Inequalities In Infant Mortality Research Articles

Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019

Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. UK National Institute for Health and Care Research.

Decomposing Socio-Economic Inequalities in Infant Mortality in Punjab, Pakistan

Decomposing Socio-Economic Inequalities in Infant Mortality in Punjab, Pakistan

Inequalities of Infant Mortality in Ethiopia.

(1) Background: Infant mortality is viewed as a core health indicator of overall community health. Although globally child survival has improved significantly over the years, Sub-Saharan Africa is still the region with the highest infant mortality in the world. In Ethiopia, infant mortality is still high, albeit substantial progress has been made in the last few decades. However, there is significant inequalities in infant mortalities in Ethiopia. Understanding the main sources of inequalities in infant mortalities would help identify disadvantaged groups, and develop equity-directed policies. Thus, the purpose of the study was to provide a diagnosis of inequalities of infant mortalities in Ethiopia from four dimensions of inequalities (sex, residence type, mother's education, and household wealth). (2) Methods: Data disaggregated by infant mortalities and infant mortality inequality dimensions (sex, residence type, mother's education, and household wealth) from the WHO Health Equity Monitor Database were used. Data were based on Ethiopia's Demographic and Health Surveys (EDHS) of 2000 (n = 14,072), 2005 (n = 14,500), 2011 (n = 17,817), and 2016 (n = 16,650) households. We used the WHO Health Equity Assessment Toolkit (HEAT) software to find estimates of infant mortalities along with inequality measures. (3) Results: Inequalities related to sex, residence type, mother's education, and household wealth still exist; however, differences in infant mortalities arising from residence type, mother's education, and household wealth were narrowing with the exception of sex-related inequality where male infants were markedly at a disadvantage. (4) Conclusions: Although inequalities of infant mortalities related to social groups still exist, there is a substantial sex related infant mortality inequality with disproportional deaths of male infants. Efforts directed at reducing infant mortality in Ethiopia should focus on improving the survival of male infants.

Female political representation and the gender health gap: a cross-national analysis of 49 European countries.

BackgroundDoes increased female participation in the social and political life of a country improve health? Social participation may improve health because it ensures that the concerns of all people are heard by key decision-makers. More specifically, when women’s social participation increases this may lead to health gains because women are more likely to vote for leaders and lobby for policies that will enhance the health of everyone. This article tries to examine whether female participation is correlated with measures of health inequality.MethodsWe draw on data from the World Health Organization Health Equity Status Report initiative and the Varieties of Democracy project to assess whether health is better and health inequalities are smaller in countries where female political representation is greater.ResultsWe find consistent evidence that greater female political representation is associated with lower geographical inequalities in infant mortality, smaller inequalities in self-reported health (for both women and men) and fewer disability-adjusted life-years lost for women and men. Finally, we find that greater female political representation is not only correlated with better health for men and women but is also correlated with a smaller gap between men and women because men seem to experience better health in such contexts.ConclusionsGreater female political representation is associated with better health for everyone and smaller inequalities.

Transitory inequalities: how individual-level cause-specific death data can unravel socioeconomic inequalities in infant mortality in Maastricht, the Netherlands, 1864–1955

ABSTRACT The decline in infant mortality played a crucial role in the health transition in the Western World. This decline among the vulnerable new-borns was however not an evenly dispersed process. Inequalities as a result of regional differences, cultural influences or socioeconomic status shaped the paths towards low mortality rates. The role of socioeconomic status in levels of infant mortality and its decline remain highly debated. In this article, we study the development of socioeconomic disparities in infant mortality in the Dutch town of Maastricht in the period 1864–1955. This study uses unique individual-level cause of death data in order to see when changes in disease patterns took place for different socioeconomic groups. The aim is to identify socioeconomic inequalities by mapping changing epidemiological patterns over time, according to age within the first year of life. By deploying a multinomial logistic regression analysis we can trace the different timing of changes in the epidemiological regime. The results reveal that for most infants the change in mortality patterns from water- and foodborne infectious diseases towards a predominance of airborne infectious diseases occurred simultaneously with the massive decline in infant mortality from the start of the First World War onwards. Infants from the upper classes, however, appeared to have gained an earlier advantage, followed by infants from unskilled workers. Finally, from qualitative data it becomes clear that the awareness of the problematic nature of infant mortality, knowledge on infant care, hygienic practices, breastfeeding practices and the economic situation of World War I were factors aiding to the uneven decline in infant mortality.

The evolution of infant mortality and neighbourhood inequalities in four world cities: 1988-2016.

To determine the level of neighbourhood inequalities in infant mortality (IM) rates in the urban core of four world cities and to examine the association between neighbourhood-level income and IM. We compare our findings with those published in 2004 to better understand how these city health systems have evolved. We compare IM rates among and within the four cities using data from four periods: 1988-1992; 1993-1997; 2003-2008 and 2012-2016. Using a maximum-likelihood negative binomial regression model that controls for births, we predict the relationship between neighbourhood-level income and IM. IM rates have declined in all four cities. Neighbourhood-level income is statistically significant for New York and, for the two most recent periods, in Paris. In contrast, there is no significant relationship between neighbourhood income and IM in London or Tokyo. Despite programmes to reduce IM inequalities at national and local levels, these persist in New York. Until the early part of this century, none of the other cities experienced a relationship between neighbourhood income and IM, but growing income inequalities within Paris have changed this situation. Policy-makers in these cities should focus on better understanding the social and economic factors associated with neighbourhood inequalities in IM.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Inequality of opportunity in infant mortality in South Asia: A decomposition analysis of survival data

Early-life environments into which newborn babies are born play principal roles in their development. This study explores inequalities in infant mortality that are rooted in household and parental socio-economic backgrounds in five South-Asian countries: Afghanistan, Bangladesh, India, Nepal and Pakistan. Considering multidimensional aspects of socio-demographic and socio-economic status, this study explores disparities in the trajectory of survival rates across infants with dissimilar circumstantial backgrounds over the first 12 months of their lives. This study proposes a new method to first cluster the data into advantaged and disadvantaged types and explore the differences in survival rates by a clustering approach and a random survival forest. Furthermore, this study extends a Shapley-value decomposition method to explore the determinants of inequality. The results indicate that demographic factors, parental educational background and household living standards are major factors contributing to inequality. In order to ameliorate the inequality of opportunity, priority should be given to protecting marginalised infants by compensating for their disadvantaged backgrounds.

General and infant mortality trends in Chile from 1909 to 2017

During the twentieth century, Chile experienced an important reduction in general mortality. To describe both general and infant mortality of Chile from 1909 to 2017. Analysis of information about births and deaths published by the Chilean National Institute of Statistics for the period between 1909 and 2017. Both general and infant mortality rates declined sharply from the 1930s to the late 1990s. However, during the last few years, general mortality rates increased slightly. This is the first increase in over a century. Another positive aspect is that there was a dramatic decrease in mortality rate gaps across Chilean regions, for both general and infant mortality. However, intraregional inequalities in infant mortality continue to be a detrimental factor. Public health efforts should be carried out to further reduce socioeconomic and regional gaps in adult and infant mortality in Chile.

Structural racism, racial inequities and urban–rural differences in infant mortality in the US

BackgroundWhile evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban–rural lines remains unexplored. The objective of this study was to...

Infant mortality inequities for\xa0M\u0101ori in New Zealand: a tale of three policies

BackgroundThe history of infant mortality inequities among Māori in New Zealand provides a remarkable case study for understanding the shortcomings of policy which fails to consider the differential risks associated with disadvantaged groups. Specifically, the failure of the initial 1991 reform in addressing Māori infant health, followed by the relative success of post-1994 policy, demonstrate that disadvantaged populations carry differential social risks which require adjusting policy accordingly. Literature on these policies show that differential risks may include disparities in representation, access to resources, socioeconomic status, and racism. The consideration of differential risks is important in analyzing the underlying causes of inequities and social policy deficiencies.AimTo describe and illustrate the need for policy addressing inequities to consider the differential risks associated with disadvantaged groups through an analysis of New Zealand’s Māori infant mortality policy progression.MethodsThe article is a commentary on a series of policies aimed at reducing infant mortality in New Zealand. It analyses three policies and how their differences are linked to the corresponding trends in equity between Māori and non-Māori populations.FindingsThe progression of Māori infant mortality policy clearly demonstrates that equitable social policy must be culturally sensitive and inclusive towards disadvantaged groups, as well as willing to adapt to changing circumstances and shortcomings of current policy. Prior to 1994, health policy which did not account for the differential risks of Māori populations caused inequities in infant mortality to increase, despite infant mortality decreasing on a national level. After policy was adjusted to account for Māori-specific risks in 1994, infant mortality inequities significantly declined. A comprehensive analysis of these policies shows that the consideration of differential risks is highly related to a decrease in corresponding inequities.ConclusionsAs New Zealand, and other countries facing inequities such as the United States and Australia, move forward in constructing policy, they would do well to consider the lessons of how New Zealand policy changed the frequency of infant mortality in Māori populations. The study shows that the consideration of differential risks associated with disadvantaged groups is necessary for policy to successfully address inequities.

Infant mortality among native-born children of immigrants in France, 2008-17: results from a socio-demographic panel survey.

BackgroundWithin Europe, France stands out as a major country that lacks recent and reliable evidence on how infant mortality levels vary among the native-born children of immigrants compared with the native-born children of two parents born in France.MethodsWe used a nationally representative socio-demographic panel consisting of 296 400 births and 980 infant deaths for the period 2008–17. Children of immigrants were defined as being born to at least one parent born abroad and their infant mortality was compared with that of children born to two parents born in France. We first calculated infant mortality rates per 1000 live births. Then, using multi-level logit models, we calculated odds ratios of infant mortality in a series of models adjusting progressively for parental origins (M1), core demographic factors (M2), father's socio-professional category (M3) and area-level urbanicity and deprivation score (M4).ResultsWe documented a substantial amount of excess infant mortality among those children born to at least one parent from Eastern Europe, Northern Africa, Western Africa, Other Sub-Saharan Africa and the Americas, with variation among specific origin countries belonging to these groups. In most of these cases, the excess infant mortality levels persisted after adjusting for all individual-level and area-level factors.ConclusionsOur findings, which can directly inform national public health policy, reaffirm the persistence of longstanding inequality in infant mortality according to parental origins in France and add to a growing body of evidence documenting excess infant mortality among the children of immigrants in Europe.

Lessons Learned from Implementing a Place-Based, Racial Justice-Centered Approach to Health Equity

As theories about the causes of racial inequities in infant mortality evolve, they are becoming increasingly complex. Interventions to address these inequities must be similarly complex, incorporating both upstream and downstream approaches. The Best Babies Zone Initiative (BBZ) has been in operation since 2012 with an aim of reducing racial inequities in infant mortality. BBZ is designed to be flexible and responsive to the conditions creating toxic stress in communities of color. After seven years of operation in nine sites across the United States, and interventions implemented in housing, economic, and environmental justice, the Initiative has identified strategies to support the development and advancement of aligned programs. Lessons learned and opportunities were identified across the Initiative's theoretical foundation (the life course perspective) and each of the four foundational strategies: place-based, community-driven, multi-sector work that contributes to broader social movements. Overarching lessons learned about advancing equity in MCH were identified including: the need to focus explicitly on racial equity, the imperative of shifting the time horizon for change, and the importance of identifying sustainable funding mechanisms. A complex initiative such as BBZ is relatively nascent in the field of Maternal and Child Health. However it represents an innovative approach to building community power and fostering strategic organizational partnerships in service of addressing root causes of racial inequities in birth outcomes. The lessons learned and opportunities identified by BBZ can serve as a foundation from which to build other programs and initiatives to advance racial justice.

Social inequality in infant mortality in Angola: Evidence from a population based study.

Within country inequality in infant mortality poses a big challenge for countries moving towards the internationally agreed upon targets on child mortality by 2030. There is a lack of high-quality evidence on infant mortality measured through different dimensions of social inequality in Angola. Thus, this paper was carried out to address the knowledge gap by conducting in-depth examination of infant mortality rate (IMR) inequality among population subgroups to provide more nuanced evidence to help end IMR disparity in the country. The World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used to analyze IMR inequality. HEAT is a software application that facilitates examination of disparities in reproductive, maternal, neonatal and child health indicators using the WHO Health Equity Monitor (HEM) database. Inequality of IMR was analyzed through disaggregation by five equity stratifiers: education, wealth, gender, subnational region and residence. These were analyzed through three inequality measures: Population Attributable Risk, Ratio and Slope Index of Inequality. A 95% confidence Interval (CI) was built around point estimates to determine statistical significance. A notable disadvantage was found for children born to poor (Population Attributable Risk (PAR): -27.0; -28.4, -26.0) and uneducated (PAR: -17.0; -17.9, -16.0), women who live in rural areas (PAR: -7.3;-7.8, -6.7) and those residing in certain regions of the country (PAR: -43.0; 45.3, -4). Male infants had a higher risk of death than female infants (PAR: -6.8;-7.5, -6.2). The subnational regional variation of IMR had been the most evident when compared with the disparities in the other equity stratifers. Policymakers and planners need to address the disproportionately higher clustering of IMR among infants born to disadvantaged subpopulations through interventions that benefit such subgroups.

Under five and infant mortality in Chile (1990-2016): Trends, disparities, and causes of death

BackgroundChild health has been a health policy priority for more than a century in Chile. Since 2000, new health and intersectoral interventions have been implemented. However, no recent analyses have explored child mortality and equity in Chile, an indispensable input to guide policies towards the achievement of the Sustainable Development Goals, specially, in the context of a deeply unequal country such as many other Latin American countries. Thus, the objectives of this study are to analyze the variations in the risk and the causes of death among Chilean children aged <5 years, to identify the determinants, and to measure inequality of infant mortality from 1990 to 2016.Materials and methodsAn observational study was conducted to analyze the Chilean children's mortality from 1990 to 2016 using under five deaths and live births data from the Vital Statistics System. To describe the variation in the risk of death, a time series analysis was performed for each of the under five mortality rate components. A comparative cause of death analysis was developed for Neonatal and 1–59 months’ age groups. The determinants of infant mortality were studied with a descriptive analysis of yearly rates according to mother’s and child factors and bivariate logistic regression models at the individual level. Finally, simple and complex measures of inequality at individual level were estimated considering three-year periods.ResultsRegarding under 5 mortality: (i) Child survival has improved substantially in the last three decades, with a rapid decline in under five mortality rate between 1990 and 2001, followed by a slower reduction; (ii) early neonatal mortality has become the main component of the under five mortality rate (50.6%); (iii) congenital abnormalities have positioned as the leading cause of death; (iv) an important increase in live births below 1,000 grs. Regarding infant mortality: (i) birth weight and gestational age are the two most relevant risk factors in the neonatal period, while social variables are more significant for post-neonatal mortality and, (ii) the inequality according to mother’s education has shown a steady decline, with persistent inequalities in post-neonatal period.ConclusionsThe Chilean experience illustrates child health achievements and challenges in a country that transitioned from middle-to high-income in recent decades. Although inequity is one of the main challenges for the country, the health sector by granting universal access was able to reduce disparities. However, closing the gap in post-neonatal mortality is still challenging. To overcome stagnation in neonatal mortality, new and specific strategies must address current priorities, emphasizing the access of vulnerable groups.

Inequalities in infant mortality in Brazil at subnational levels in Brazil, 1990 to 2015

BackgroundIn this study, infant mortality rate (IMR) inequalities are analyzed from 1990 to 2015 in different geographic scales.MethodsThe Ministry of Health (MoH) IMR estimates by Federative Units (FU) were compared to those obtained by the Global Burden of Disease (GBD) group. In order to measure the inequalities of the IMR by FU, the ratios from highest to lowest from 1990 to 2015 were calculated. Maps were elaborated in 2000, 2010, and 2015 at the municipality level. To analyze the effect of income, IMR inequalities by GDP per capita were analyzed, comparing Brazil and the FU to other same-income level countries in 2015, and the IMR municipal estimates were analyzed by income deciles, in 2000 and 2010.ResultsIMR decreased from 47.1 to 13.4 per 1000 live births (LB) from 1990 to 2015, with an annual decrease rate of 4.9%. The decline was less pronounced for the early neonatal annual rate (3.5%). The Northeast region showed the most significant annual decline (6.2%). The IMR estimates carried out by the GBD were about 20% higher than those obtained by the MoH, but in terms of their inequalities, the ratio from the highest to the lowest IMR among the 27 FU decreased from 4 to 2, for both methods. The percentage of municipalities with IMR higher than 40 per 1000 LB decreased from 23% to 2%, between 2000 and 2015. Comparing the IMR distribution by income deciles, all inequality measures of the IMR decreased markedly from 2000 to 2010.ConclusionThe results showed a marked decrease in the IMR inequalities in Brazil, regardless of the geographic breakdown and the calculation method. Despite clear signs of progress in curbing infant mortality, there are still challenges in reducing its level, such as the concentration of deaths in the early neonatal period, and the specific increases of post neonatal mortality in 2016, after the recent cuts in social investments.

Does socio-economic inequality in infant mortality still exists in India? An analysis based on National Family Health Survey 2005–06 and 2015–16

IntroductionDespite impressive progress, socio-economic inequalities in infant mortality persist in India. Therefore, the study determines the change in percentage contribution of different factors to total economic inequalities for infant mortality in India from 2005–06 to 2015–16. MethodsThe study used the National Family Health Survey to carve out the results. Descriptive, bivariate, and binary logistic regression were used. Further, Income-related inequality in infant mortality was quantified by the concentration index (CI) and the concentration curve (CC). The study used Wagstaff's decomposition analysis to decompose the concentration index. The effective sample size for the study was 51,555 for NFHS 2005–06 and 259,627 for 2015–16. ResultsThe study found that economic inequality in infant mortality has increased over the two survey periods. The value of the concentration index increased from −0.14 in 2005–06 to −0.18 in 2015–16. The increase in inequality in infant mortality is higher in rural India than in urban India. Mother's education and open defecation contributed half (52%) of the inequality in infant mortality during 2015–16. ConclusionRecommendations concerning the WASH (Water, Sanitation, and Hygiene) actions should be emphasized. The focus should be on eradicating the practice of open defecation, construction of latrines, and safe disposal practice of feces. There is also a need to provide mass education regarding nutrition and health, along with focusing on the correlates that aim at improving female's education.

The evolution of infant mortality inequality in the United States, 1960-2016.

What is the relationship between infant mortality and poverty in the United States and how has it changed over time? We address this question by analyzing county-level data between 1960 and 2016. Our estimates suggest that level differences in mortality rates between the poorest and least poor counties decreased meaningfully between 1960 and 2000. Nearly three-quarters of the decrease occurred between 1960 and 1980, coincident with the introduction of antipoverty programs and improvements in medical care for infants. We estimate that declining inequality accounts for 18% of the national reduction in infant mortality between 1960 and 2000. However, we also find that level differences between the poorest and least poor counties remained constant between 2000 and 2016, suggesting an important role for policies that improve the health of infants in poor areas.

Understanding Trends in the Concentration of Infant Mortality Among Disadvantaged White and Black Mothers in the United States, 1983-2013: A Decomposition Analysis.

The United States compares unfavorably with other high-income countries in infant mortality, which recent literature has attributed to the poor birth outcomes among disadvantaged (i.e., unmarried and less-educated) mothers. Describing and decomposing the trend of the concentration of infant mortality among disadvantaged mothers thus provides important clues for improving birth outcomes. We develop the infant mortality disadvantage index (IMDI) to measure such concentration. Using the 1983-2013 Birth Cohort Linked Birth and Infant Death data, we show that although the IMDI-as a measure of mortality inequality-was persistently higher for Blacks than Whites, the trends were different between the two groups. The IMDI declined for Black women; for White women, however, it increased in the 1980s, then plateaued until the early 2000s, and declined thereafter. We then use Das Gupta's decomposition method to assess the contribution of five demographic/social factors (age, education, marriage, fertility, and infant mortality) to the IMDI trend. Nonmarital fertility among women with less than 12 years of education contributed most to Whites' changing IMDI; for Blacks, a shrinking proportion of the less-educated group and declines in infant mortality among disadvantaged mothers contributed to their declining IMDI. These findings explicate links between population-level compositional changes and infant mortality inequality.

Inequality in Infant Mortality Among Population of Modern Russia

Based on official statistics, the author tries to address the question of why the infant mortality rate in Russia is significantly higher than might be expected given the measures taken to protect the health of pregnant women and newborns. In the introduction, the author explains the relevance of studying inequality in the level of infant mortality among the population of modern Russia as a factor holding back the positive downward trend.After presenting the latest history of the evolution of the information and statistical base for population studies on the subjects under review, the author confirms the approach according to which it is advisable to work with data for real generations when analyzing the differentiation of infant mortality and generations born in 2014-2016 are chosen as the object of analysis.To determine the relevance of individual factors contributing to infant mortality, the author cross-tabulated raw data. Data on such initial characteristics (factors) as the birth order of the child, whether a mother is in a contracted civil marriage or not, mother’s level of education, were grouped by age groups of mothers. The use of cross-tabulation allowed to affirm not only the influence of individual factors on the level of infant mortality but also a quantitative differentiation between them. The article concludes the extent to which the overall level of infant mortality is determined by mortality rates from individual causes of death.A significant part of the article is presented in the format of author generalization using statistical methods regarding the educational differences of mothers, which have become differentiation factors in infant mortality rates.The socio-demographic analysis based on official statistics has confirmed not only some hypotheses as to why, despite the relatively rapid decrease in infant mortality in Russia in recent years, its level remains higher than in almost all European countries with reliable demographic statistics, but also to reveal the extent of the inequality of infant mortality in our country.The author argues that the reason why Russia lags behind many countries with the positive downward infant mortality trend is strongly associated with causes of death from conditions arising in the perinatal period as well as congenital disorders. This suggests that the level of medical care for pregnant women and newborns in Russia is still lower than in developed European countries. It also has to be assumed that different educational groups have unequal access to quality health care. А proactive approach to life as well as a progressive achievement of the right to choose a medical institution and a doctor - is one of the important directions for resolving a whole set of national health care issues.