Births and infant mortality by ethnicity in England and Wales: 2007 to 2019

• The stillbirth rate and infant mortality rate for each of the ethnic groups have fluctuated but generally decreased from 2007 to 2019 following the national trends.

• Babies from the Black ethnic group have the highest rates of stillbirths and infant deaths, with babies from the Asian ethnic group consistently the second highest.

• A higher proportion of live births within the Asian, Black and Any Other ethnic groups were in the most deprived areas compared with the White ethnic group.

• For most ethnic groups, immaturity-related conditions are the main cause of infant mortality, however, for Bangladeshi and Pakistani ethnic groups the main cause is congenital anomalies.

Statistician’s comment

“While stillbirth and infant mortality rates across all ethnic groups have generally been declining since 2007, babies from black ethnic groups have the highest rates.

"One known risk factor for both stillbirths and infant mortality is deprivation. Babies from Asian, Black and Any Other ethnic group were more likely to live in more deprived areas compared with their white counterparts which could explain higher rates in those ethnic groups.”

Thomas Maddox, Vital Statistics Outputs Branch, Office for National Statistics

Follow Vital Statistics Outputs Branch on Twitter @SarahCaul_ONS

Trends in live births and stillbirths

The number of live births decreased between 2007 and 2019, however, the number of Asian, Mixed or Multiple, and Any Other ethnic group babies has increased over the time period. Although the number of live births in the White ethnic group has been falling, it had the highest number of live births each year, whereas the Any Other ethnic group had the lowest number of live births each year.

The stillbirth rate for each ethnic group has fluctuated but generally decreased between 2007 and 2019 (Figure 1). This follows the national trend in stillbirth rates. Since 2007, stillbirth rates among babies from the Black ethnic group were highest with a peak of 9.2 stillbirths per 1,000 total births in 2007 decreasing to 7.1 stillbirths per 1,000 total births in 2019. All subcategories within the Black ethnic group had similarly high stillbirth rates.

Babies within the Asian ethnic group generally had the second highest stillbirth rate across the years, with a rate of 5.1 stillbirths per 1,000 total births in 2019. Out of all the Asian ethnicities, the Pakistani group had the highest stillbirth rates. In recent years, the stillbirth rate for babies from the Pakistani ethnic group decreased, aligning closer with the rates of the remaining Asian ethnicities with a stillbirth rate of 5.9 stillbirths per 1,000 total births in 2019 compared with 8.9 in 2007.

The White ethnic group saw the lowest stillbirth rates across all years except for 2019, where the Mixed or Multiple ethnic groups category had the lowest stillbirth rate.

Trends in infant mortality

The overall infant mortality rate decreased from 4.7 infant deaths per 1,000 live births in 2007 to 3.7 in 2019. The Black ethnic group has had the highest infant mortality rate each year with a rate of 6.4 deaths per 1,000 live births in 2019. All subcategories of the Black ethnic group have relatively high infant mortality rates. Babies with an Asian ethnicity had the second highest infant mortality rate across all years, at 5.5 deaths per 1,000 live births in 2019. The Pakistani ethnic group consistently had the highest rate of infant mortality of all the Asian subcategories.

The White ethnic group had the lowest infant mortality rate across all years, at 3.0 deaths per 1,000 live births in 2019. Both subcategories of the White ethnic group (White British and White Other) have an infant mortality rate below the rate for all infants across the time period (3.0 and 2.7 infant deaths per 1,000 live births in 2019 respectively).

The Index of Multiple Deprivation (IMD) is a measure of deprivation based on many factors including employment, health, education, crime, living environment and access to housing within an area. Deprivation measures are derived differently for England and Wales and are not directly comparable.

For each ethnic group, the percentage of live births in deprived areas has remained stable across the time period. The Black ethnic group has the highest percentage of live births to mothers who live in the most deprived areas of England for all years, with 82.9% of babies from the Black ethnic group born in the most deprived areas in 2019. The White ethnic group had the lowest percentage of live births occurring in the most deprived areas, with 53.1% of babies from the White ethnic group born in these areas in 2019.

IMD is a known risk factor for stillbirths and infant mortality. For Asian, Mixed or Multiple ethnic groups, Any Other ethnic group, and White ethnic groups, the stillbirth rate is higher in more deprived areas compared with less deprived areas. However, for the Black ethnic group, the stillbirth rate is similar across most levels of deprivation. Similar trends can be seen in the infant mortality rates.

Data for 2017, 2018 and 2019 have been combined to assess infant mortality by cause of death. For most ethnic groups, immaturity related conditions were the main contributor to the infant mortality rate, followed by congenital anomalies. However, for the Bangladeshi and Pakistani ethnic groups, congenital anomalies are the most common cause of death.

A 2016 report by Public Health England (PHE) investigated trends in infant mortality in the West Midlands, and more recent updates to Public Health England data on child and maternal health has helped inform an inquiry into infant mortality rates in Birmingham. Within these reports, the risk of congenital anomalies for babies born with a Pakistani ethnicity within consanguineous marriages are discussed alongside other risk factors.

A baby is defined as having a low birthweight if they weigh less than 2,500 grams. The percentage of live births with a low birthweight has remained stable for all ethnic groups from the years 2007 to 2019, which follows the national trend for low birthweight. The Asian ethnic group saw the highest percentage of low birthweight live births across all years, with 9.3% of live births being low birthweight in 2019. The White ethnic group had the lowest percentage of low birthweight live births at 6.1% in 2019.

Low birthweight is a known risk factor for infant mortality. The Black ethnic group had the highest infant mortality rates for low birthweight babies, with a rate of 43.8 deaths per 1,000 low birthweight live births in 2019. The remaining ethnic groups had similar infant mortality rates to each other for low birthweight babies. Similar trends can be seen in the stillbirth rates.

Babies from the Asian ethnic group have the second highest infant mortality rate. However, when we only consider low birthweight babies, the infant mortality rate becomes similar to the infant mortality rate for babies from the White ethnic group. This pattern could be explained by congenital anomalies, the most common cause of death for babies from the Asian ethnic group. In 2019, congenital anomalies accounted for 44% of infant deaths for normal birthweight babies compared with 25% of infant deaths for low birthweight babies.

A preterm birth is classified as a birth that occurs before 37 weeks gestation. The percentage of live births classified as preterm have remained stable between 2007 and 2019 for all ethnic groups, following the overall trend. The Black ethnic group had the highest percentage of preterm live births out of all the ethnic categories in all years, with 8.5% of all live births being preterm in 2019. The Any Other ethnic group consistently saw the lowest percentage of preterm live births, with 7.2% in 2019.

Infant mortality rates can be affected by changes in the number of babies born under 24 weeks that are classified as live births, therefore it's useful to consider trends for babies born at 24 weeks or over separately.

For the years 2007 to 2019, infant mortality rates for babies born at 24 weeks or over are highest for the Black and Asian ethnicities, similar to the trend for babies of any gestational age. Within the Asian ethnic group, the Pakistani group had the highest rate of infant mortality for babies born at 24 weeks or over.

Live birth

A baby showing signs of life at birth.

Stillbirth

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

Infant death

The death of a child under one year.

Background

We have updated the ethnic groups used to present statistics on ethnicity of the baby to better align with Census 2021. We have created new groupings and used them to analyse live births, stillbirths, and infant mortality from 2007 to 2019.

Previously, we published statistics on the ethnicity of babies at two levels, grouped at a 5 or 9 category level. Following a review of these groups, we created new 6 and 12 category ethnic groupings so we can get a more detailed understanding of the trends. The ethnicity variable is derived from the birth notification. For some babies, the ethnicity is Not Stated, so we cannot analyse them in relation to ethnicity.

We welcome feedback on the new ethnic groupings and the analysis we have presented in this article.

Ethnic groups

The ethnicity of the baby comes from 68 subcategories available on the birth notification, which were previously grouped based on the 2001 Census. We evaluated these 68 subcategories and compared them with the 2011 Census to develop new ethnic groupings. These align with the GSS harmonised standards for ethnicity and Census 2021.

By comparing the new and old ethnic groups across the time period, we found fewer fluctuations in the data for the new categories. One of the biggest differences was in the Any Other ethnic group. At the 5-category level, the Any Other ethnic group accounted for 9% of all live births in 2019, however, this dropped to 2% using the new categories. These babies were assigned to more specific categories, for example, the Mixed or Multiple ethnic group.

Not Stated category

One way of understanding the quality of the ethnicity data is to assess the Not Stated category, which indicates the coverage of ethnicity for births and infant deaths. The smaller the Not Stated category, the more confident we can be that the other ethnic groups are complete.

The ethnicity was not stated for 9.1% of live births in 2007. This decreased to 3.2% in 2011, and then increased slightly to 4.0% in 2019 (Figure 8). A slightly higher percentage of stillbirths and infant deaths has the Not Stated ethnicity in 2019 (6.1% and 6.4% respectively). Some births and infant deaths did not successfully link to their birth notification, therefore, the ethnicity of the baby is not known.

The number of babies whose ethnicity is Not Stated is larger than some categories with an assigned ethnic group. For example, when considering the six level categories in all years, the Any Other ethnic group has fewer live births, stillbirths, and infant deaths than the Not Stated category.

Quality

More quality and methodology information on strengths, limitations, appropriate uses, and how the data were created is available in the Births QMI, User Guide to births statistics and the Child and Infant Mortality QMI.