Infant mortality rate is defined as the number of children less than a year old that die every year. It can be considered a good measure of development as it is suggestive of the state of healthcare and sanitation in a country. The infant mortality globally has been steadily falling, although not equally, over the past 30 years by 55.3% (1). This may be correlated with the improvement of water access for hygiene purposes (2), or the increase in funding for research (3) but the most likely reason is a variety of factors, such as those highlighted below.
Increase in sanitation
Only around 50% of hospitals in Africa have access to clean water, with less than two thirds having places for staff to wash their hands with soap. It has been known from the 19th century, of the importance of hand washing when delivering a baby, and without clean water, babies are at risk of contracting neonatal sepsis from either the mother or the environment. However, with increased awareness of the importance of sanitation, infant mortality due to infection has been decreasing (4). The improvement in sanitation can be attributed to programmes such as sanitation marketing - which seeks to understand the barriers that householders face to sanitation and working with them to provide more appropriate sanitation services (5). Another cause of infant mortality, especially after the first few days of life, is infant diarrhoea which causes dehydration. However, it is not only the increase in clean water, but the improved access to oral rehydration solutions which are saving these infants which would have otherwise died.
Increase in awareness
Ranging from advising expecting mothers to stop smoking to reducing cases of cot death, general practices for the first year of life have improved substantially in 30 years. Research has associated smoking with infant mortality (6) and subsequently, organisations such as Smokefree and the Stop Smoking Service have honed in on encouraging pregnant women to stop smoking. For the latter, awareness against Sudden Infant Death Syndrome has increased substantially. However, although the numbers have decreased by more than 70% in the United States and remain at global lows in Japan and the Netherlands, the number has been increasing in the UK (7). This, combined with decreasing vaccination rates (8) in high-income countries such as the UK, show that for infant mortality to decrease globally, a greater effort must be undertaken to work with parents to assist them in understanding the potential consequences of their decisions.
Advances in healthcare
Increasing the funding for research, providing more neonatal wards with specialised equipment, and helping to reduce the effects of nutrient deficiency associated with malnutrition are all slowly contributing to the global decrease in infant mortality. Recent collaborations of trusts such as Great Ormond Street Hospital and quality improvement organisations has led to an increase in specialist neonatal care and more focus on a less stressful experience for the families involved (9). This has been shown to decrease infant mortality before in other well-established studies (10). The most significant cause of infant mortality has been premature births, however, by conducting further research into how to maximise new-born survival, the issue has been tackled by international organisations such as the Centres for Disease Control and Prevention which have set further goals for even lower infant mortality for 2030 (11).
Although the above list is not exhaustive, it provides three major categories with substantially differing global rates, that have caused drastic improvements and have ultimately led to increasing rates of infants surviving until their first birthday.
OECD (2019), Infant mortality rates (indicator). doi: 10.1787/83dea506-en (Accessed on 21 June 2019)
Prüss-Üstün A, Bos R, Gore F, Bartram J. (2008) Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. World Health Organization, Geneva,.
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Jenkins MW, Scott B. Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana. Soc Sci Med. 2007;64:2427–42
Hall ES, Venkatesh M, Greenberg JM. A population study of first and subsequent pregnancy smoking behaviors in Ohio. J Perinatol. 2016;36(11):948–953
Kattwinkel J, Hauck FR, Keenan ME, et al. Task Force on Sudden Infant Death Syndrome, American Academy of Pediatrics. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005;116:1245–55. doi:10.1542/peds.2005-1499
Rayat P, Screening & Immunisations Team, NHS Digital, Childhood Vaccination Coverage Statistics England, 2017-18 (2018), National Statistics, Surrey
Leading Change, Adding Value Team (2019) Improving the quality of care for neonatal patients, NHS England, London
Aleman, J., Brännström, I., Liljestrand, J., Peña, R., Persson, L. A., & Steidinger, J. (1998). Saving More Neonates in Hospital: An Intervention towards a Sustainable Reduction in Neonatal Mortality in a Nicaraguan Hospital. Tropical Doctor, 28(2), 88–92. https://doi.org/10.1177/004947559802800211
Shapiro-Mendoza CK, Barfield WD, Henderson Z, et al. CDC Grand Rounds: Public Health Strategies to Prevent Preterm Birth. MMWR Morb Mortal Wkly Rep 2016;65:826–830. DOI: http://dx.doi.org/10.15585/mmwr.mm6532a4external icon.