Infant mortality and mother’s country of birth- what information is currently available? Nicola Dennis- Knowledge Transfer Facilitator, KIT(WM), PHE

Infant mortality and ethnicity Topics 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 2Infant mortality and ethnicity

Long term trend 3Infant mortality and ethnicity Source: PHOF

West Midlands infant mortality rates Source: ChiMat infant mortality profiles 4Infant mortality and ethnicity

5 England Local authority rate

Further breakdowns As 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) 6Infant mortality and ethnicity

West Midlands stillbirth rates Source: ChiMat infant mortality profiles 7Infant mortality and ethnicity

West Midlands perinatal mortality rates Source: ChiMat infant mortality profiles 8Infant mortality and ethnicity

West Midlands neonatal mortality rates Source: ChiMat infant mortality profiles 9Infant mortality and ethnicity

West Midlands post neonatal mortality Source: ChiMat infant mortality profiles 10Infant mortality and ethnicity

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 11Infant mortality and ethnicity

Country of birth, 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. Source: Child Mortality Statistics: Childhood, Infant and Perinatal,

Country of birth, 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. Information currently not available for the WM

Live births: country of birth of mother, Infant mortality and ethnicity Source: ONS: Parents' Country of Birth, England and Wales 2013

Live births: country of birth of mother, Infant mortality and ethnicity Source: ONS: Parents' Country of Birth, England and Wales 2013

Live births: country of birth of mother, Infant mortality and ethnicity Source: ONS: Parents' Country of Birth, England and Wales 2012, 2013

Live births: country of birth of mother, Infant mortality and ethnicity 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? 18Infant mortality and ethnicity

Country of birth, 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.

Country of birth, 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.

Country of birth, Infant mortality and ethnicity

Country of birth, Infant mortality and ethnicity

Changes over time 23Infant mortality and ethnicity

Changes over time 24Infant mortality and ethnicity

Changes over time 25Infant mortality and ethnicity

Distribution by region, Infant mortality and ethnicity Source: ONS: Parents' Country of Birth, England and Wales 2013

Maternal deaths Non-UK born mothers are also at higher risk of maternal death 27Infant mortality and ethnicity

Maternal deaths by country 28Infant mortality and ethnicity Source: CMACE, MBRRACE-UK

Maternal deaths “Women born outside the UK were significantly more likely to die than those born in the UK (RR 1.77, 95% CI ). Women born in Nigeria had the highest maternal mortality rate (34.2 per 100,000 maternities, 95% CI ). 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 , Page 19 uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf 29Infant mortality and ethnicity

Further information Nicola Dennis: ChiMat infant mortality information: 30Infant mortality and ethnicity