New JSNA: This is the test site for the new Joint Strategic Needs Assessment

Infant Mortality

Introduction

While the rate of infant mortality in Reading is similar to the national average, residents who are less affluent and living in more deprived areas are likely to be disproportionately affected by a range of risk factors. Although Reading's population is largely affluent, there are areas of deprivation within the borough (Reading Borough Council, 2015) where risk of infant mortality may be higher than average.

What do we know?

Infant mortality is considered a useful indicator of maternal and newborn health and care and is usually expressed as the number of deaths in children under the age of one year, per 1,000 live births (sometimes known as the Infant Mortality Rate or IMR). This takes into account both: 

  • neonatal deaths (those occurring during the first 28 days of life) (the neonatal mortality rate), and 
  • the number of infants who die between 28 days and less than one year (the post-neonatal mortality rate). 

Between 2012 and 2014, 33 children in Reading died before their 1st birthday - a rate of 4.2 per 1,000 live births. This is slightly higher than the infant mortality rate of 4.0 per 1,000 live births for England in the same period, but within the range considered statistically similar to the England average. 

Figure 1: IMR in Reading and England (Public Health Outcomes Framework Indicator 4.01)

Figure 1 IMR
Figure 1 IMR

Source: Public Health Outcomes Framework

Improvements in general healthcare, midwifery and neonatal care have contributed to a continual decrease in the rate of infant mortalities in England and Wales since the early 1900's and the rate of this decrease increased substantially between the 1980's and 1990's. In 2014, as in previous years, mortality rates were much higher in babies of low birth weight, which is often linked to smoking in pregnancy, and in babies born to families with lower incomes. Analysis by the Office of National Statistics (ONS) also confirmed that significant differences in rates of infant and perinatal  mortality continued to exist between socioeconomic groups. These differences have been attributed to poorer maternal health, including greater prevalence of smoking during pregnancy in lower income and routine and manual occupation groups (ONS, 2016). 

Figure 2: Infant and Perinatal Mortality Rate by Socioeconomic Status

‚ÄčFigure 2
Figure 2

Source: ONS 2016

The number of infant deaths in the population is low and when broken down into deaths occurring in smaller areas the numbers become too small to make confident assertions about local trends. The data in Figure 3 shows combined infant mortality rate for 2006-2013 by ward and suggest that the greater numbers of infant deaths in Reading are clustered in ward areas with higher levels of deprivation. Although the wide confidence intervals indicate that this conclusion may not be statistically robust, the results are well supported by various published evidence based on national data. 

Figure 3: Pooled Infant Mortality Rate 2006-2013 by Reading ward

Figure 3
Figure 3

Source: Primary Care Mortality Database    

Risk factors for infant mortality are complex and interconnected. There are clear links with low birth weight, smoking in pregnancy and higher levels of deprivation, and commentators have also highlighted obesity during pregnancy, ethnicity and country of mother's birth, maternal age (especially for those aged under 17 years), whether the mother has previously experienced a stillbirth, and the presence of infection (Parliamentary Office of Science and Technology, 2016; ONS 2016).

Low Birth Weight - Babies born weighing less than 2,500 grams are at much higher risk of infant mortality and of poor health outcomes through infancy and childhood and in the longer term. Those born to mothers who smoked during pregnancy, who had a poor diet before and during pregnancy, or who are aged younger than 17 years or older than 35 years, and babies born before 37 weeks of pregnancy are at greatest risk of having low birth weight. The latest information published by Public Health England shows that, in 2014, 3% of babies born at term in Reading had a low birth weight (similar to the England average of 2.9%) (Public Health Outcomes Framework, Indicator 2.01) and between 2012 and 2014 76.4 per 1,000 births in Reading were premature (again, similar to the England average of 77.6 per 1,000 births) (Local Tobacco Control Profiles) (see figures 3 and 4 below). 

Figure 4: Low birth weight of term babies in Reading compared to England average

Figure 4
Figure 4

Source: Public Health Outcome Framework (Indicator 2.01)

Figure 5: Premature births (less than 37 weeks gestation) in Reading compared to England average

Figure 5
Figure 5

Source: Local Tobacco Control Profiles

Smoking in Pregnancy - In 2014/15, 7.4% of new mothers in Reading in were estimated to be current smokers at the time of giving birth, significantly better than the England average of 11.4% and 12% for areas with similar levels of deprivation to Reading (Public Health England Health Profile - Children and Young People's Health, from KIT East from the Health and Social Care Information Centre's return on Smoking Status At Time of delivery (SSATOD.) 

Figure 6: Percentage of women smoking at time of delivery in Reading compared to England average

Figure 6
Figure 6

Public Health England Health Profile - Children and Young People's Health, from KIT East from the Health and Social Care Information Centre's return on Smoking Status At Time of delivery (SSATOD.)

Deprivation - Whilst Reading benefits from high employment and high earnings, there are some areas in the borough that are experiencing high and rising levels of deprivation. Between the 2001 census and the most recent census in 2011, two areas in South Reading (the far south of Whitley ward and to the south of Northumberland Avenue in Church ward) fell into the 10% most deprived areas in England. Smoking, poor maternal health and other factors related to infant mortality tend to be more prevalent in more deprived populations (Reading Borough Council, 2015). As elsewhere, smoking prevalence is all adults is higher in those employed in routine and manual occupations (Public Health England, Local Tobacco Control Profiles, 2015)

Teenage Pregnancy - There is evidence that low birth weight and premature birth are more common in babies born to mothers aged 17 and younger (DCSF/DH, 2010; Fraser, Brockert and Ward, 1995). Teenage conceptions are also positively associated with deprivation, unemployment and children living in poverty (ONS, 2013). The rate of teenage pregnancy in Reading has fallen almost every year in the last ten years and is now statistically similar to the average rates for England and for Local Authority areas with similar levels of deprivation (Public Health Outcomes Framework, Indicator 2.04).

National and Local Strategies 

There are a range of complex and interconnected risk factors for infant mortality, many of which are related or correlated to deprivation and living in poverty. A recent report by PHE analysing factors surrounding infant mortality in London highlights the key role of targeting mothers and babies living in poverty in reducing infant mortality (PHE, 2015). The report recommends local coordination and care pathways to identify those at risk before conception or birth to reduce the chance of infant death. This includes improving access to contraception and sexual health advice for the most vulnerable and helping to identify women in the early weeks of pregnancy. 

Reading Borough Council's strategy to reduce inequalities affecting the most deprived people living in Reading takes particular account of the need to reduce rates of teenage pregnancy and increase employment, education and training opportunities for vulnerable and disadvantaged young people (See Tackling Poverty in Reading). 

The National Institute for Health and Care Excellence (NICE) has published evidence-based recommendations for helping pregnant women and their partners to stop smoking and for reducing the rates of teenage pregnancy. 

Smoking in Pregnancy

NICE recommends that midwives and other health professionals (such as GPs, obstetricians, family nurses) explain the health benefits of quitting and refer those who smoke and partners who smoke to smoking cessation services; midwives should assess pregnant women's exposure to tobacco smoke, through discussion and using a carbon monoxide test, and review at subsequent appointments. Smoking cessation providers should ensure they contact all pregnant women referred to them and provide telephone advice or self-help materials to those who do not attend. 

Local smoking cessation services are provided in Reading by Smokefreelife Berkshire. They offer services from the Royal Berkshire Hospital maternity wing where they can support new mothers and fathers to quit.

Reducing Rates of Teenage Pregnancy 

NICE recommends that sexual health services are provided to deliver one-to-one sexual health and contraception advice and support for accessing advice about future education, training and employment targeted to vulnerable young people, including those from disadvantaged backgrounds, who are leaving care or who have low educational attainment (See https://www.nice.org.uk/guidance/ph3/chapter/1-Recommendations

A teenage pregnancy strategy and strategy group has been in place in Reading since 2001. Over the past 14 years, a wide range of services and targeted interventions have been commissioned and put in place to reduce teenage pregnancies. Over the last ten years a progressive downward trend in the teenage pregnancy rate in Reading has suggested that this local strategy is now starting to have a positive impact. 

What is this telling us?

Most of the key indicators associated with infant mortality for Reading are similar to the national average; however, those who are less affluent and living in more deprived areas are likely to be disproportionately affected by a range of risk factors. Although Reading's population is largely affluent, there are areas of extreme deprivation within the borough (Reading Borough Council, 2015) where risk of infant mortality may be higher than average.

Some of the risks are less clear than others. For instance, more information is needed about the relationship between ethnicity and parent's place of birth and the risk of infant mortality in order to fully understand the needs of Reading's ethnically diverse population.

What are the unmet needs or gaps in service?

Targeting resources on the most deprived and disadvantaged to reduce smoking in pregnancy, reduce teenage pregnancy, improve maternal nutrition and diet and improve and encourage access to maternal health services, especially in the early weeks of pregnancy, are likely to help to reduce the local rate of infant mortality. 

This section links to the following sections in the JSNA

Smoking in pregnancy

Deprivation

Teenage pregnancy

Also see: Tackling Poverty in Reading

References 

Parliamentary Office of Science and Technology (2016). Infant Mortality and Stillbirth in the UK. Available at: http://researchbriefings.files.parliament.uk/documents/POST-PB-0021/postpn527_UK_Infant_Mortality_and_Stillbirth_online.pdf (online). [Accessed 1st November 2016]. 

Reading Borough Council (2015). Overview of Poverty Factsheet. Available at: http://www.reading.gov.uk/media/2290/Overview-of-Poverty-Factsheet/pdf/general_deprivation_factsheet_2015.pdf (online). [Accessed 1st November 2016].

Department of Children, Schools and Families and the Department of Health (2010). Teenage Pregnancy Strategy: Beyond 2010. (DCSF, Nottingham). Available at https://www.education.gov.uk/consultations/downloadableDocs/4287_Teenage%20pregnancy%20strategy_aw8.pdf [Accessed 3rd November 2016]. 

Fraser, AM, Brockert, JE, and Ward, RH. (1995). Association of young maternal age with adverse reproductive outcomes. The New England Journal of Medicine. 332, 17, 1113-1117. Available at http://www.nejm.org/doi/full/10.1056/NEJM199504273321701#t=article [Accessed 3rd November 2016]. 

Office of National Statistics (ONS) (2013). An Analysis of under 18 conceptions and their links to measure of deprivation, England and Wales, 2008-2010. Available at: http://webarchive.nationalarchives.gov.uk/20160105160709/http://www.ons.gov.uk/ons/dcp171766_299768.pdf [Accessed 3rd November 2013].

 

Switch To High Contrast Mode