Starting Well - Health
Infant Mortality
Introduction
Infant mortality is defined as infant deaths under 1 year of age. Infant mortality is an important indicator as it is a general indicator of the health of the whole population. There are many linkages between infant mortality and the upstream determinants of health including socioeconomic factors and environmental conditions. Neonatal mortality (deaths occurring in the first 28 days after birth) are also a useful indicator of the health and care of mother and baby.
Social factors are a major factor in infant deaths and tackling the socioeconomic factors is key. There is a social gradient in infant mortality. Socially graded inequalities are present prenatally and these increase throughout childhood. Interventions that can reduce the impact of poverty on mothers both before and during pregnancy will have an impact on infant mortality and stillbirth.
Factors that increase the risk of infant mortality include:
Smoking during pregnancy
Teenage pregnancy
Low birth rate
Parental obesity
Deprivation
Not being breastfed
Ensuring that we maximise the health of mother and child during pre-conception, pregnancy and following birth is vital. This includes smoking cessation programmes and support, promoting the uptake of breastfeeding and ensuring that we promote the importance of a healthy weight for women of childbearing age. Other sections of the JSNA outline needs and progress in some of these areas.
National data form the Office for National Statistics shows:
- There were 2,636 infant deaths in England and Wales in 2017. (A decrease of 0.6% compared with 2,651 in 2016).
- Fewer live births in England and Wales in 2017 meant the infant mortality rate increased to 3.9 deaths per 1,000 live births compared with 3.8 in 2016.
- The infant mortality rate decreased from 12.0 deaths per 1,000 live births in 1980 to a low of 3.6 deaths per 1,000 live births in 2014; it has since increased to 3.9 deaths per 1,000 live births in 2017.
- The infant mortality rate was highest in the most deprived areas of England at 5.2 deaths per 1,000 live births and lowest in the least deprived areas at 2.7 deaths per 1,000 live births
Main Issues
Hartlepool’s infant mortality rate, which looks at deaths under 1 year of age, is at its highest level for 7 years. After peaking with an infant mortality rate of 7.1 per 1000 in 2006-08, Hartlepool had seen 5 years of general decline in its infant mortality rate, down to 2.7 per 1000. However since this point there has been a gradual increase year on year, up to 4.4 per 1000 in 2014-16.
While Hartlepool has remained statistically similar to the regional and England averages during this period of increase, as a trend it is one which Hartlepool must look to reverse. Hartlepool’s rate is currently the 3rd highest in the region and 2nd highest amongst its Children's services statistical neighbour benchmarking tool (CSSNBT) nearest neighbours.
If the focus is broken down to stillbirths, neonatal mortality, which is deaths under 28 days, and post-neonatal mortality, which is deaths between 28 days and 1 year, then different pictures emerge. Neonatal mortality has increased year on year for 3 years, but still births have fallen for the last 4 years. All 3 figures have remained statistically similar to the England average, however due to the very small numbers, each of these 3 figures, stillbirths, neonatal and post-neonatal mortality, must be taken with caution, as their confidence interval is very high. Post-neonatal mortality has a confidence range of 0.34 to 3.23 per 1000, which could see it move anywhere from 3rd lowest in the region to 3rd highest.
Current activities
The current Joint Health and Wellbeing Strategy for Hartlepool has five priorities – the relevant priority for this section is:
Starting Well – All children and Young People living in Hartlepool have the best start in life.
The Children’s Strategic Partnership focuses on three obsessions:
Life Chances (Heath, Wellbeing, Education and Stability)
Being and Feeling Safe
Relationships and Resilience
This is delivered through the Hartlepool Children and Young People Plan 2018 – 2021.
The key areas relevant to infant mortality are:
Building a better future for our children and young people
Goal: Children and young people will be and will feel safe
Goal: Children and young people will have improved life chances
The 0-19 Children’s Public Health Service delivers an integrated prevention and early help service through locality teams. They work with a range of partner organisations in each locality to deliver at the 4 levels of intervention recommended by existing national guidance i.e. community, universal services, universal plus and universal partnership plus. The first three reviews outlined in the Healthy Child Programme contribute to achieving the goal of reducing infant mortality.
Future intentions
The Children’s Strategic Partnership is in the process of reviewing their priorities and action plan. The outcome of this will guide the strategic approach to all children’s and young people’s activities including Early Help
Health Visitors and Midwives have reviewed the antenatal offer and will be delivering the Pregnancy Birth and Beyond course in partnership with new parents.
