Inequalities in Infant Mortality Work Programme
The NPEU has undertaken a programme of work for the Department of Health to help strengthen the evidence base for interventions which reduce infant mortality and narrow the health inequalities gap. The project has focused in particular on health service and public health interventions which could be implemented in the context of the NHS.
The outputs from the programme to date are listed below. Current work is focusing on ethnic variations in infant mortality. Aims are:
- To describe ethnic variations in infant mortality, preterm birth and other birth outcomes.
- To explore the individual and joint effects of ethnicity, area deprivation (Index of Multiple Deprivation (IMD)) and migration status (UK vs. non-UK born) on these outcomes.
- To describe ethnic variations in the incidence of sudden unexplained death in infancy (SUDI) and to explore the extent to which these variations are attributable to other factors such as preterm birth.
- To describe ethnic and socioeconomic variations in infant mortality following preterm birth.
More information about the work on ethnic variations in infant mortality can be found on the research project page.
The two systematic reviews of effectiveness have been conducted to evaluate the evidence relating to:
- Interventions focused on the organisation and delivery of antenatal care as a means of reducing infant mortality or one of its major causes (particularly preterm birth) in socially disadvantaged and vulnerable groups of women;
- Interventions to increase the early uptake of antenatal care in socially disadvantaged and vulnerable groups of women.
A third mixed methods review synthesises the qualitative literature relating the views and experiences of Black and Minority Ethnic (BME) women in the UK to identify and describe the barriers to and facilitators of early initiation of antenatal care in BME women in the UK; the review also explores ways in which existing interventions may address these barriers.
A systematic review of the effectiveness of antenatal care programmes to reduce infant mortality and its major causes in socially disadvantaged and vulnerable women
This review examines the evidence relating to the effectiveness of various alternative models of delivering antenatal care, covering both clinic-based antenatal care and a range of stand-alone health and social care interventions delivered in conjunction with standard antenatal care. The review focuses specifically on the effectiveness of these interventions as a means of reducing preterm birth and infant mortality in disadvantaged and vulnerable groups of women. Interventions targeting specific at risk groups such as teenagers and substance users are also covered. The review identifies both the available evidence and gaps in the evidence.
A systematic review of the effectiveness of interventions to increase the early initiation of antenatal care in socially disadvantaged and vulnerable women
This review evaluates the evidence relating to interventions aiming to increase the early uptake of antenatal care in socially disadvantaged and vulnerable groups of women, with a particular focus on interventions relevant in the context of the NHS. In addition to evaluating the evidence, the report provides a bibliography of interventions reported in the literature which have been designed to increase early uptake of antenatal care.
Increasing the early initiation of antenatal care by Black and Minority Ethnic women in the United Kingdom: a systematic review and mixed-methods synthesis of women's views and the literature on intervention effectiveness
This mixed methods review uses the qualitative literature relating the views and experiences of BME women in the UK to identify and describe the barriers to and facilitators of early initiation of antenatal care in BME women in the UK. It then builds on our related effectiveness review (see above) by exploring the extent to which interventions designed to increase the early initiation of antenatal care in socially disadvantaged and vulnerable women address the barriers experienced by BME women in the UK.
A series of briefing papers has been produced on the following topics:
Infant mortality: overview and context
Briefing paper 1 provides an overview of trends in infant mortality in England and Wales and sets these trends in the context of recent changes in the maternal and infant population.
Health Inequalities Infant Mortality Target: technical background
Briefing paper 2 explains the technical background to the Health Inequalities Public Service Agreement (PSA) target. The paper provides a concise overview of the concepts underpinning the target, how these are operationalised, and what the target measures and excludes. Examples are given illustrating key points, such as the differences between relative and absolute measures of inequality.
Towards an understanding of variations in infant mortality rates between different ethnic groups in England and Wales
Briefing paper 3 provides an overview of patterns and trends in infant mortality in England and Wales by ethnic group and discusses the factors which may contribute to these variations. The paper brings together relevant data on ethnicity from a range of sources.
The contribution of congenital anomalies to infant mortality
Congenital anomalies are the second commonest cause of infant deaths overall. Briefing paper 4 describes patterns of infant mortality from congenital anomalies (e.g. variations by socioeconomic position), and discusses issues related to primary and secondary prevention.
An evidence map of the systematic review literature
The evidence map provides a comprehensive descriptive overview of the systematic review literature relating to the effectiveness of interventions targeting:
- infant mortality and its major medical causes (preterm birth, major congenital anomalies and SIDS/SUDI)
- major potentially modifiable risk factors for infant mortality (smoking in pregnancy and the postnatal period, maternal obesity and risk factors for SIDS/SUDI)
Two 'user's guides' provide an overview of the relevant literature and provide hyperlinks enabling the user to directly access the full-text articles. An online, searchable version of the evidence map of interventions targeting infant mortality is also available and can be accessed via a link below. Detailed methods are described in two 'technical guides'.
The map will be of particular use to:
- public health practitioners
- commissioners, particularly those responsible for commissioning maternal and neonatal services and public health programmes
Reports 1 and 2: Interventions targeting infant mortality
Report 1: The effectiveness of interventions targeting infant mortality: a user's guide to the systematic review evidence
Report 2: Technical guide to the infant mortality evidence map: systematic reviews of interventions targeting infant mortality
Reports 3 and 4: Interventions targeting major potentially modifiable risk factors for infant mortality
Report 3: The effectiveness of interventions targeting major potentially modifiable risk factors for infant mortality: a user's guide to the systematic review evidence
Report 4: Technical guide to the infant mortality evidence map of interventions targeting major potentially modifiable risk factors for infant mortality
Chief investigator: Ron Gray
Other investigators: Jenny Kurinczuk, Peter Brocklehurst
Lead researcher/Project Manager: Jennifer Hollowell (email: email@example.com)