1. Main points

  • There were 2,686 infant deaths (deaths under 1 year) in England and Wales in 2013, compared with 2,912 infant deaths in 2012 and 6,381 in 1983

  • In 2013, the infant mortality rate was 3.8 deaths per 1,000 live births, the lowest ever recorded in England and Wales. This compares with an infant mortality rate of 4.0 deaths per 1,000 live births in 2012 and 10.1 deaths per 1,000 live births in 1983

  • Infant mortality rates were lowest for babies of mothers aged 25 to 29 years (3.4 deaths per 1,000 live births) and highest for babies of mothers aged under 20 years (6.1 deaths per 1,000 live births)

  • In 2013, the infant mortality rates for very low birthweight babies (under 1,500 grams) and low birthweight babies (under 2,500 grams) were 164.0 and 32.4 deaths per 1,000 live births respectively

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2. Summary

This bulletin presents final statistics on infant deaths and childhood deaths that occurred in England and Wales in 2013. It also contains additional analyses by some of the key 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. Data are also available for babies born in 2012 who died before their first birthday: the 2012 birth cohort for infant deaths.

This is the first time that we have published 2013 figures on infant and childhood mortality, based on occurrences. It is also the first time that the 2012 birth cohort data for infant deaths have been published.

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3. Background

Although infant mortality rates have continued to fall in England and Wales over the past 30 years, the rates of change varied over the period. The change in the first half of the period was more than twice that in the second half. General improvements in healthcare and more specific improvements in midwifery and neonatal intensive care can partly explain the overall fall in the rate of change (National Children’s Bureau, 2014).

Despite the downward trend, evidence in the Marmot Review: Fair Society, Healthy Lives noted that factors, including births outside marriage, maternal age under the age of 20 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’.

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4. Infant and perinatal mortality rates

There were 2,686 infant deaths in England and Wales in 2013, resulting in an infant mortality rate of 3.8 deaths per 1,000 live births (the lowest rate ever recorded in England and Wales). Since 1983, when the rate was 10.1 deaths per 1,000 live births, there has been a 62% fall in infant mortality rates in England and Wales. This continues the overall decline in infant mortality rates in England and Wales over the past 30 years (Figure 1). The infant mortality rate in 2012 was 4.0 deaths per 1,000 live births.

Over the same period, 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). The neonatal mortality rate fell by 54%, from 5.9 deaths per 1,000 live births in 1983, to 2.7 deaths per 1,000 live births in 2013. The postneonatal mortality rate fell by 72% over the same period, from 4.3 deaths per 1,000 live births in 1983, to 1.2 deaths per 1,000 live births in 2013.

In 2013, there were 3,284 stillbirths and 1,423 deaths at age under 7 days, resulting in a perinatal mortality rate of 6.7 deaths per 1,000 total births. Since 1983, when the perinatal mortality rate was 10.4 deaths per 1,000 total births, the rate has fallen by more than a third.

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5. Linking birth and death records

Linking birth and infant death records improves our understanding of the key characteristics of the baby’s parents that were registered on the birth registration record (background note 4). In 2013, 98% of infant deaths in England and Wales were successfully linked to their corresponding birth registration record. The linkage rate for infant deaths has remained consistent since the linking exercise began.

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6. Cause of infant deaths

The broad ONS cause groups showed that immaturity-related conditions, for example, respiratory and cardiovascular disorders, were the most common cause of infant deaths in 2013, with 44% due to these causes. Immaturity-related conditions accounted for 14% of all postneonatal deaths and 57% of all neonatal deaths. Congenital anomalies were another major cause group, accounting for 28% of all infant deaths. Congenital anomalies accounted for 32% of all postneonatal deaths and 27% of all neonatal deaths.

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7. Age of mother at birth

The infant mortality rate for all infant deaths linked to their corresponding birth registration record was 3.8 deaths per 1,000 live births in 2013. For these linked deaths, infant mortality rates were lowest for babies of mothers aged 25 to 29 years (3.4 deaths per 1,000 live births) and highest for mothers aged under 20 years (6.1 deaths per 1,000 live births).

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8. Birthweight

Low birthweight, one of the known risk factors for infant deaths, can be caused by a number of factors. For example, smoking has been identified as a major risk factor contributing to low birthweight. Babies born to women who smoke weigh, on average, 200g less than babies born to non-smokers (NHS, Why should I stop smoking if I’m pregnant?).

In 2013, the infant mortality rates for very low birthweight babies (under 1,500 grams) and low birthweight babies (under 2,500 grams) were 164.0 and 32.4 deaths per 1,000 live births respectively. This is much higher than the rate of 1.3 deaths per 1,000 live births among 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 (44.8 deaths per 1,000 live births) and lowest among mothers aged 40 and over (28.9 deaths per 1,000 live births) (Figure 2).

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9. Socio-economic status

Significant differences in infant mortality rates by socio-economic group persist in England and Wales (Oakley et. al. 2009 (720.5 Kb Pdf)). One measure of social circumstances is that of occupational status. This information is collected at birth. Infant mortality rates were highest for the National Statistics Socio-economic Classification (NS-SEC) groups describing routine and manual occupations (Groups 5 to 7) with 5.4 deaths per 1,000 live births (the three-class version of NS-SEC has been used, there is more information in background note 9). In contrast there were 2.2 deaths per 1,000 live births for higher managerial, administrative and professional occupations (Groups 1.1, 1.2 and 2) and 3.2 deaths per 1,000 live births for intermediate occupations (Groups 3 and 4). For the 2012 data year onwards, the way that socio-economic status is reported has changed; details can be found in background note 8.

Similar patterns in perinatal mortality by socio-economic group were recorded, with mortality rates highest for the NS-SEC groups describing routine and manual occupations (8.3 deaths per 1,000 total births). Higher managerial, administrative and professional occupations had a perinatal mortality rate of 5.1 deaths per 1,000 total births while for intermediate occupations the rate was 6.5. These variations may be the result of the link between lower socio-economic status and poorer maternal health, which can ultimately affect infant mortality rates (Oakley et. al. 2009 (720.5 Kb Pdf)).

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10. Mother’s country of birth

The infant mortality rate for babies of mothers born outside the UK was 4.2 deaths per 1,000 live births compared with 3.6 deaths per 1,000 live births for mothers born inside the UK. The highest infant mortality rates were for babies of mothers born in the Caribbean (9.0 deaths per 1,000 live births) and mothers born in Central Africa (8.3 deaths per 1,000 live births) (please note this rate has been calculated from fewer than 20 deaths and its reliability as a measure maybe affected by the small number of events). Babies of mothers born in the Caribbean also had the highest stillbirth rate (8.3 deaths per 1,000 total births). 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.

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11. Child mortality rates

Between 1983 and 2013, the age-specific mortality rate for children aged 1 to 14 years fell by 66%, from 29 deaths per 100,000 population in 1983 to 10 deaths per 100,000 in 2013. The age-specific mortality rate for children aged 1 to 4 years also fell by 66% over the same period, from 44 deaths per 100,000 population in 1983 to 15 deaths per 100,000 in 2013. 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 generally. In 2013, congenital related conditions and cancers were the most common form of death for children aged under 16 years.

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12. Birth cohort for infant deaths 2012

Singleton and multiple births using the 2012 birth cohort tables

Of the 729,674 live births in 2012, a total of 2,939 infants had died before their first birthday, resulting in an infant mortality rate of 4.0 deaths per 1,000 live births. There were 3,558 stillbirths and 1,577 deaths at age under seven days over the same time period, resulting in a perinatal mortality rate of 7.0 deaths per 1,000 total births (live births and stillbirths).

The infant mortality rate for multiple births in the 2012 birth cohort was nearly five times higher than for singletons (17.7 deaths per 1,000 live births compared with 3.6 deaths per 1,000 live births). This was most marked in the first 28 days of life (neonatal deaths) when the mortality rate for multiple births was nearly six times higher than for singletons (13.8 deaths per 1,000 live births compared with 2.4 deaths per 1,000 live births). For those who survived beyond their first month but died before their first birthday (postneonatal deaths), the mortality rate was over three times higher for multiple births (3.9 per 1,000 live births) compared with singleton births (1.1 deaths per 1,000 live births) (Figure 3).

On average multiple births tend to have lower birthweights than singletons, which is one reason why the infant mortality rate is around five times higher for multiple births than for singleton births. Just over half of multiple birth babies (56% of those with a known birthweight) were low birthweight (less than 2,500 grams) and 8.9% of those with a known birthweight were very low birthweight (less than 1,500 grams) (Figure 4). Multiple pregnancies are also associated with a higher risk of stillbirth, death under 28 days and child disability (Human Fertilisation and Embryology Authority (HFEA)).

In contrast, 5.4% of singletons were born with a low birthweight and 0.9% were very low birthweight. The main reason why multiple birth babies tend to have lower birthweight than singleton babies is because multiple births rarely go to term.

The highest infant mortality rates were for the extremely low birthweight babies (less than 1,000 grams). For singletons the rate was 316.3 deaths per 1,000 live births and for multiples the rate was 331.5 deaths per 1,000 live births.

Although most multiple births occur naturally, many occur as a result of fertility treatment. On average, 1 in 5 of In Vitro Fertilisation (IVF) pregnancies result in multiple births compared with 1 in 80 for women who conceive naturally (HFEA). With approximately 17,800 IVF babies born in the UK in 2012, this contributes considerably to the multiple birth rate (HFEA, 2014). In 2009, the Human Fertilisation and Embryology Authority launched the elective single embryo transfer (eSET) policy, which 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 (HFEA).

Age of mother at birth using the 2012 birth cohort tables

Nearly two-thirds (64%) of all multiple births in 2012 were to women aged 30 years or over compared with 49% of all singleton births. The 2012 birth cohort tables for infant deaths show that mothers aged under 20 years have the highest infant mortality rate for singletons (5.9 deaths per 1,000 live births). Younger mothers (under 20 years) also have the highest infant mortality rate for multiple births (36.1 deaths per 1,000 live births).

Marital status and registration type using the 2012 birth cohort tables

The infant mortality rate for babies born inside marriage was lower than for those born outside marriage. The 2012 birth cohort for infant deaths shows that for singletons, there were 3.1 deaths per 1,000 live births inside marriage and 4.1 deaths per 1,000 live births outside marriage. For multiple births there were 15.2 deaths per 1,000 live births inside marriage and 21.2 deaths per 1,000 live births outside marriage.

The infant mortality rate for singletons was highest for those registered solely by their mother, or registered jointly by parents living at different addresses (5.9 and 4.9 deaths per 1,000 live births respectively). For multiple births the infant mortality rate was highest for those jointly registered by both parents living at different addresses (25.3 deaths per 1,000 live births) compared with 21.7 deaths per 1,000 live births for those jointly registered by parents living at the same address. The very small numbers in these groups affects the robustness of estimated mortality rates. Differences in mortality rates by marital status and birth registration type will also reflect complex underlying factors including mother’s age and social circumstances (Messer, 2011).

For married women the infant mortality rate for singleton births was higher for women who have previously had three or more children (4.7 deaths per 1,000 live births) compared with women who have had no previous children (3.5 deaths per 1,000 live births). Other factors may be relevant here, especially the mother’s age. For multiple births, the infant mortality rate was higher for women who have previously had two children (16.4 deaths per 1,000 live births).

Socio-economic status using the 2012 birth cohort tables

The 2012 birth cohort tables for infant deaths show that for singleton births, the highest infant mortality rate was for the NS-SEC groups describing routine and manual occupations (Groups 5 to 7) with 5.0 deaths per 1,000 live births (the three-class version of NS-SEC has been used, background note 9 has more detail). In contrast there were 2.0 deaths per 1,000 live births for higher managerial, administrative and professional occupations (Groups 1.1, 1.2 and 2) and 3.0 deaths per 1,000 live births for intermediate occupations (Groups 3 and 4). The same pattern was found for multiple births where there were smaller numbers, although the infant mortality rate for each group was between four and seven times higher than for singletons. For the 2011 data year onwards, the way in which socio-economic status is reported has changed; details can be found in background note 8.

Studies have shown that infant mortality rates are comparatively higher for low income families (Duncan and Brooks-Gunn, 2000). Mothers from routine and manual occupation are less likely to breastfeed (NICE, 2008) which can result in poorer immunity and poorer digestive health for the baby.

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13. Users and uses of infant mortality statistics

Infant mortality is seen as a key measure among health outcomes and there is a long established link between social and health inequalities, and infant mortality. The Department of Health (DH) is a key user of child mortality statistics. Infant mortality continues to take a central role in DH’s work on tackling health inequalities within the NHS Outcomes Framework 2014/15 and the Public Health Outcomes Framework.

There are also two specific users of the birth cohort data; the Department of Midwifery and Child Health, City University London; and Public Health England, who provide information and intelligence to improve decision making for policy makers, commissioners, managers, regulators, and other health stakeholders working on children's, and maternal health, for example by providing service snapshots for infant mortality and stillbirths for local areas.

Other users of infant mortality data include academics, independent researchers, charities and media.

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14. Changes to child mortality outputs

Changes to child mortality publications were outlined in an information note, available on our website. These changes are being implemented.

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15 .Further information

More data on childhood, infant and perinatal mortality statistics in England and Wales in 2013 are available on our website.

All data for the birth cohort tables for infant deaths in England and Wales in 2012 are available on our website.

A Quality and Methodology Information document for Child mortality statistics is available on our website.

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

Gestation-specific infant 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 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 please see the latest Vital Statistics: Population and Health Reference Tables.

The Births summary tables, England and Wales provide key 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 (2.7 Mb Pdf) .

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16 .References

Department of Health (DH) (2013) Public Health Outcomes Framework

Department of Health (DH) (2013) NHS Outcomes Framework

Duncan, G. and Brooks-Gunn, J. (2000) ‘Family Poverty, Welfare Reform, and Child Development’, Child Development, Vol. 71, No. 1, pp. 188–196

Human Fertilisation and Embryology Authority (HEFA), Multiple births and single embryo transfer review

Human Fertilisation and Embryology Authority (HEFA) (2014), Fertility Treatment in 2013: trends and figures

Marmot, M. (2010) ‘Fair Society, Healthy Lives – Strategic Review of Health Inequalities in England post-2010’. London: The Marmot Review

Messer, J. (2011) ‘An analysis of socio-demographic characteristics of sole registered births and infant deaths’, Health Statistics Quarterly 50, pp 79–107

National Children’s Bureau (NCB) (2014) Why children die: death in infants, children and young people in the UK

National Health Service, Why should I stop smoking if I’m pregnant? [accessed 4 March 2015]

National Institute for Health and Care Excellence (NICE) (2008) Maternal and child nutritio

Oakley, L., et al (2009) ‘Multivariate analysis of infant death in England and Wales in 2005–06, with focus on socio-economic status and deprivation’, Health Statistics Quarterly 42, pp 22–33

Office for National Statistics (ONS) (2011) Results from the ICD-10 v2010 bridge coding study: stillbirths and neonatal deaths

Office for National Statistics (ONS) (2009) Results of the ICD-10 v2010 bridge coding study, England and Wales, 2009

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17 .Background notes

  1. The live birth and stillbirth numbers are based on all births that occurred in the reference year, plus any late birth registrations from the previous year. Infant and child mortality figures are based on deaths that occurred in the reference year and may differ from previously published figures based on deaths registered in a reference year.

  2. In the birth cohort tables, the infant death figures are based on babies born in 2012 who died before their first birthday: the 2012 birth cohort for infant deaths. This includes babies who died either in 2012, or in 2013 and were under 1 year of age.

  3. We also publish infant mortality statistics according to the year in which the death was registered. Mortality data based on death registrations can include deaths that occurred in previous years, meaning that the total number of infant deaths based on death registrations may differ from the total number of infant deaths used in this statistical bulletin. Figures based on death registrations provide more timely infant mortality statistics.

  4. The linkage of infant death records to their corresponding birth registration record has been conducted since 1975 to obtain information on social and biological factors of the baby and parents collected at birth registration. These include the baby’s birthweight; mother's age; mother's country of birth; father's socio-economic status (based on his occupation); and the number of previous children born. The main reasons for an infant death not being linked are either; a birth registration record cannot be found, or the birth was registered outside England and Wales.

  5. Definitions used in child mortality statistics:

    Stillbirth – born after 24 or more weeks completed gestation and which did not, at any time, breathe or show signs of life
    Early neonatal – deaths under 7 days
    Perinatal – stillbirths and early neonatal deaths
    Neonatal – deaths under 28 days
    Postneonatal – deaths between 28 days and 1 year
    Infant – deaths under 1 year
    Childhood – deaths between 1 and 15 years of age
    Stillbirths and perinatal mortality rates are reported per 1,000 total births (live and stillbirths)
    Early neonatal, neonatal, postneonatal and infant mortality rates are reported per 1,000 live births
    Childhood mortality rates are reported per 100,000 population of the same age

  6. On 1 October 1992, the legal definition of a stillbirth was changed from a baby born dead after 28 or more weeks completed gestation to one born dead after 24 or more weeks completed gestation. This means that perinatal and stillbirth data for 2013 can only be compared with data from 1993 onwards.

  7. The National Statistics Socio-economic Classification (NS-SEC) has eight analytic classes, the first of which can be subdivided:
    1 Higher managerial and professional occupations
    1.1 Large employers and higher managerial occupations
    1.2 Higher professional occupations
    2 Lower managerial and professional occupations
    3 Intermediate occupations
    4 Small employers and own-account workers
    5 Lower supervisory and technical occupations
    6 Semi-routine occupations
    7 Routine occupations
    8 Never worked and long-term unemployed

    Students, occupations not stated or inadequately described, and occupations not classifiable for other reasons are added as ‘Not classified’.

  8. Up until the 2011 data year, we published child mortality and birth statistics by NS-SEC using the father’s NS-SEC. Historically, the decision to use father’s NS-SEC was based on the premise that many mothers either do not have a paid occupation or choose not to state their occupational details at birth registration.

    From the 2012 data year for child mortality data and the 2011 data year for birth cohort data, we have used the combined method for reporting NS-SEC for birth statistics (using the most advantaged NS-SEC of either parent and creating a household level classification rather than just using the father’s classification). These changes mean that figures from the 2012 data year onwards are not directly comparable with previous years.

  9. The three-class version of the National Statistics Socio-economic Classification (NS-SEC) has been used to report infant and perinatal mortality rates in this bulletin. Those who have never worked and the long-term unemployed have not been included as a separate group due to very small numbers. More information on the three-class version of NS-SEC is available on our website.

  10. The population estimates used for the calculation of mortality rates are the latest consistent estimates available at the time of production. Further information on population estimates and their methodology can be found on our website.

  11. The Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD–10) has been used to classify cause of death at age 28 days and above.

  12. A hierarchical classification in ICD–10 has been developed by ONS for statistics relating to stillbirths and neonatal deaths. These are derived from a special death certificate (instead of the standard death certificate), introduced in 1986. More information on neonatal and stillbirth cause of death certificates can be found in section 2.9 of Child mortality statistics metadata (163.2 Kb Pdf) .

  13. In January 2011, we began using ICD-10 v2010. A bulletin presenting the main findings from a Bridge Coding Study of 2009 Stillbirth and Neonatal Death Registrations (in which deaths were independently coded using v2001.2 and v2010), is available to help users understand the impact of this change on perinatal mortality statistics for England and Wales. The impact of ICD–10 v2010 on other deaths has been investigated in a separate study.

  14. A list of the names of those given pre-publication access to the statistics and written commentary is available in pre-release access - Child Mortality Statistics. The rules and principles which govern pre-release access are featured within the Pre-release Access to Official Statistics Order 2008.

  15. Special extracts and tabulations of child mortality data for England and Wales are available to order (subject to legal frameworks, disclosure control, resources and agreements of costs, where appropriate). Such enquiries should be made to:

    Vital Statistics Outputs Branch
    Life events and Population Sources Division
    Office for National Statistics
    Segensworth Road
    Titchfield
    Fareham
    Hampshire
    PO15 5RR

    Tel: +44 (0)1329 444 110
    E-mail: vsob@ons.gsi.gov.uk

    The ONS charging policy is available on our website. In line with the ONS approach to open data, all ad hoc data requests will be published onto the website.

  16. We would welcome feedback on the content, format and relevance of this release. Please send feedback to the postal or email address above.

  17. Follow us on Twitter, Facebook and LinkedIn.

  18. Details of the policy governing the release of new data are available by visiting www.statisticsauthority.gov.uk/assessment/code-of-practice/index.html or from the Media Relations Office email: media.relations@ons.gsi.gov.uk

    The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics.

    Designation can be broadly interpreted to mean that the statistics:

    • meet identified user needs
    • are well explained and readily accessible
    • are produced according to sound methods
    • are managed impartially and objectively in the public interest

    Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed.

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Contact details for this Statistical bulletin

Elizabeth McLaren
vsob@ons.gsi.gov.uk
Telephone: +44 (0)1329 444110