Infant and child deaths in England and Wales increased in 2021 compared with the previous year but did not buck an overall downward trend of the last 40 years, new official figures showed. However, the Government's ambition to halve the neonatal mortality rate for babies, and the stillbirth rate, by the middle of the current decade continued to recede, according to the Office for National Statistics (ONS).
There were 2323 infant deaths and 852 child deaths in 2021 – up from 2226 and 789, respectively. That equated to a child mortality rate of 8 deaths per 100,000 of the population, and an infant mortality rate of 3.7 deaths per 1000 live births.
Statisticians said the figures for both 2020 and 2021 were in line with an overall declining trend since records began in the 1980s, and contrasted with an infant mortality rate of 12.0 deaths per 1000 live births recorded in 1980. They suggested that the overall decline in infant mortality probably reflected improvements made in antenatal and neonatal care.
In England, the West Midlands continued to have the highest infant mortality rate (5.6 deaths per 1000 live births), and the South West the lowest (2.5 deaths per 1000 live births). Across Wales, the infant mortality rate was 3.6 deaths per 1000 live births. Wales reported 103 infant deaths during 2021.
Causes of Death
The main causes of death among infants and children aged 28 days to 15 years continued to be congenital malformations, deformations, and chromosomal abnormalities. Immaturity-related conditions accounted for 48.7% of neonatal deaths, with congenital anomalies and antepartum infections 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. The ONS highlighted that this was lower than the equivalent figure of 13.3% for the general population that year.
Among other key findings in the analysis:
- Low birthweight babies, weighing less than 2500g, had an infant mortality rate of 30.2 deaths per 1000 live births in 2021 – an increase from 27.9 deaths per 1000 live births the previous year.
- Normal birthweight babies, weighing 2500g or over, had an infant mortality rate of 0.8 deaths per 1000 live births, which the ONS found consistent with the 2020 rate.
- Babies from the Black ethnic group continued to have the highest rates of death, followed by those from the Asian ethnic group. Infant mortality rates in both those ethnic groups increased in 2021 in comparison with 2020.
- Babies born to mothers aged 30 to 34 years had the lowest risk of infant mortality, at 3.1 deaths per 1000 live births, whilst babies born to mothers aged under 20 years had the highest risk, at 5.7 deaths per 1000 live births.
Neonatal and Stillbirth Mortality Targets
The ONS analysis suggested that fewer stillbirths and neonatal deaths were needed to meet the Government's ambition to halve the neonatal mortality rate of 2010 for babies born at a gestational age of 24 weeks or over, as well as the stillbirth rate, by 2025.
A target rate for England was set at 1.0 neonatal deaths per 1000 live births, but in 2021 the rate was 1.4 per 1000 live births. Achieving that 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, statisticians calculated.
While the ambition for England was 2.6 stillbirths per 1000 live births by 2025, the 2021 stillbirth mortality rate stood at 4.1 per 1000 live births, which was at least 896 stillbirths behind the target number, the analysis showed.