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Infant mortality and mother’s country of birth- what information is currently available?
Nicola Dennis- Knowledge Transfer Facilitator, KIT(WM), PHE
Infant mortality and ethnicityTopics to be covered
• The West Midlands has significantly higher infant mortality rates than the rest of England
• Infant mortality has been shown to be higher in non-UK born mothers than UK born mothers
• Maternal death rates are also higher in non-UK born mothers
• Numbers of non-UK born mothers vary across the WM local authorities
2 Infant mortality and ethnicity
Long term trend
3 Infant mortality and ethnicity
0
1
2
3
4
5
6
7
8R
ate
per
1,0
00 l
ive
bir
ths
West Midlands England
Source: PHOF
West Midlands infant mortality rates
Source: ChiMat infant mortality profiles
4 Infant mortality and ethnicity
3.23.5 3.5 3.6 3.8
4.1
4.8 4.8 55.6
5.9
6.87.1 7.1
7.4 7.5
0
2
4
6
8
Rate of infant deaths under one year per 1,000live births (2011-2013)
5 Infant mortality and ethnicity
England
Local authority rate
Further breakdownsAs well as examining infant mortality as a whole, we can also look at
• Stillbirths
• Perinatal mortality rates (under 7 days)
• Neonatal mortality rates (under 28 days)
• Post neonatal mortality rates (28 days-1 year)
6 Infant mortality and ethnicity
West Midlands stillbirth rates
Source: ChiMat infant mortality profiles
7 Infant mortality and ethnicity
3.5 3.74.1 4.2 4.3 4.5 4.6 4.7 4.7 4.8 4.8 4.9
5.3 5.4 5.5
6.5
0
2
4
6
8
The rate of still births per 1,000 total births (2011-13)
West Midlands perinatal mortality rates
Source: ChiMat infant mortality profiles
8 Infant mortality and ethnicity
5.7 5.7 5.9 6.3 6.6 6.9 7.1 7.1 7.38 8.3 8.5 8.7 8.7
10.1
11.2
0
2
4
6
8
10
12
Stillbirths plus early neonatal deaths (deaths at under 7 completed days of life) per 1,000 births (2011-13)
West Midlands neonatal mortality rates
Source: ChiMat infant mortality profiles
9 Infant mortality and ethnicity
2.4 2.52.8 2.9 3 3.1 3.1 3.2
3.5 3.5
4.1
4.8 4.9 5.15.4 5.4
0
1
2
3
4
5
6
Rate of deaths of babies aged less than 28 days old per 1,000 live births (2009-2013)
West Midlands post neonatal mortality
Source: ChiMat infant mortality profiles
10 Infant mortality and ethnicity
0.60.7
11.1
1.2 1.21.3
1.51.6 1.6
1.81.9
22.2 2.2
2.3
0
0.5
1
1.5
2
2.5
Rate of deaths of babies aged between 28 days and 1 year old per 1,000 live births (2009-13)
Non-UK born mothers: What information is available?• There are many potential risk factors for stillbirth, infant mortality and
maternal mortality
• Rates of all of these have been shown to be higher in non-UK born mothers
• However, because of (overall) small numbers, the information available is currently limited
11 Infant mortality and ethnicity
Country of birth, 2012
12 Infant mortality and ethnicity
United Kingdom‚ Isle of Man and Channel Islands 4.5 6.6 2.7 1.1 3.8
Total outside the United Kingdom 5.8 8.1 3.0 1.3 4.2
Total 4.9 7.0 2.7 1.2 3.9
Stillbirths Perinatal Neonatal Post-neonatal Infant
RatesCountry of birth
Rates:
Stillbirths and perinatal deaths per 1,000 live births and stillbirths.Neonatal, postneonatal and infant deaths per 1,000 live births.
Source:
Child Mortality Statistics: Childhood, Infant and Perinatal, 2012
http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-332784
Country of birth, 2012
13 Infant mortality and ethnicity
United Kingdom‚ Isle of Man and Channel Islands 4.5 6.6 2.7 1.1 3.8
Total outside the United Kingdom 5.8 8.1 3.0 1.3 4.2
Total 4.9 7.0 2.7 1.2 3.9
Stillbirths Perinatal Neonatal Post-neonatal Infant
RatesCountry of birth
Rates:
Stillbirths and perinatal deaths per 1,000 live births and stillbirths.Neonatal, postneonatal and infant deaths per 1,000 live births.
Information currently not available for the WM
Live births: country of birth of mother, 2013
14 Infant mortality and ethnicity
Birmingham 60.9 39.1
Coventry 63 37
Sandwell 67.7 32.3
Wolverhampton 72.6 27.4
West Midlands 76.5 23.5
Stoke-on-Trent 79.7 20.3
Walsall 80.8 19.2
Herefordshire 84.2 15.8
Warwickshire 84.5 15.5
Telford and Wrekin 84.7 15.3
Worcestershire 86 14
Dudley 86.1 13.9
Solihull 88.7 11.3
Staffordshire 90.4 9.6
Shropshire 91.7 8.3
ENGLAND 72.7 27.3
2013
Names UK Outside UK
Source: ONS: Parents' Country of Birth, England and Wales 2013
Live births: country of birth of mother, 2013
15 Infant mortality and ethnicity
Birmingham 60.9 39.1
Coventry 63 37
Sandwell 67.7 32.3
Wolverhampton 72.6 27.4
West Midlands 76.5 23.5
Stoke-on-Trent 79.7 20.3
Walsall 80.8 19.2
Herefordshire 84.2 15.8
Warwickshire 84.5 15.5
Telford and Wrekin 84.7 15.3
Worcestershire 86 14
Dudley 86.1 13.9
Solihull 88.7 11.3
Staffordshire 90.4 9.6
Shropshire 91.7 8.3
ENGLAND 72.7 27.3
2013
Names UK Outside UK
Source: ONS: Parents' Country of Birth, England and Wales 2013
Live births: country of birth of mother, 2013
16 Infant mortality and ethnicity
Birmingham 60.9 39.1
Coventry 63 37
Sandwell 67.7 32.3
Wolverhampton 72.6 27.4
West Midlands 76.5 23.5
Stoke-on-Trent 79.7 20.3
Walsall 80.8 19.2
Herefordshire 84.2 15.8
Warwickshire 84.5 15.5
Telford and Wrekin 84.7 15.3
Worcestershire 86 14
Dudley 86.1 13.9
Solihull 88.7 11.3
Staffordshire 90.4 9.6
Shropshire 91.7 8.3
ENGLAND 72.7 27.3
2013
Names UK Outside UK
Birmingham 61.5 38.5
Coventry 64.2 35.8
Sandwell 70.1 29.9
Wolverhampton 73.1 26.9
West Midlands 77.3 22.7
Walsall 80.6 19.4
Stoke-on-Trent 81 19
Warwickshire 84.2 15.8
Telford and Wrekin 85.7 14.3
Herefordshire 85.9 14.1
Worcestershire 87.2 12.8
Dudley 87.8 12.2
Solihull 89 11
Staffordshire 90.1 9.9
Shropshire 91.4 8.6
ENGLAND 73.3 26.7
Names UK Outside UK
2012
Source: ONS: Parents' Country of Birth, England and Wales 2012, 2013
Live births: country of birth of mother, 2013
17 Infant mortality and ethnicity
Birmingham 60.9 39.1
Coventry 63 37
Sandwell 67.7 32.3
Wolverhampton 72.6 27.4
West Midlands 76.5 23.5
Stoke-on-Trent 79.7 20.3
Walsall 80.8 19.2
Herefordshire 84.2 15.8
Warwickshire 84.5 15.5
Telford and Wrekin 84.7 15.3
Worcestershire 86 14
Dudley 86.1 13.9
Solihull 88.7 11.3
Staffordshire 90.4 9.6
Shropshire 91.7 8.3
ENGLAND 72.7 27.3
2013
Names UK Outside UK
Birmingham 61.5 38.5
Coventry 64.2 35.8
Sandwell 70.1 29.9
Wolverhampton 73.1 26.9
West Midlands 77.3 22.7
Walsall 80.6 19.4
Stoke-on-Trent 81 19
Warwickshire 84.2 15.8
Telford and Wrekin 85.7 14.3
Herefordshire 85.9 14.1
Worcestershire 87.2 12.8
Dudley 87.8 12.2
Solihull 89 11
Staffordshire 90.1 9.9
Shropshire 91.4 8.6
ENGLAND 73.3 26.7
Names UK Outside UK
2012
Source: ONS: Parents' Country of Birth, England and Wales 2012, 2013
What does this mean?• We do not have WM specific rates for mortality and country of birth
• However, the numbers of UK born and non-UK born mothers across LAs may indicate areas of greater need
• What else do we know about the higher risks for non-UK mothers?
18 Infant mortality and ethnicity
Country of birth, 2012
19 Infant mortality and ethnicity
Rates:
Stillbirths and perinatal deaths per 1,000 live births and stillbirths.Neonatal, postneonatal and infant deaths per 1,000 live births.
United Kingdom‚ Isle of Man and Channel Islands 4.5 6.6 2.7 1.1 3.8
Total outside the United Kingdom 5.8 8.1 3.0 1.3 4.2
EU 4.7 6.5 2.5 0.8 3.3
Rest of Europe (non EU) 4.2 5.2 1.1 0.9 2.0
Africa 7.4 10.1 3.4 1.8 5.2
The Americas and the Caribbean 4.7 7.8 3.7 1.1 4.9
Middle East and Asia 6.2 8.7 3.2 1.5 4.7
Antartica and Oceania 4.0 5.8 2.6 0.9 3.5
Other/Not stated 206.9 275.9 : - :
Total 4.9 7.0 2.7 1.2 3.9
Neonatal Post-neonatal InfantCountry of birth
Rates
Stillbirths Perinatal
Country of birth, 2012
20 Infant mortality and ethnicity
Rates:
Stillbirths and perinatal deaths per 1,000 live births and stillbirths.Neonatal, postneonatal and infant deaths per 1,000 live births.
United Kingdom‚ Isle of Man and Channel Islands 4.5 6.6 2.7 1.1 3.8
Total outside the United Kingdom 5.8 8.1 3.0 1.3 4.2
EU 4.7 6.5 2.5 0.8 3.3
Rest of Europe (non EU) 4.2 5.2 1.1 0.9 2.0
Africa 7.4 10.1 3.4 1.8 5.2
The Americas and the Caribbean 4.7 7.8 3.7 1.1 4.9
Middle East and Asia 6.2 8.7 3.2 1.5 4.7
Antartica and Oceania 4.0 5.8 2.6 0.9 3.5
Other/Not stated 206.9 275.9 : - :
Total 4.9 7.0 2.7 1.2 3.9
Neonatal Post-neonatal InfantCountry of birth
Rates
Stillbirths Perinatal
Country of birth, 2012
21 Infant mortality and ethnicity
England and Wales 4.5 6.5 2.7 1.1 3.8
Scotland 4.6 7.1 2.7 1.2 3.9
Northern Ireland 5.9 7.7 2.3 : 3.2
New EU 5.0 6.8 2.4 0.7 3.1
Irish Republic 6.7 8.7 3.0 : 3.7
North Africa 4.6 6.0 1.4 1.1 2.6
Western Africa 8.2 11.3 4.0 2.3 6.4
Central Africa 8.8 10.9 2.5 3.4 5.9
Eastern Africa 8.5 11.8 3.9 1.6 5.5
Southern Africa 2.9 4.3 1.6 0.7 2.3
North America and Central America 2.2 4.7 3.3 0.8 4.1
South America 3.6 5.2 2.4 1.2 3.7
Caribbean 9.8 15.6 5.8 1.6 7.4
Middle East and Central Asia 6.7 8.1 2.0 1.3 3.2
Eastern Asia 2.9 3.5 0.8 0.5 1.2
Southern Asia 6.8 9.8 3.8 1.7 5.5
India 7.8 10.7 3.6 1.4 4.9
Pakistan 7.3 10.6 4.0 2.0 6.1
Bangladesh 4.8 7.7 4.1 2.3 6.4
South East Asia 3.9 6.3 3.0 0.9 3.9
Total 4.9 7.0 2.7 1.2 3.9
Country of birth
Rates
Stillbirths Perinatal Neonatal Post-neonatal Infant
Country of birth, 2012
22 Infant mortality and ethnicity
England and Wales 4.5 6.5 2.7 1.1 3.8
Scotland 4.6 7.1 2.7 1.2 3.9
Northern Ireland 5.9 7.7 2.3 : 3.2
New EU 5.0 6.8 2.4 0.7 3.1
Irish Republic 6.7 8.7 3.0 : 3.7
North Africa 4.6 6.0 1.4 1.1 2.6
Western Africa 8.2 11.3 4.0 2.3 6.4
Central Africa 8.8 10.9 2.5 3.4 5.9
Eastern Africa 8.5 11.8 3.9 1.6 5.5
Southern Africa 2.9 4.3 1.6 0.7 2.3
North America and Central America 2.2 4.7 3.3 0.8 4.1
South America 3.6 5.2 2.4 1.2 3.7
Caribbean 9.8 15.6 5.8 1.6 7.4
Middle East and Central Asia 6.7 8.1 2.0 1.3 3.2
Eastern Asia 2.9 3.5 0.8 0.5 1.2
Southern Asia 6.8 9.8 3.8 1.7 5.5
India 7.8 10.7 3.6 1.4 4.9
Pakistan 7.3 10.6 4.0 2.0 6.1
Bangladesh 4.8 7.7 4.1 2.3 6.4
South East Asia 3.9 6.3 3.0 0.9 3.9
Total 4.9 7.0 2.7 1.2 3.9
Country of birth
Rates
Stillbirths Perinatal Neonatal Post-neonatal Infant
Changes over time
23 Infant mortality and ethnicity
0.0
1.0
2.0
3.0
% o
f al
l liv
e b
irth
s
* Note: Where a country has a blank space for one or more year groups, this indicates that country was not in the top ten
2004 2012 2013
Countries Total %Pakistan 15,736 2.5India 9,146 1.4Bangladesh 8,857 1.4Somalia 4,880 0.8Germany 4,615 0.7Nigeria 4,039 0.6Ireland 3,597 0.6South Africa 3,559 0.6Ghana 3,165 0.5United States 2,916 0.5Total non-UK 124,563 19.5
10 most common countries of birth for non-UK mothers (England and Wales, 2004)
Countries Total %Poland 21,156 2.9Pakistan 19,091 2.6India 14,621 2.0Bangladesh 8,224 1.1Nigeria 7,685 1.1Somalia 5,300 0.7Germany 5,064 0.7Lithuania 4,535 0.6Romania 4,406 0.6South Africa 4,231 0.6Total non-UK 189,079 25.9
10 most common countries of birth for non-UK mothers (England and Wales, 2012)
Countries Total %Poland 21,275 3.0Pakistan 18,578 2.7India 14,044 2.0Bangladesh 7,982 1.1Nigeria 7,267 1.0Romania 4,956 0.7Somalia 4,897 0.7Germany 4,838 0.7Lithuania 4,595 0.7South Africa 3,824 0.5Total non-UK 185,075 26.5
10 most common countries of birth for non-UK mothers (England and Wales, 2013)
Changes over time
24 Infant mortality and ethnicity
0.0
1.0
2.0
3.0
% o
f al
l liv
e b
irth
s
* Note: Where a country has a blank space for one or more year groups, this indicates that country was not in the top ten
2004 2012 2013
Countries Total %Pakistan 15,736 2.5India 9,146 1.4Bangladesh 8,857 1.4Somalia 4,880 0.8Germany 4,615 0.7Nigeria 4,039 0.6Ireland 3,597 0.6South Africa 3,559 0.6Ghana 3,165 0.5United States 2,916 0.5Total non-UK 124,563 19.5
10 most common countries of birth for non-UK mothers (England and Wales, 2004)
Countries Total %Poland 21,156 2.9Pakistan 19,091 2.6India 14,621 2.0Bangladesh 8,224 1.1Nigeria 7,685 1.1Somalia 5,300 0.7Germany 5,064 0.7Lithuania 4,535 0.6Romania 4,406 0.6South Africa 4,231 0.6Total non-UK 189,079 25.9
10 most common countries of birth for non-UK mothers (England and Wales, 2012)
Countries Total %Poland 21,275 3.0Pakistan 18,578 2.7India 14,044 2.0Bangladesh 7,982 1.1Nigeria 7,267 1.0Romania 4,956 0.7Somalia 4,897 0.7Germany 4,838 0.7Lithuania 4,595 0.7South Africa 3,824 0.5Total non-UK 185,075 26.5
10 most common countries of birth for non-UK mothers (England and Wales, 2013)
Changes over time
25 Infant mortality and ethnicity
0.0
1.0
2.0
3.0
% o
f al
l liv
e b
irth
s
* Note: Where a country has a blank space for one or more year groups, this indicates that country was not in the top ten
2004 2012 2013
Countries Total %Pakistan 15,736 2.5India 9,146 1.4Bangladesh 8,857 1.4Somalia 4,880 0.8Germany 4,615 0.7Nigeria 4,039 0.6Ireland 3,597 0.6South Africa 3,559 0.6Ghana 3,165 0.5United States 2,916 0.5Total non-UK 124,563 19.5
10 most common countries of birth for non-UK mothers (England and Wales, 2004)
Countries Total %Poland 21,156 2.9Pakistan 19,091 2.6India 14,621 2.0Bangladesh 8,224 1.1Nigeria 7,685 1.1Somalia 5,300 0.7Germany 5,064 0.7Lithuania 4,535 0.6Romania 4,406 0.6South Africa 4,231 0.6Total non-UK 189,079 25.9
10 most common countries of birth for non-UK mothers (England and Wales, 2012)
Countries Total %Poland 21,275 3.0Pakistan 18,578 2.7India 14,044 2.0Bangladesh 7,982 1.1Nigeria 7,267 1.0Romania 4,956 0.7Somalia 4,897 0.7Germany 4,838 0.7Lithuania 4,595 0.7South Africa 3,824 0.5Total non-UK 185,075 26.5
10 most common countries of birth for non-UK mothers (England and Wales, 2013)
Distribution by region, 2013
26 Infant mortality and ethnicity
60.9 63.067.7
72.679.7 80.8
84.2 84.5 84.7 86.0 86.1 88.7 90.4 91.7
76.55.7
10.98.0
7.8
5.4 4.1
12.28.2 7.3
7.82.8
3.14.7 4.5
6.423.313.8
17.913.1
11.8 12.3
4.1 4.63.7
8.45.4
3.6
11.6
7.9 10.64.1 4.7 3.9
50%
60%
70%
80%
90%
100%
UK EU (exc. UK) Europe (exc. EU) Middle East/ Asia Africa Elsewhere
Source: ONS: Parents' Country of Birth, England and Wales 2013
Maternal deathsNon-UK born mothers are also at higher risk of maternal death
27 Infant mortality and ethnicity
Maternal deaths by country
28 Infant mortality and ethnicity
Source: CMACE, MBRRACE-UK
https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf
UK 2458671 211 8.6 7.5-9.8 1 (Ref)Outside UK 724229 110 15.2 12.5-18.3 1.77 1.39-2.24
Bangladesh 33299 3 9 1.9-26.3 1.05 0.21-3.11India 55203 8 14.5 6.3-28.6 1.69 0.72-3.39Pakistan 73523 8 10.9 4.7-21.4 1.27 0.54-2.54Sri Lanka 13630 4 29.4 8-75.1 3.42 0.92-8.89Ghana 13650 3 22 4.5-64.2 2.56 0.52-7.59Nigeria 29235 10 34.2 16.4-62.9 3.99 1.88-7.48Somalia 22512 4 17.8 4.8-45.5 2.07 0.56-5.38Poland 78889 7 8.9 3.6-18.3 1.03 0.41-2.17
Specific countries
Woman's country of birthMaternities 2009-2012
Total deathsRate per 100,000
maternities95% CI
Relative risk (RR)
95% CI
Maternal deaths
“Women born outside the UK were significantly more likely to die than those born in the UK (RR 1.77, 95% CI 1.39-2.24). Women born in Nigeria had the highest maternal mortality rate (34.2 per 100,000 maternities, 95% CI 16.4- 62.9). Three of the ten women from Nigeria who died, died from cardiac disease (30%). Most (70%) were long-term migrants (>5 years of residence). Nine of the ten women received antenatal care, but only one of them received the NICE recommended level of care (booking at less than 10 weeks and no antenatal appointments missed).”
Saving Lives, Improving Mothers’ Care Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012, Page 19
https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf
29 Infant mortality and ethnicity
Further informationNicola Dennis: [email protected]
ChiMat infant mortality information:
http://atlas.chimat.org.uk/IAS/dataviews/infantmortalityprofile
30 Infant mortality and ethnicity