Child and infant mortality in England and Wales: 2021

• In 2021, 2,323 infant deaths (aged under one year) and 852 child deaths (aged 1 to 15 years) occurred in England and Wales; these figures were both higher than in 2020 (2,226 and 789, respectively).

• In 2021, the infant mortality and child mortality rates in England and Wales were 3.7 deaths per 1,000 live births and 8 deaths per 100,000 population of the same age, respectively, both following a general decline since the 1980s.

• The neonatal mortality rate (aged under 28 days) was 2.7 deaths per 1,000 live births in England and Wales in 2021; with the mortality rate increasing for neonates of shorter gestational ages.

• In 2021, infants with a low birthweight (less than 2,500g), Black ethnicity, or a mother aged under 20 years were at the highest risk of infant mortality.

• In 2021, the main causes of death among infants and children aged 28 days to 15 years continued to be congenital malformations, deformations and chromosomal abnormalities.

• In 2021, there were 32 deaths of infants and children aged 28 days to 15 years where the underlying cause was “coronavirus (COVID-19).”

In 2021, there were 852 child deaths (aged 1 to 15 years) and 2,323 infant deaths (aged under one year) in England and Wales. This equates to a child mortality rate of 8 deaths per 100,000 population of the same age, and an infant mortality rate of 3.7 deaths per 1,000 live births (see Table 1 of our accompanying dataset). Although the child and infant mortality rates are higher than in 2020, both have followed an overall declining trend since records began in the 1980s.

The overall decline in infant mortality rates since 1980 (Figure 1) likely reflects general improvements in healthcare and more specific improvements in antenatal and neonatal care.

In England, the West Midlands continued to have the highest infant mortality rate (with 5.6 deaths per 1,000 live births), while the South West had the lowest (2.5 deaths per 1,000 live births; see Table 3 of our accompanying dataset).

There were 103 infant deaths in 2021 in Wales, and an infant mortality rate of 3.6 deaths per 1,000 live births.

Infant mortality rates within English regions and Wales are more variable than the rate for England and Wales combined, because there are fewer births and deaths recorded in each area. As a result, they are less reliable at describing trends than the combined England and Wales rate.

A neonatal death is the death of an infant aged under 28 days. In England, the government has an ambition to halve the 2010 neonatal mortality rate for babies born at a gestational age of 24 weeks or over, and to halve the 2010 stillbirth rate, by 2025.

The neonatal mortality rate ambition in England is 1.0 deaths per 1,000 live births of babies born at 24 weeks or over. In 2021, the rate was 1.4 deaths per 1,000 live births (Figure 2). Achieving the ambition in 2021 would have required at least 220 fewer neonatal deaths of babies born at 24 weeks or over, so that the total did not exceed 592.

The stillbirth ambition in England is 2.6 stillbirths per 1,000 births. In 2021, the rate was 4.1 stillbirths per 1,000 births (Figure 2). Achieving the ambition in 2021 would have required at least 896 fewer stillbirths, so that the total did not exceed 1,556.

Figure 2:  Fewer stillbirths and neonatal deaths needed to meet government ambition by 2025

Stillbirths and neonatal mortality (babies born at 24 weeks or over) rates, England, 2010 to 2021

Notes:

1. Stillbirth data refer to stillborn babies born at 24 weeks and over.
2. Neonatal death data in this chart refer to babies who were born alive at 24 weeks and over, and died within 28 days of birth.

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In Wales, the stillbirth rate was 4.4 per 1,000 births. The neonatal mortality rates were 2.6 per 1,000 live births for babies of all gestations, and 1.6 per 1,000 live births for babies born at 24 weeks or over (see Table 2 of our accompanying dataset).

Gestational age

In 2021, the overall neonatal mortality rate was 2.7 deaths per 1,000 live births which is consistent with the 2020 rate. Babies born at shorter gestational ages have higher neonatal mortality rates than those born at longer gestational ages (Figure 3). This is likely because of complications related to prematurity.

Cause of death

Congenital malformations, deformations and chromosomal abnormalities continued to be the leading cause of death in 2021 among infants and children aged 28 days to 15 years, followed by neoplasms, also known as an abnormal growth of tissue (see Table 8 of the accompanying dataset). Immaturity-related conditions accounted for 48.7% of neonatal deaths, with congenital anomalies and antepartum infections (infections occurring just before birth) together accounting for another 42.7%.

In 2021, coronavirus (COVID-19) appeared on the death certificates of 43 infants and children aged 28 days to 15 years, of which 32 recorded COVID-19 as the underlying cause of death. The percentage of the deaths of infants and children aged 28 days to 15 years where COVID-19 appeared on the death certificate increased from 1.0% in 2020 to 2.9% in 2021. This is lower than the equivalent figure of 13.3% for the general population in 2021.

Some mortality statistics on deaths because of and involving COVID-19 may differ as they are based on the number of deaths registered in a reference period, rather than when they occurred.

Birthweight

Low birthweight babies, weighing less than 2,500g, had an infant mortality rate of 30.2 deaths per 1,000 live births in 2021, an increase from 27.9 deaths per 1,000 live births in 2020. Normal birthweight babies, weighing 2,500g or over, had an infant mortality rate of 0.8 deaths per 1,000 live births, consistent with the 2020 rate (see Table 9 of our accompanying dataset).

Ethnicity

In 2021, babies from the Black ethnic group continued to have the highest rates of death, followed by the Asian ethnic group (see Table 18 of our accompanying dataset). For both groups, the infant mortality rates have increased in comparison with 2020 (Figure 4). However, small numbers of births and deaths in some ethnic groups can cause larger fluctuations over time.

Maternal age

In 2021, babies born to mothers aged 30 to 34 years had the lowest risk of infant mortality, at 3.1 deaths per 1,000 live births. Babies born to mothers aged under 20 years had the highest risk, at 5.7 deaths per 1,000 live births (see Table 10 of our accompanying dataset). In comparison with 2010, the infant mortality rate of babies has reduced for every maternal age group, except babies of mothers aged under 20 (Figure 5).

Deprivation

Infant mortality risk varies by socio-economic background. In 2021, the 10% most deprived areas in England had higher infant mortality rates compared with the 10% least deprived areas (see Table 21 of our accompanying dataset). Additionally, babies with a parent from a routine and manual background had higher infant mortality rates compared with babies with a parent from a higher managerial, administrative and professional background (see Table 12 of our accompanying dataset, and Section 7 of the National Statistics Socio-economic classification for class definitions).

Equivalent trends in Wales are more difficult to assess because of fewer infant deaths and the resultant fluctuation.

Other known risk factors

There are a range of other risk factors (PDF, 1.05MB) associated with infant mortality that we are unable to assess from the data we currently have available. Examples of these include maternal health factors such as smoking, alcohol consumption and obesity.

Child

The death of those aged 1 to 15 years.

Child mortality rate

The number of child deaths, per 100,000 population of the same age.

Early neonatal

The death of an infant aged under seven days.

Infant

The death of those aged under one year.

Infant mortality rate

The number of infant deaths, per 1,000 live births.

Neonatal

The death of an infant aged under 28 days.

Perinatal

A baby who was recorded as either a stillbirth or early neonatal death.

Postneonatal

The death of an infant aged 28 days to 1 year.

Stillbirth

A baby born after 24 or more weeks completed gestation and which did not, at any time, breathe or show signs of life.

Child and infant mortality data are based on deaths occurring in 2021. In normal circumstances, deaths of all ages are typically registered within five days. In the case of infant deaths, this delay can be much longer if the death requires coroner investigation. Consequently, our annual death cohort for infant deaths occurring in 2021 includes infant deaths registered before 9 October 2022.

Coronavirus (COVID-19) and child and infant mortality statistics

Birth registrations and infant death registrations may have been delayed during the coronavirus pandemic. This may have reduced the likelihood of infant death registrations being received in time to be included in this release, and so were less likely to be linked with a birth registration and notification.

Linking infant deaths to their birth registration and birth notification improves our understanding of the main characteristics of the baby and the baby’s parents. Prior to 2020, over 95% of infant deaths were successfully linked to their birth registration and birth notification. In 2020, the linkage rate fell to 90.5%. In 2021, the linkage rate partially recovered to 94.9%. More information can be found in our User guide to child and infant mortality statistics methodology.

Quality

More information on the strengths, limitations and accuracy of the data is available in our Child and infant mortality statistics Quality and Methodology Information (QMI) report.

Our User guide to child and infant mortality statistics methodology provides further information on data quality, legislation and procedures relating to mortality and cause of death coding, and includes a full glossary of terms.