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

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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 released today.

National figures on infant deaths in 2022 reveal that, after a brief hiatus, infant mortality is rising once again, exposing stark inequalities across society.

Analysis by Health Equity North (HEN) found the most deprived parts of the country, the North of England and Black and Asian ethnic groups experienced an increase in infant mortality rates (IMR).

The increase has been linked to risk factors such as prematurity, congenital anomalies, low birthweight, ethnicity, maternal age, deprivation, poverty and inequality.

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.

The figures suggest that the increases from 2021 to 2022 is largely driven by regions in the North of England.

The analysis, which was prepared by experts from the Child of the North group – a partnership between Health Equity North and N8 Research Partnership, found:

• IMR in the North of England in 2022 was 4.6 per 1,000 live births – compared to 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
• IMR was 3.9 per 1,000 live births in England in 2022 – a rise from 3.7 the previous year.
• 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 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 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 Organisation for Economic Co-operation and Development (OECD), plummeting from a position of 10^th in 1960 to 29^th 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.

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.

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.”

Professor Kate Pickett OBE, Academic Co-Director at Health Equity North, and Director of the Public Health & Society Research Group and the York Cost of Living Research Group at the University of York, said: “It is shocking that a country such as the UK continues to lag so far behind similar high income countries when 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 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 prioritise reducing health inequalities with specific targets to address infant mortality.”

Health Equity North has laid out a series of policy asks which, if implemented, could help tackle the increases in IMR across the country. This includes:

Regional Government

• Local maternity systems and integrated care boards working together in the roll out of the Women’s Health Strategy should adapt to the specific needs of their population.
• This should involve considering women who live in adverse conditions, by targeting services and resource to need, and ensuring cultural sensitivity in the commissioning of services for women from Black, Asian, mixed and ethnic minority backgrounds.

Central Government

• Commit to a policy to reduce health inequalities with a specific target to reduce overall infant mortality.
• Increase investment in welfare, health and social care systems that support children’s health, particularly in deprived areas.
• Key measurable indicators of the efforts to reduce poverty with a particular focus on geographical areas within northern regions include household relative poverty rates, employment rates, and relative child poverty.

Health System

• The NHS must improve maternity staff retention and recruitment, with additional fiscal measures put in place, to make sure there is continuity of care for women living in disadvantaged areas and for those from Black, Asian, and mixed ethnic backgrounds.
• Put in place a target of 75% for women from these communities and backgrounds to have access to the same midwife or team of midwives throughout their pregnancy journey and in the post pregnancy period.
• Incorporate culturally sensitive approaches across the entire system to improve access to healthcare, uptake of early booking in pregnancy and uptake of vaccines to reduce vaccine-preventable deaths.

Health Equity North is a virtual institute focused on place-based solutions to public health problems and health inequalities across the North of England. It brings together world-leading academic expertise from the Northern Health Science Alliance’s members of leading universities and hospitals.

Read the full analysis of Infant Mortality in England here: https://www.healthequitynorth.co.uk/app/uploads/Infant-mortality-report-FINAL.pdf