A POSTnote which reviews recent data on stillbirth and infant mortality rates in the UK and examines the factors contributing to increased risk. It then looks at the policy options that may help to improve health outcomes for infants and their families.

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Baby

When a baby dies the impact on a family can be profound, with many parents reporting symptoms of anxiety and depression for years after their baby has died. Although infant mortality in the UK has halved since the 1990s and stillbirths have declined since the 1950s, the rates of decline in recent years have slowed. Stillbirth rates in the UK have not decreased significantly since the 1980s. The UK currently has a higher infant mortality and stillbirth rate than several other European countries. This table shows the rates of stillbirths (after 28 weeks), neonatal and infant mortality across Europe.

 

Rate per 1,000 births

Data – Lancet

Rate per 1,000 live births

Data – World Health Organisation

 

Country

Stillbirth (2015)

Neonatal mortality (2015)

Infant mortality (2015)

France

4.7

2.2

3.5

Italy

3.3

2.9

2.1

Spain

2.9

2.8

3.5

Slovakia

2.9

4.2

5.8

UK

2.9

2.4

3.5

Czech Republic

2.5

1.8

2.8

Germany

2.4

2.1

3.1

Poland

2.3

3.1

4.5

Norway

2.2

1.5

2.0

Croatia

2.0

2.6

3.6

Sweden

1.9

1.6

2.4

Finland

1.8

1.3

1.9

Netherlands

1.8

2.4

3.2

Denmark

1.7

2.5

2.9

Several complex and interacting risk factors are linked to an increased risk of infant mortality and stillbirth, many of which could be addressed. These include:

  • social inequality
  • maternal obesity
  • maternal age and ethnicity
  • smoking in pregnancy
  • a previous stillbirth
  • infections contracted during pregnancy.

In the first year of life risk factors for mortality include low birth weight and prematurity, which are also risk factors for stillbirth. Tackling the risk factors for stillbirth could thus reduce both the stillbirth and infant mortality rate. Issues have been raised about the care women receive during pregnancy. For example a 2015 enquiry carried out for the government highlighted the need for: improvements in how the growth of babies in the womb is monitored; how women who feel their babies moving less are monitored; and how women at risk of developing diabetes during pregnancy are identified and monitored.

In the UK, the Department of Health has a target to half the number of stillbirths and neonatal deaths in England by 2030. As a part of the Department of Health target, NHS England has released new guidelines in the Saving Babies’ Lives Care Bundle. This includes advice to improve smoking cessation rates in pregnancy, detection of fetal growth restriction and awareness of the importance of fetal movements. The government currently has no specific target for reducing overall infant mortality rates.

Acknowledgements

POST would like to thank the following interviewees for kindly giving up their time during the preparation of this briefing:

  • Dr Alexander Heazell, University of Manchester
  • Dr Dimitrios Siassakos, University of Bristol
  • Dr Peter Goldblatt, UCL Institute of Health Equity
  • Prof Jenny Kurinczuk, National Perinatal Epidemiology Unit (NPEU)
  • Royal College of Obstetricians and Gynaecologists
  • Royal College of Midwives
  • Royal College of Paediatricians and Child Health
  • Francine Bates, The Lullaby Trust
  • Janet Scott, Sands – Stillbirth and neonatal death charity
  • Claire Roche, Maternity Network Wales
  • Department of Health
  • NHS England
  • Public Health England
  • Group B Strep Support

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