnic groups, comprising Black African, Black Caribbean and any other Black background (6.8 per 1,000 live births), followed by those from Asian background, which includes Bangladeshi, Indian, Pakistani and any other Asian background (5.7 per 1,000 live births), then "Any Other" ethnic group (3.6 per 1,000 live births).
• The IMR for White British and other White Background in 2022 was the lowest at 3.1 per 1,000 live births following 3.2 per 1,000 live births for "Mixed/multiple" ethnic groups category.
• Within Europe, the UK is one of the worst performing countries with IMR significantly higher than the European Economic Area (EEA) average of 3.1 in 2022, and rates twice as high as Finland and Norway.
• The UK's infant mortality rate fares poorly compared to other similar countries in the Organization for Economic Co-operation and Development (OECD), plummeting from a position of 10th in 1960 to 29th out of 38 countries in 2021.

The researchers behind the new analysis say action is needed to address the causes of infant mortality with better support during pregnancy, appropriately resourced maternity and early years services and fiscal measures to alleviate poverty.

Whooping cough

They have also warned that there may be further rises in IMR due to the increase in prevalence of vaccine preventable diseases affecting infants and pregnant mothers, notably measles and pertussis (whooping cough).

There have been 4,793 cases of pertussis in England and eight deaths in infants from January to April 2024, compared to 858 cases in the whole of 2023, with the last reported infant death in 2019. In addition, pertussis vaccine uptake in pregnant women has declined—down from 74% in 2017 to 59% in 2023.

Wrong direction

Professor David Taylor-Robinson, Academic Co-Director at Health Equity North, and Professor of Public Health and Policy at the University of Liverpool, said, "An increase in infant mortality rates is uncommon in affluent nations. As a sensitive measure of how we are doing as a society, rising infant mortality serves as an early indicator of policy going in the wrong direction.

"For many years, infant mortality was declining thanks to policies that set out to address health inequalities in the early 2000s. However, that success has slowed in recent years with rates beginning to rise again, particularly in more deprived communities.

"Our analysis builds on previous Child of the North research which exposed the regional differences in IMR. These latest figures show that the increase in infant mortality rates is not evenly distributed across regions and socioeconomic demography, with the North of England an outlier, compared to the rest of the country and to London. This is against a backdrop of cuts to local government, a struggling NHS, and increasing numbers of families living in poverty.

"Without coherent action to address socioeconomic inequalities in health, we are unlikely to see improvements in the IMR in the years ahead. We need to see rapid action from the new government to address the worrying increase in infant mortality in areas of deprivation, the North of England and in Black and Asian ethnic groups."