What is happening with infant mortality in England?

In England 100 years ago, of every 10,000 children born, around 800 died in their first year of life. By 2022, that number had fallen to less than 40. This is an enormous achievement, brought about by improvements in public health and medicine. But the number of infant deaths is still higher than the number of deaths at any other age below 50. And, alarmingly, progress in reducing infant deaths has stalled in the last 10 years.

Health Equity North’s recent report explores infant mortality in England. Increases in infant mortality in the north of England are driving increases nationally, with socioeconomically deprived areas and black and Asian communities experiencing a particular rise. Such disparity is concerning, with families clearly experiencing inequalities in the care and support needed for a good start in life.

For the new government to meet the goal of halving the difference in healthy life expectancy between regions, there must be an explicit focus on children’s and young people’s health. Reducing infant mortality is an important part of this. Addressing some of the issues behind the inequalities in infant mortality – such as poverty, discrimination and access to services – will help build healthier lives for children and young people across the UK.

This blog explores the latest infant mortality data, looks at how trends have changed over time and considers the implications for the new government.

What are the historical trends in infant mortality?

In 1980, for every 10,000 children born in England, 120 died in their first year of life. Thanks to advances in antenatal and neonatal care, this reduced by two-thirds over the subsequent three decades, down to around 40 infants dying for every 10,000 born. However, progress has stalled since 2014, with the infant mortality rate still fluctuating around 40.

This stagnation between 2014 and 2022 is relatively unique among highly developed nations. In 1980, the UK ranked 13th out of 22 peer countries, falling to 19th by 2022 (only Canada, New Zealand and the USA have worse infant mortality outcomes). Compared to its peers, England (and the wider UK) is increasingly falling behind in terms of infant mortality.

How have trends varied by geography, deprivation and ethnicity?

The stagnating infant mortality rate at national level masks considerable variation by geography, deprivation and ethnicity. In 2022, the West Midlands had the highest infant mortality rate in England, with 56 deaths per 10,000. This is twice that of the south west, where the rate is lowest (28 per 10,000). And, crucially, while regions with the lowest infant mortality rates saw continuing decreases between 2008 and 2022, the regions with the highest infant mortality rates did not see such continued decreases – meaning the disparity between regions is widening.

Inequalities are also increasing by deprivation level (Figure 1). In 2022, babies born in the most deprived 10% of areas were almost three times as likely to die in their first year of life (61 per 10,000) compared with babies born in the least deprived 10% of areas (22 per 10,000). These disparities are higher than they were in 2010, driven by infant mortality increasing in the most deprived areas in recent years (and the national average masks improvements in the least deprived areas). 

There are also large disparities by ethnic group, with babies from black ethnic backgrounds being more than twice as likely to die in their first year of life compared with babies from white ethnic backgrounds. In 2022, babies from black ethnic groups (comprising Black African, Black Caribbean and any other black background) had the highest infant mortality rate, with 68 deaths per 10,000 births, followed by babies from Asian backgrounds (comprising Bangladeshi, Indian, Pakistani and any other Asian background), with 57 deaths per 10,000 births. In contrast, babies from white British backgrounds have the lowest infant mortality rate (31 deaths per 10,000 births). These inequalities have been increasing since 2020, with black and Asian groups seeing year-on-year increases in infant mortality.

The risk of pre-term birth and foetal growth restriction, two of the main causes of infant deaths, are also higher among deprived socioeconomic groups, and among black and Asian communities. Addressing adverse birth outcomes will require efforts to improve maternal health before and during pregnancy (including reducing stress related to social disadvantage, for example).

What does this mean for the new government?

The new government faces a troubling trend with stalling progress in infant mortality rates and growing inequalities. Improving outcomes will be challenging, but is vital.

To reverse the trend of growing inequalities, the government must address the main causes of higher infant deaths among deprived socioeconomic groups and among black and Asian communities. This should include a serious investigation into the underlying drivers of higher infant mortality among certain populations, as also suggested by Health Equity North. 

Delivering the overall ambition of the government’s health mission will require broader action to address the inequalities in health outcomes for children and young people – including obesity and mental health problems. Supporting children to thrive has a moral and economic imperative. Poor mental health is the biggest factor in young people failing to enter the workplace and obesity is a driver of many avoidable major health conditions – all of which are set to rise according to Health Foundation projections.

The government, through its mission boards, has a unique opportunity to commit to a cross-government approach to tackle poverty, inequality and the wider determinants of health. Given that so much of the action needed falls beyond the remit of the Department of Health and Social Care, there needs to be joint ownership and commitment between the ‘health’ and the ‘opportunity’ mission boards to address these concerning trends in infant mortality. 

Ultimately, the concerning rise in inequalities in infant mortality by geography, deprivation and ethnicity highlights the need for action to ensure that everyone has an equal start in life.