Infant mortality reflects the effect of socioeconomic conditions on the health of mothers and newborns, as well as the effectiveness of health systems, particularly in addressing any life-threatening problem during the neonatal period (i.e. during the first four weeks).
Infant mortality rates are low in most EU countries, with an average of less than 4 deaths per 1 000 live births across EU countries in 2016 ( 3.18). However, a small group of countries – Romania, Bulgaria, Malta and the Slovak Republic – still have infant mortality rates above 5 deaths per 1 000 live births. These rates, though, have declined steadily over the past 25 years. In Malta, infant mortality rates may be higher because induced abortions following the detection of congenital anomalies are illegal, whereas this is possible in other countries in cases of severe and/or lethal anomalies.
Around two-thirds of the deaths during the first year of life occur during the first month (i.e. neonatal mortality). The main causes of death during the first month are congenital anomalies, prematurity and other conditions arising during pregnancy. For deaths beyond one month (post neonatal mortality), there tends to be a greater range of causes – the most common being Sudden Infant Death Syndrome (SIDS), birth defects, infections and accidents.
All European countries have achieved notable progress in reducing infant mortality rates over the past few decades. The EU average went down from over 10 deaths per 1 000 live births in 1990 to 3.6 deaths in 2016. Reductions in infant mortality rates have been particularly rapid in Bulgaria, Poland and Romania, converging towards the EU average ( 3.19). However, the downward trend in infant mortality has halted in recent years in a number of Western European countries, at least partly because of increasing numbers of low birth weight infants.
Across EU countries, 1 in 14 babies (7.0%) weighed less than 2 500 grams at birth in 2016 ( 3.20). This is up slightly from 1 in 15 babies (6.7%) in 2000. Low birth weight can occur as a result of restricted foetal growth or from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to have health problems and disabilities later in life. Some of the main risk factors for low birth weight include maternal smoking, alcohol consumption and poor nutrition during pregnancy, low body mass index, lower socio-economic status, having had in-vitro fertilisation treatment and multiple births, and a higher maternal age. The increased use of delivery management techniques such as induction of labour and caesarean delivery, which have increased the survival rates of low birth weight babies, also partly explain the small rise in low birth weight infants.
The Baltic countries (Estonia, Latvia and Lithuania) and the Nordic countries (Finland, Sweden and Denmark) have the lowest proportion of low birth weight babies, whereas some countries in Southern Europe (Cyprus, Greece, Bulgaria and Portugal) have the highest proportion. While this proportion has decreased slightly over the past decade in Cyprus, it has increased slightly in Greece. Some suggest that the peak of 10% of low birth weight infants in 2010 in Greece, a sharp increase compared with 2008, may be due to the impact of the economic crisis on household’s access to health care (Kentikelenis, 2014). In Portugal, the proportion of low birth weight babies also increased over the past decade, from 7.6% of all live births in 2006 to 8.7% in 2013, with the rate broadly stable since then.
