Infant mortality: tragic, unjust … and usually preventable

Nov 15, 2021
by Deborah Wolfe
Infant mortality occurs when a child dies before his or her first birthday. In 2018, an estimated four million of the world’s children passed away within that first year of life after birth. Most of these deaths were preventable.

The loss of every child is heartbreaking. The risk of such a tragedy is disproportionately high for people struggling against poverty. Especially those without access to health care, nutrition, education, clean water and sanitation.

Infant mortality rates are highest in the world’s toughest regions, where poverty is compounded by factors like drought and violent conflict. Sub-Saharan Africa has the world’s highest rate, with an estimated 52 infants dying for every 1,000 born.

Even within wealthy countries like Canada, infant mortality rates vary according to a community’s circumstances. Families living in the most materially deprived areas lose 60 per cent more infants than families with ready access to life’s essentials.  

But there is hopeful news. Globally, the annual infant mortality rate has more than halved since 1990, thanks to clear targets and worldwide efforts like the Born on Time program. We have effective, often inexpensive, ways to save babies’ lives.

In this article, you’ll learn what causes infant mortality and what can be done to prevent it. We’ll explore why doing so is so critical. We’ll share what’s being done to prevent infant deaths and how you can help.
  1. What is infant mortality?
  2. How is ‘infant mortality rate’ measured?
  3. What are the leading causes of infant mortality?
  4. How does a mother’s well-being affect infant mortality?
  5. What does infant mortality rate say about a society?
  6. What is the infant mortality landscape in Canada?
  7. What is World Vision doing to help prevent infant mortality?
  8. How can I help prevent infant mortality?

1. What is infant mortality?
Infant mortality occurs when a child dies “before completing the first year of age”, says the World Health Organization. The term applies regardless of cause, which can vary dramatically, depending on context.

A baby girl sits snugly in a sling worn by her smiling grandmother.
In the Democratic Republic of Congo, baby Séraphine is being raised by her grandmother (right) after her mother and twin brother died from complications of preterm birth. Photo: Didier Nagifi Sademoke
 
Here are a few examples, all of which are considered ‘infant mortality’:
  • a child in Lithuania dies in a traffic accident;
  • a child in Somalia dies as the result of complications from preterm birth;
  • a child in Canada dies from sudden infant death syndrome;
  • a child in Nepal dies from infection, due to her community’s lack of access to health care;
  • a child in Syria dies as the result of a missile attack; and
  • a child in Bolivia dies as the result of a congenital birth defect
That said, most infant deaths have nothing to do with attacks or accidents. They are related to complications from infections, birth asphyxia and being born too early.

2. How is ‘infant mortality rate’ measured?
The magnitude of infant mortality in a country or region is expressed as the ‘infant mortality rate’ – the number of deaths per 1,000 live births.

For example:
A closeup of a baby’s face and hand as she sits on her mom’s lap.
In Afghanistan, political, economic and environmental factors have contributed to a high infant mortality rate: 47 deaths per 1,000 births. In this camp for people displaced within the country, a mother has brought her severely malnourished baby to a clinic for help. Photo: Stefanie Glinski

The infant mortality rate can reflect a great deal more than the number of infant deaths within a country or region. It’s a critical indicator of the overall health of the society in question.
Infant mortality rates can help us understand more about:
  • the overall health of mothers in a society;
  • the amount of prenatal and postnatal health care – as well as trained support with delivery – received by pregnant women and teen girls;
  • the degree of access to clean water and sanitation, as well as nutrition and education; and
  • the level of gender equality in a particular country or region.

3. What are the leading causes of infant mortality?
Infants are the most vulnerable people in any society. They can do nothing to protect themselves or meet their own needs. Even the healthiest infant is born with an extremely fragile immune system.

Globally, three-quarters of all newborn deaths occur within the first week of life. But the reasons for these fatalities differ by country and region.  

Typical causes in wealthier countries

Here are some causes of infant mortality in countries with stable, healthy economies like Canada, Australia and Japan:
  • premature births and low birth weight;
  • congenital disabilities e.g., respiratory system anomalies;
  • problems with brain function due to lack of oxygen during birth;
  • infection such as sepsis and tetanus;
  • sudden infant death syndrome (SIDS); and
  • accidents e.g., suffocation.

A doctor in a North American hospital listens to the heartbeat of a healthy, howling newborn baby.
In Canada, moms and babies typically have access to quality prenatal and postnatal health care, as well as delivery support. Many problems in the early days of life can be detected and treated. Photo: Solen Feyissa

Even within wealthier countries, however, contributing factors to infant deaths can include:
  • low maternal education;
  • inadequate housing;
  • lack of access to health care;
  • food insecurity; and
  • poverty and unemployment.
Babies born in communities facing poverty, instability and threats such as drought face the same threats as those born in Canada – and then some. Here are some of the causes of infant mortality in countries such as Afghanistan, Somalia and Honduras: In many developing countries, poverty and malnutrition are contributing factors to causes of infant death. Consider these scenarios:
  • A woman becomes pregnant while severely malnourished. The baby doesn’t receive sufficient nutrients in the womb. The mother is unable to produce breastmilk for her newborn.
  • A woman gives birth far from the nearest trained help, with no sterilized tools and supplies to keep her baby safe. The child develops a severe infection during birth.
  • A 13-year-old girl is forced into a marriage planned to free her from poverty. Before her body is ready for childbirth, she becomes pregnant. The baby has insufficient oxygen during birth.
In Bangladesh’s Cox’s Bazar refugee camp, a young mother sits on the step of her hut, preparing to breastfeed her baby.
In Bangladesh, this young Rohingya mother is among more than 4,000 women in the world’s largest refugee camp receiving fresh, supplementary food. Pregnant women can better nourish themselves and their fetuses, as well as their newborn babies, when the time comes. Photo: Himaloy Joseph Mree

4. How does a mother’s wellbeing affect infant mortality?
The health and wellbeing of women during pregnancy and childbirth has a direct impact on the survival of their newborns. When mothers don’t receive adequate health care during these critical windows, infant mortality rates increase.

Globally, 91 per cent of all maternal deaths occur in low- and middle-income families. Here are some of the causes of 75 per cent of maternal deaths, according to the World Health Organization:
  • Without health care during pregnancy, a mother with high blood pressure (pre-eclampsia and eclampsia) typically goes unnoticed and untreated. She is at risk of death from heart attack or stroke.
  • Without support from trained health workers, mothers are at risk of severe bleeding, infections and other complications during and after delivery. These numbers are highest among adolescent girls.
A mother sits on a chair and holds her healthy baby twins
If not for the help of a trained nurse, Felistus (centre) might have bled to death when delivering her twins in Zambia. “Death was waiting for me,” she says. Photo: Jon Warren
Maternal and infant deaths

In regions where women lack trained health care support during and after delivery, a mother’s death often leads to the death of her infant.

One study conducted in Kenya found that when mothers died during childbirth, their infants survived less than half the time. Of newborns who did survive those deliveries, half died in their first weeks of life.

Lack of breastmilk

The death of a mother eliminates the breastmilk newborns rely on, particularly in developing countries when safe infant formula is rarely available.

Without mother’s breastmilk, a newborn child may die from dehydration, malnutrition or infections like diarrhea from unsafe water.

5. What does infant mortality rate say about a society?
The rate at which babies die is an important marker of the overall health of a society. High infant mortality rates are generally indicative of unmet human health needs in sanitation, health care, nutrition and education.

Infant mortality rates can also indicate a lack of social justice within a country. Gender inequality is a major contributor to infant mortality globally. The correlation is especially pronounced in regions where mothers:
  • were denied an education as girls;
  • are prevented from accessing trained support for pre- and post-natal care, and delivery; and
  • were denied reproductive health education as adolescents.

Father and teenage daughter hug smiling at the camera
In Honduras, 13-year-old Nahomy (left, with her father) has learned her rights through World Vision’s child sponsorship program. She now campaigns for girls’ equal access to education – and against early marriage leading to teen pregnancy. Photo: Jon Warren

In countries with remote or rural regions, infant mortality rates can vary significantly throughout – particularly in regions like sub-Saharan Africa. In rural areas, infant death rates are higher than in cities.

Every newborn baby comes into the world packed with potential. Even a child just minutes old possesses a full set of human rights. Among other things, she or he has the right to life, to health, to protection … to opportunity.

If a society can’t protect and provide for its most vulnerable members – no matter where they live – changes need to be made. Otherwise, rights go unrecognized, potential goes unmet, human development is hindered and hearts are perpetually broken.

6. What is the infant mortality landscape in Canada?

According to UNICEF, Canada’s infant mortality rate is just four deaths per 1,000 live births. Compare that with the highest rate in the world – 81 infant deaths per 1,000 live births in the Central African Republic – and Canada appears to be doing pretty well.

Then consider the inequities across our country. According to the Government of Canada’s website, infant mortality rates in the most ‘materially deprived’ areas are 1.6 times higher than in the least ‘materially deprived.’
Canada’s remote communities

In Canada, we have a vast geographic landscape to contend with when ensuring each resident has access to clean water and sanitation, health care and education.

A long-shot of a village during a sunny day in Nunavut.
Nunavut’s 25 health centres are isolated and spread across long distances. A newborn baby in crisis might need to be airlifted as far as Ontario or Manitoba. Photo: Isaac Demeester

According to the Organisation for Economic Cooperation and Development (OECD) infant mortality rates are higher in Indigenous communities, particularly in families living on reserves in rural areas.

Some 60 per cent of Indigenous Canadians are likely be located in rural regions. Many Indigenous communities face infrastructure deficits, like lack of clean water and sanitation, particularly in remote areas.

Lack of birth and health facilities  

According to one study, Indigenous families in Canada face striking inequities in access to birth facilities and providers, compared to non-Indigenous families.

Travelling 200 km or more for birthing is common for Indigenous mothers, the researchers found. For Indigenous women, the journey may include rough roads, late at night. If no one is available to accompany the mother, she would go alone.

7. What is World Vision doing to help prevent infant mortality?
The World Health Organization notes that while some 8.7 million infants died in 1990 globally, that number was reduced by half by 2018.

Organizations like World Vision are playing a critical part in preventing the deaths of millions of babies worldwide. Working with families and communities, we’re helping:
In Kenya, a man puts his arm around his pregnant wife. Both are smiling.
In Kenya, husbands are attending Mencare groups through a partnership between World Vision and Canada’s government. Meshack (left) is learning how to better nourish and support his pregnant wife, Abigael, and their unborn baby. Photo: Dickson Kahindi

Significantly reducing infant mortality is no small challenge – it takes a global community. Read on, to see how World Vision is partnering with others to help make it happen.

Emergency care and feeding programs

World Vision provides urgently needed care for children battling extreme malnutrition, helping restore them to health. Such programs are especially critical in regions battling multiple emergencies – drought and conflict, for instance.

One key approach we used is called Community-based Management of Acute Malnutrition Model (CMAM). This equips volunteers to identify and initiate treatment for children and infants with acute malnutrition before they come seriously ill.

Supplementary feeding plays a critical part in recovery. One aspect is take-home rations for infants and young children, as well as pregnant and lactating mothers.

A baby holds a packet of high-nutrient, supplementary food.
In Angola, six-month-old Beto recovered from extreme malnutrition after the country’s worst drought in 38 years. World Vision partnered with Canadian charity Food for Famine to help Beto make a full recovery. Photo: Eunice Lopes

1000 Day Journey initiative

World Vision is working to ensure mothers and their babies get proper nutrition in a child’s first 1000 days, from conception to their second birthdays. This window plays a critical role in determining their future.

The ENRICH 1000 Day journey is a six-year initiative to support women and children’s health, in impoverished communities in four African and Asian countries. It’s led by World Vision, with funding from the Government of Canada.

The ENRICH 1000 Day Journey is part of Canada’s contribution to ending preventable child deaths by 2030 – one of the United Nations’ Sustainable Development Goals.

Born on Time program

Preterm birth complications are among the leading causes of infant mortality When babies are born too early, they are often insufficiently grown and developed to thrive outside the womb.

In Canada, a preterm infant would likely receive intensive care – perhaps spend weeks in an incubator. But that’s not an option in most parts of the world.

Through the Born on Time program, World Vision has been working to prevent and treat preterm births. From 2016 to 2021, we worked with government, corporate and charity partners to tackle barriers to newborn and maternal health.

A health care worker checking the belly of a pregnant woman during a pre-natal care visit.
In Bangladesh, Ethiopia and Mali, the Born on Time program has supported health care workers to provide pre-natal, parental and post-natal care and counselling. Post-natal and delivery support are also critical in reducing infant mortality rates. Photo: Suborno Chisim

Born on Time focused on Bangladesh, Ethiopia and Mali, three countries with high preterm birth rates. In addition to saving lives, it improved gender equality, nutrition and health care access for many families in many communities. Moreover, Born on Time led to learnings which World Vision and others will implement moving forward, to continue reducing global infant mortality.

8. How can I help prevent infant mortality?
The good news is this: most infant deaths are preventable. World Vision offers Canadians a number of ways to help. Some involve tackling causes of infant mortality. Others involve reducing contributing factors.
Here are some options: Raw Hope: Support families in dire need, in some of the world’s toughest places e.g., Afghanistan, Honduras and South Sudan. Nutrition alone can save the lives of some of the world’s most vulnerable citizens – pregnant mothers and young babies among them.