Infant Mortality

Key Messages

Putting infant mortality in context

“The infant mortality rate—the rate at which babies of less than one year of age die—reflects economic and social conditions for the health of mothers and newborns, as well as the effectiveness of health systems,” states the OECD Factbook 2009.¹ Many health experts see the infant mortality rate as a sentinel indicator of child health and the well-being of a society over time. It also indicates health disparities between different populations, both within and between countries.

The causes of infant mortality are “strongly correlated to those structural factors, like economic development, general living conditions, social wellbeing, and the quality of the environment, that affect the health of entire populations,” according to a 2003 article in the Journal of Epidemiology and Community Health.² The 2005 United Nations’ Human Development Report states: “No indicator captures the divergence in human development opportunity more powerfully than child mortality.”³ And the Canadian Institute for Health Information notes that infant mortality rates are “a long-established measure, not only of child health, but also of the well-being of a society.”⁴

How does Canada compare internationally on infant mortality?

In 2007, Canada’s infant mortality rate—or the number of deaths of children less than one year of age per 1,000 live births—was 5.1.⁵ This was significantly higher than the rate in almost all its peer countries. Canada earns a “C” on this indicator. The only comparator country with a worse record on infant mortality is the U.S., with 6.5 infant deaths per 1,000 live births.

Of the 17 OECD countries examined here, 12 have an infant mortality rate below 4, a rate deemed to be exceptional. Japan, Sweden, and Finland all have infant mortality rates of under 3 deaths per 1,000 live births.

Is Canada’s infant mortality rate improving?

Canada’s infant mortality rate fell significantly between 1960 and 1980—from 27 deaths per 1,000 live births to 10 deaths. The mortality rate continued to improve in the 1980s and 1990s, but not as dramatically. It has been relatively stable since 1998, although it did drop from 5.4 in 2005 to 5.0 in 2006. Canada’s infant mortality rate was 5.1 in 2007.

Even though Canada’s infant mortality rate has decreased since the 1960s, the rate of improvement has been lower than in most of Canada’s peer countries. Japan’s infant mortality rate, for example, was higher than Canada’s in 1960, at 31 infants per 1,000 live births. In 2007 it was 2.6, about half the rate in Canada.

In 1990, Canada ranked 5th among the 17 peer countries. It now has the second-highest infant mortality rate—only the U.S. performs worse.

Has Canada improved its relative performance on infant mortality?

No. Even though Canada’s rate of infant mortality is lower now than it was in previous decades, Canada’s relative ranking has fallen. Other countries have seen much more substantial reductions in their infant mortality rates.

Canada’s relative grade on infant mortality dropped from a “B” in the 1960s, 1970s, and 1980s to a “C” in the 1990s and 2000s.

Finland and Sweden maintained “A” grades over all five decades. Italy has seen the most marked improvement, rising from a “D” in the 1960s, 1970s, and 1980s to a “B” in the 2000s.

Why is Canada’s infant mortality rate higher than those of most peer countries?

Part of the answer may lie in international differences in the registration of babies with an extremely low birth weight or countries’ classifications of births as live births or stillbirths. Some researchers suggest that comparisons between countries should therefore be interpreted with caution.⁶ A European report on perinatal indicators, for example, noted a wide variation in how European countries define infant mortality, due to differences in birth and death registration practices (that is, differences in the cut-off points for acceptable weight or estimated gestation period to be registered as a birth and subsequent death).⁷ This discrepancy can lead to under-reporting of infant deaths by some countries, particularly when compared with countries that use a broader definition for live birth. The international discrepancies in data may have existed for some time, but they have been overlooked because of much higher infant mortality rates. Now that rates are so much lower, however, differences in registration may be more important in explaining inter-country differences in infant mortality.⁸

Other researchers suggest that Canada’s ability to reduce infant mortality is constrained by the successful delivery of more preterm babies and babies with very low birth weight. These babies face higher risk of death. Statistics Canada reports that the increase in the infant mortality rate in 2002 was entirely due to the deaths of infants less than one day old.⁹ The factors underlying an increase in the number of low-birth-weight babies may include socio-economic and environmental determinants of maternal and child health, as well as health-system factors such as the use of new technologies in high-risk deliveries.

New fertility programs are also resulting in more multiple births (two or more babies). These babies are usually born preterm, with a higher risk of early death.

The greater number of low-birth-weight and preterm babies, coupled with the discrepancies among countries in defining “live births,” could be contributing to Canada’s relatively higher rate of infant mortality. These medical and methodological factors undoubtedly play a role in Canada’s infant mortality rate.

But how much of a role? The fact that Canada does not seem able to break below the rate of 5 deaths per 1,000 live births, while 14 peer countries already have, suggests that further attention must be paid to better understanding international differences in infant mortality rates—whether they are due to methodological or socio-economic factors, or both.

Footnotes

1 Organisation for Economic Co-operation and Development, OECD Factbook 2009: Economic, Environmental and Social Statistics (Paris: OECD, 2009), 246.

2 Daniel Reidpath and Pascale Allotey, “Infant Mortality Rate as an Indicator of Population Health Journal of Epidemiology and Community Health,” 57 (2003), 344–346 .

3 United Nations, Human Development Report 2005 (New York: UNDP, 2005), 4.

4 Canadian Institute for Health Information website (accessed September 23, 2009).

5 The most recent year of data on infant mortality for the majority of peer countries is 2009. The U.S. has data up to 2008 and Canada has data up to 2007.

6 See, for example, M.S. Kramer et al., “Registration Artifacts in International Comparisons of Infant Mortality,” Paediatric and Perinatal Epidemiology 16,1 (January 22, 2002), 16–22.

7 Jennifer Zeitlin and Katherine Wildman, Indicators for Monitoring and Evaluating Perinatal Health in Europe, European Union Health Monitoring Programme, 2000; W.C. Graafmans et al., “Comparability of Published Perinatal Mortality Rates in Western Europe: The Quantitative Impact of Differences in Gestational Age and Birthweight Criteria,” BMOJ: An International Journal of Obstetrics and Gynaecology 108 (2001), 1237–45.

8 M.S. Kramer et al., “Registration Artifacts in International Comparisons of Infant Mortality,” Paediatric and Perinatal Epidemiology, 21.

9 Statistics Canada, The Daily, September 27, 2004.