Why Do More Babies Die in Britain Than in Comparable Countries?

England and Wales recorded an infant mortality rate of 3.6 deaths per 1,000 live births in 2022 — a figure that has barely shifted since 2014. Before that, the rate had fallen steadily for decades. The stall matters because comparable nations have kept improving: Germany now sits at 3.0, France at 3.2, the Netherlands at 3.4, and Sweden at 2.3. More than 3,000 stillbirths occur in England and Wales each year. Neonatal deaths — those in the first 28 days — account for the majority of all infant mortality, and preterm birth is the single leading cause, affecting around 1 in 13 pregnancies.

The death rate is not distributed evenly. In the most deprived areas, 5.4 babies per 1,000 live births die before their first birthday; in the least deprived, the figure is 2.2 — a gap of more than 2.5 times. Race compounds this: MBRRACE-UK's annual perinatal mortality reports have consistently found that babies born to Black and South Asian mothers face significantly elevated risks of stillbirth and neonatal death, driven by a combination of underlying health conditions, access to antenatal care, and institutional failings in maternity services. Regional variation mirrors the deprivation gradient, with infant mortality rates in parts of the North and Midlands persistently above the national average.

The NHS England Saving Babies' Lives Care Bundle, launched in 2016 and updated in 2019, brought standardised protocols for fetal movement monitoring, carbon monoxide testing, and CTG interpretation into maternity units. Trusts that fully adopted it saw stillbirth rates fall by approximately 20%. MBRRACE-UK's surveillance programme enables hospital-level benchmarking, making poor-performing units visible to regulators. Yet progress has stalled partly because of maternity staffing shortfalls — RCOG estimates a shortage of more than 500 consultant obstetricians — and because continuity of carer, which evidence links to better outcomes, remains available to fewer than a quarter of women. The gap with Sweden is not inevitable; it is a policy choice.

Ethnic disparities in infant mortality reflect compounding structural failures. Research consistently shows Black women's pain is underassessed in maternity settings, complaints are more likely to be dismissed, and language barriers reduce the quality of antenatal care for mothers whose first language is not English. Socioeconomic deprivation intersects with ethnicity — Black and South Asian families are disproportionately concentrated in the most deprived quintile. Scotland's Best Start programme and Wales's Flying Start scheme invest earlier in pregnancy support and nutrition, producing marginally better trajectories. Smoking cessation before 15 weeks and folic acid supplementation remain the highest-impact individual interventions. Yet after 15 years of monitoring, the MBRRACE-UK reports show no meaningful narrowing of the racial gap in maternal or infant death. A realistic policy response would combine targeted midwifery continuity, culturally competent bereavement care, and sustained funding for deprived-area maternity units.

MBRRACE-UK publishes the most authoritative surveillance data, but small number suppression at hospital and local authority level means that individual trust performance cannot be reliably assessed for rarer outcomes. The term “infant mortality rate” is used inconsistently — some presentations include only deaths under one year, while others separate neonatal deaths (under 28 days) from post-neonatal deaths, creating confusion in headline comparisons. Ethnicity recording in birth and death registrations remains patchy, with maternal ethnicity missing or recorded as “not stated” in roughly 5–8% of records. International comparisons are complicated by differing gestational age thresholds for registering a live birth — some countries do not register births below 24 weeks, while England registers from 22 weeks, which inflates the apparent mortality rate. Stillbirth definitions also vary, with thresholds ranging from 22 to 28 weeks across countries.