Child and infant mortality in England and Wales: 2014

There were 2,517 infant deaths (deaths under 1 year) in England and Wales in 2014, compared with 2,686 in 2013 and 6,037 in 1984

In 2014, the infant mortality rate was 3.6 deaths per 1,000 live births, the lowest ever recorded in England and Wales

In 2014, the infant mortality rates for very low birthweight babies (under 1,500 grams) and low birthweight babies (under 2,500 grams) were 156.0 and 30.9 deaths per 1,000 live births respectively

This bulletin presents final statistics on infant deaths and childhood deaths that occurred in England and Wales in 2014. It also contains additional statistics on some of the main risk factors affecting infant deaths, including age of mother and birthweight. These characteristics are derived from linking the death registration to the corresponding birth registration record. Statistics are also available for babies born in 2013 who died before their first birthday: the 2013 birth cohort for infant deaths. This is the first time that these statistics have been published.

There were 2,517 infant deaths in England and Wales in 2014. The infant mortality rate was 3.6 deaths per 1,000 live births, the lowest rate ever recorded in England and Wales and a decrease from 3.8 in 2013.

Infant mortality rates have decreased in England and Wales since the early 1900s. More recently, over the past 30 years, the rate of decline has varied; the decrease between 1984 and 1994 was more than double the decrease recorded in each of the latter 2 decades (Figure 1). Since 1984, when the rate was 9.5 deaths per 1,000 live births, there has been a 62% fall in the infant mortality rate in England and Wales. General improvements in healthcare and more specific improvements in midwifery and neonatal intensive care can partly explain the overall fall in mortality rates.

There has been a similar fall in neonatal mortality rates (deaths under 28 days) and postneonatal mortality rates (deaths between 28 days and 1 year) over the last 3 decades. The neonatal mortality rate and the postneonatal mortality rate have fallen by 55% and 72% respectively since 1984.

In 2014, there were 3,254 stillbirths and 1,376 deaths at age under 7 days, resulting in a perinatal mortality rate of 6.6 deaths per 1,000 total births. Since 1993 (following a change to the stillbirth definition), the rate has fallen by just over a quarter.

Several different factors are associated with increased risk of infant death and these vary according to age at death. For example, the effect of prematurity and low birthweight is greater in the first 28 days. Despite the downward trend in the infant mortality rate, evidence in the Marmot Review: Fair Society, Healthy Lives noted that factors, including births outside marriage, maternal age under 20 years and deprivation, were independently associated with an increased risk of infant mortality. The review went on to say that, “low birthweight in particular is associated with poorer long-term health outcomes and the evidence also suggests that maternal health is related to socio-economic status”.

The ONS cause groups showed that immaturity-related conditions, for example, respiratory and cardiovascular disorders were the most common cause of infant deaths in 2014, with 40% due to these causes. Immaturity-related conditions accounted for 14% of all postneonatal deaths and 51% of all neonatal deaths.

Congenital anomalies were another major cause group, accounting for 30% of infant deaths, 31% of postneonatal deaths and 29% of neonatal deaths.

Further information on data quality, legislation and procedures relating to childhood, infant and perinatal mortality is available on our website in our User guide to Child mortality statistics.

Low birthweight, one of the known risk factors for infant deaths, can be caused by a number of factors including smoking. Babies born to women who smoke weigh, on average, 200 grams less than babies born to non-smokers.

In 2014, the infant mortality rates for very low birthweight babies (under 1,500 grams) and low birthweight babies (under 2,500 grams) were 156.0 and 30.9 deaths per 1,000 live births respectively. This is much higher than the rate of 1.1 for babies of normal birthweight (over 2,500 grams).

For babies of low birthweight, the infant mortality rate was highest among mothers aged under 20 years and lowest among mothers aged 40 and over (35.9 and 23.8 deaths per 1,000 live births respectively) (Figure 2).

Significant differences in infant mortality rates by socio-economic classification persist in England and Wales.

Infant and perinatal mortality rates were highest for the National Statistics Socio-economic Classification (NS-SEC) groups describing routine and manual occupations (Table 1). Variations in infant and perinatal mortality by socio-economic classification may be the result of the link between increasing levels of deprivation and poorer maternal health, which can ultimately affect infant mortality.

Studies have also shown that infant mortality rates are comparatively higher for low income families. Mothers from routine and manual occupation are more likely to smoke before or during pregnancy and are less likely to breastfeed which can result in poorer immunity and poorer digestive health for the baby.

The infant mortality rate for babies of mothers born outside the UK was 3.8 deaths per 1,000 live births compared with 3.5 for mothers born inside the UK. The highest infant mortality rates were for babies of mothers born in Pakistan and Western Africa (7.4 and 6.7 deaths per 1,000 live births respectively).

Differences in infant mortality rates by mother’s country of birth are likely to reflect underlying factors including mother’s age, together with a range of other socio-demographic characteristics mentioned earlier in this bulletin.

Between 1984 and 2014, the mortality rate for children aged 1 to 14 years fell by 64%, from 28 deaths per 100,000 population in 1984 to 10 in 2014. The mortality rate for children aged 1 to 4 years also fell by 67% over the same period, from 42 deaths per 100,000 population in 1984 to 14 in 2014.

Over the past 30 years, child death rates from respiratory and circulatory diseases in England and Wales have been falling, as they have for the whole population, reflecting advances in medical care and preventative measures as well as the reduction in the emission of air pollutants. In 2014, cancers and diseases of the nervous system were the most common cause of death for children aged under 16 years.

The infant mortality rate for multiple births in the 2013 birth cohort was just over 4 times higher than for singletons. This was most marked in the first 28 days of life (neonatal deaths) when the mortality rate for multiple births was nearly 5 times higher than for singletons. For those who survived beyond their first month but died before their first birthday (post-neonatal deaths), the mortality rate was over 3 times higher for multiple births compared with singleton births (Figure 3).

On average multiple births tend to have lower birthweights than singletons (Table 2) as many twins and triplets are born prematurely which is 1 reason why the infant mortality rate is around 4 times higher for multiple births than for singleton births.

The highest infant mortality rates were for the extremely low birthweight babies (less than 1,000 grams) with 311.5 deaths per 1,000 live births for singletons and 299.1 for multiple births.

Although most multiple births occur naturally, many occur as a result of fertility treatment. On average, 1 in 6 of In Vitro Fertilisation (IVF) pregnancies result in multiple births compared with 1 in 80 for women who conceive naturally. With approximately 18,000 IVF babies born in the UK in 2013, this contributes considerably to the multiple birth rate. In 2009, the HFEA launched the elective single embryo transfer (eSET) policy (now called the multiple births minimisation policy). This allowed centres to develop their own eSET strategy, with the aim to reduce the UK IVF multiple pregnancy rate to 10% over a period of years.

Two-thirds (66%) of all multiple births in 2013 were to women aged 30 years or over compared with 50% of all singleton births. Mothers aged under 20 years have the highest infant mortality rate for singletons and multiple births (5.5 and 37.0 deaths per 1,000 live births respectively).

Proposed changes to child mortality publications were outlined in an information note. These changes have been implemented.

More data on child mortality in England and Wales 2014 and birth cohort tables for infant deaths, England and Wales, 2013, are available on our website.

The Child mortality Quality and Methodology Information document contains important information on:

• the strengths and limitations of the data
• the quality of the output: including the accuracy of the data, how it compares with related data
• uses and users
• how the output was created

Further information on data quality, legislation and procedures relating to childhood, infant and perinatal mortality is available on our website in our User guide to Child mortality statistics.

Pregnancy and ethnic factors influencing births and infant mortality (previously called Gestation specific mortality) presents data on live births and infant deaths by gestational age, while unexplained deaths in infancy includes both sudden infant deaths and deaths for which the cause remained unknown or unascertained.

For infant mortality data for other UK countries (based on registrations) please see the latest infant death statistics for Northern Ireland and the latest infant death statistics for Scotland.

For infant mortality data for the UK (based on registrations) please see the latest Vital Statistics: Population and Health Reference Tables.

The Births summary tables, England and Wales provide main summary statistics for live births in England and Wales.

More general information on the collection, production and quality of mortality data is available in Mortality metadata.