Infant Mortality Rate, an Unbalanced Global Decline Hiding Inequalities

Dec 12, 2021
5 min read

By: Marie Jo Abdul-Hay

Health inequalities are a worldwide problem and can take various forms. They can even start way before birth, since a major part of inequalities are passed down from generation to generation, as well as emerge throughout one’s life. The biggest indication of those inequalities would be the infant mortality rate (IMR) of each country. The IMR is the number of infant deaths for every 1000 live births, or in other words, how many newborns pass away before reaching the age of one, as defined by the WHO. Even though this rate has been declining everywhere, its distribution is not uniform. This paper will discuss the clear imbalance in IMR around the globe between different countries, inside a country, as well as the factors contributing to this inequity.

The UNICEF 2016 report has shown a decline in the overall IMR among all countries since 1990. DaVanzo and Habicht (1986) showed a decline in Malaysia’s IMR during the second half of the twentieth century linked to an increase in the mothers’ education and an improvement in clean water access and sanitation (another factor noticed was a decline in breastfeeding; however, this goes against the trend as it should be linked to an increase death among newborns). Another study showed a decline in Costa Rica’s IMR from 1972 till 1980, 40% of this reduction is linked to an increase in rural and community health programs. Community involvement, vaccination and environmental sanitation also contributed to this decline; however, socioeconomic obstacles are still the main determinant of infant death.

Even though an overall global decline in IMR is being seen over the years, it is clear that the rate of this decline differs heavily between high income countries and emerging countries. It is no surprise that these differences are tightly linked to various factors, first of which would be sanitation. Access to clean water and sanitation has been shown to be responsible for more than half of the diarrheal diseases, which are responsible for 10% of deaths in children under 5. Besides, air pollution has been shown to cause half of the lower respiratory tract infections, which accounts for 15% of deaths in children under 5. Access to clean water, clean air and sanitation are basic human rights; however, poor children are significantly less likely to have access to those even though some improvements have been made in the past years. Other factors include nutrition and access to shelters; almost 50% of children die of malnutrition, probably because a well-nourished child is more likely to be able to fight any disease.

Huge differences in IMRs are seen between countries, for example Luxembourg had an IMR of 2 in 2015, compared to Central African Republic, which had an IMR of 92. However, these differences are not only seen between countries, but also between different regions of the same country. The infant mortality rate of the state of Mississippi in 2013, for example, was double that of the state of Massachusetts. Other factors influencing newborn survival are unfortunately linked to ethnicity. Watkins shows that infants born to African American parents in 2013, were more than twice as likely to die compared to those born to white Americans. Therefore, other surprising demographic factors also influence IMR, like the birthplace of the baby. This shows that most health and social inequities can originate before birth: transmission of inequities can be thought as partially – if not mostly – intergenerational.

As previously discussed, inequalities can originate way before birth; however, it is way more intuitive to think of inequalities originating throughout one’s life. Child development, for instance, can be delayed based on the parents’ education level, family income, parenting lifestyle and potential deleterious life experiences. It has been shown that those factors are tightly associated with the size of critical brain areas of the child, as well as the formation of neural networks, and ultimately, brain development, which will have a dramatic impact on the child’s quality of life (and odds of survival). Also, another factor that can affect neonatal outcome and later behavioral and mental problems is parental stress. Parental stress is not only linked to maltreatment of children, but also to miscarriage, therefore contributing to an increase in IMR.

Disadvantaged children are underprivileged and deprived of many, if not most, rights, like access to clean water, sanitation, nutrition and a safe environment to grow in, so, what can be improved?

Well first, it is clear that access to child health services can easily prevent some newborn deaths by using simple and preventable approaches and treatments. However, for low income families, those services are not affordable, especially due to a lack of medical insurance. Case studies in Africa, Asia and Latin America that studied accessibility of health, nutrition and population programs showed that better performance in reaching poor and marginalized communities is both needed and feasible. In addition, investing in early education for disadvantaged children can help reduce the achievement gap by reducing their need for special education. This will also increase the likelihood of healthier lifestyles, lower crime rate and reduce overall social costs. Some other high impact-low cost interventions would be preventing many diseases using early vaccination, treating diarrhea using oral rehydration salts and preventing malaria by using insecticide treated nets. More specific approaches to directly reduce IMR would be providing primary health services, like birth attendants, to reduce complications during delivery and labor, as well as encouraging breast feeding during the first 6 months of life. Note that these are only some examples, and that there are many ways to reduce the gap and prevent infant mortality.

To conclude, even though there is a decline in the overall global IMR trend, the decline rate is extremely disproportionate among different countries and is tightly linked to various factors, all of which emerge from limited access to education and healthcare.