Poverty kills

Britain stands near the bottom of the western European infant
mortality league. Yet there is some good news, reports Kendra
Inman.

The number of babies who die in the UK every year is falling but
not fast enough, say experts. The latest figures from the
Department of Health for 2002 show a continuing downward trend to
5.3 per thousand live births in England and Wales – the lowest
figure ever recorded.¹

On the face of it this is good news – the death rate for babies
under one is less than half the rate recorded in 1981.

However there are variations between regions and countries that
give cause for concern. In England, Birmingham and the Black
Country had the highest infant mortality rates at 7.9 deaths per
thousand live births and Norfolk, Suffolk and Cambridge had the
lowest at 3.8.

Infant mortality is a poignant marker of a nation’s
success in caring for its citizens. The number of babies who make
it through their first year of life is used across the globe to
measure wealth and progress. High rates suggest poverty, poor
health care and a struggling population while low rates indicate
wealth, a health service and good maternal care.

Last year a report commissioned by Save the Children,
The
Well-being of Children in the UK, found
significant variations between countries. Figures showed Northern
Ireland had the worst infant mortality rate at 6.4 per thousand
live births compared with 6.1 in Wales, 5.7 in England and 5.0 in
Scotland.²

The charity called for the routine collection of statistics
tracking children’s well-being from all countries and regular
reports to explain the differences.

Globally, the West’s infant mortality rates are generally
low but when it comes to European comparisons, the UK comes off
badly. A report from Unicef reveals the rates in England and Wales
for 2002 were still higher than those for France, Germany, Italy
and Spain in 2001 and although falling they are the second worse in
EU, beaten only by Greece.³ Worrying for the fourth
richest country in the world.

Statistics are clay in the politicians hands and there are no
shortage of attempts to hook up infant mortality statistics to a
wider agenda. While experts agree that poverty has an impact on
baby survival rates within industrialised nations other factors
also come into play, says Jonathan Bradshaw, professor of social
policy at York University.

For example, the success of the “back to sleep” campaign to
prevent cot death is thought to be responsible for a sharp decline
in infant deaths after 1988. Also, developments in medicine and
technology mean “doctors are managing to sustain many foetuses to
birth,” says Bradshaw.

“These very ill babies can die soon after birth and therefore
are included in the infant mortality statistics,” he explains.

In addition, “the UK has a higher number of low birth weight
babies than it should have and there is a direct relationship
between low birth weight and infant mortality”.

Nonetheless the gap between rich and poor remains the most
persistent problem according to Bradshaw. And there is solid
evidence supporting a link between higher infant mortality and the
prevalence of poverty, he adds.

Bradshaw’s concerns are echoed by the Maternity Alliance
and the Food Commission, whose research found many young women who
depend on state benefits could not afford the kind of food needed
to keep mother and foetus healthy.

The organisation carried out interviews with 46 pregnant
under-18s and found that nutrition was poor, says Helen Burchett,
public health policy officer for the charity.

The report, Good Enough to Eat, found almost all the young women
did not eat enough fruit and vegetables. Most ate too much salt,
sugar and fatty foods.

“Many of them had made a positive change to their diet when they
found out they were pregnant,” she says. But for many these changes
weren’t enough. Young women still living at home fared better
than those in hostels or bed and breakfast accommodation where
they

didn’t have access to proper cooking facilities. Most of
the respondents said they frequently missed meals. The two main
reasons given were not being hungry and not having enough
money.

“With less than £5 a day to pay for all their needs
it’s not surprising that typically less than £3 could be
afforded for food,” says the report which calls for an increase in
support for this group.

The evidence that money matters when it comes to your chances of
survival is undeniable. It is a sad fact that between 1998 and 2000
children born into low income groups were twice as likely to die
before the age of one than children born to parents in the highest
income group.

Over a third of ethnic minority householders in England live in
the 10 per cent most deprived wards. Infant mortality rates in 2000
were highest among mothers born in Pakistan – and more than double
the overall infant mortality rate.

Figures like these led the government to accept the challenge of
tackling poverty and health inequalities knowing they will have an
impact on the life chances of thousands of children. A twin-pronged
attack on infant mortality and poverty was launched together with
tough targets to tackle deprivation.

In 1999, chancellor Gordon Brown said child poverty was, “a scar
on the soul of Britain,” and promised the government would halve it
by 2010 and abolish it completely 2020. Two years later, in
February 2001 ministers announced they would reduce the gap in
infant mortality rates of the richest and poorest by at least 10
per cent by the year 2010.

Measures under way to close the gaps in infant mortality include
Sure Start – the programme to improve chances of young children and
their parents in disadvantaged areas. The drive to cut teenage
pregnancies is also expected to have an impact on infant mortality.
The babies born to this group have a mortality rate 60 per cent
higher than the average, according to figures published by the
Department of Health in January 2002. The babies of teenage mothers
are also more likely to have lower birth weights. Other
interventions include promotion of breastfeeding, parental support
and improved maternal and neo-natal health care.

Gradually, evidence is emerging of how best to tackle these
problems. In May the Health Development Agency published a review
of the evidence about breastfeeding. The review found that
breastfeeding has both short and long-term health benefits and an
“important contribution to make towards meeting the new target to
reduce infant mortality”.

Teenage pregnancies have also been on the decline – overall
rates have dropped by 9 per cent since 1998 according to government
figures. Ministers have pledged to cut rates by 50 per cent by
2010.

Despite these positive developments, Bradshaw says progress on
tackling poverty is slow.

“Child poverty is falling but there are doubts that the
government will reach next year’s target of cutting child
poverty by a quarter. Sure Start is a helpful programme but it is
area-based and much poverty exists outside Sure Start areas,” he
says.

Optimistically, the statisticians estimate that if the current
downward trend in infant mortality continues, rates per thousand
live births will fall below five by 2006. The government, inspired
by Sweden which at 2.8 has the lowest baby death rate in Europe,
believes that a social class gradient is not inevitable. Research
has shown that infant mortality in Sweden is low despite social
inequalities. The fact that a social class gradient exists in the
UK means there is scope for improvement argues the government.

But research published by Save the Children in September found
that nearly one in 10 British children still experience severe and
persistent poverty. Improving the life chances of this group may
prove a bigger challenge.

¹ Department of Health,
Health Statistics Quarterly, Autumn 2003 from

www.statistics.gov.uk/downloads/theme_health/HSQ19.pdf

²
The State of the
World’s Children 2002, Unicef 2003.

³
Britain’s
Poorest Children, Save the Children,
www.savethechildren.org.uk