Neonatal Mortality Risk Up to 81% Higher in Black Mothers – European Medical Journal

Report on Neonatal Mortality Inequalities in England and Wales and Implications for Sustainable Development Goals

Introduction: A Challenge to SDG 3 and SDG 10

A retrospective cohort study conducted between 2012 and 2022 in England and Wales has identified significant inequalities in neonatal mortality, directly challenging progress towards key Sustainable Development Goals (SDGs). The findings highlight that disparities linked to socioeconomic deprivation and maternal ethnicity are undermining efforts to achieve SDG 3 (Good Health and Well-being), particularly Target 3.2 to end preventable deaths of newborns, and SDG 10 (Reduced Inequalities). The analysis of over 709,000 neonatal unit admissions reveals that despite overall improvements in care, the benefits are not being distributed equitably.

Key Findings: Disparities Undermining SDG Targets

The data reveals a persistent social gradient in neonatal outcomes, indicating a failure to fully address the principles of equity central to the SDG framework. The primary disparities are:

• Socioeconomic Inequality (SDG 1 & SDG 10): Babies born to mothers in the most deprived areas faced a 63% higher risk of mortality compared to those from the least deprived areas. Even after adjusting for clinical factors, a 23% higher risk remained, demonstrating a clear link between poverty, deprivation, and adverse health outcomes.
• Ethnic Inequality (SDG 10): Significant disparities were observed across ethnic groups. The risk of neonatal mortality was 81% higher for babies born to Black mothers and 48% higher for babies born to Asian mothers when compared to those born to White mothers. These persistent inequalities highlight systemic barriers to achieving equal health outcomes.

Analysis of Factors and Systemic Gaps

The study identifies several layers contributing to these inequalities, which must be addressed to make meaningful progress on the SDGs.

1. Clinical Case-Mix: Some of the disparity is attributable to differences in gestational age, birthweight, and congenital anomalies, which are often linked to the social determinants of health affecting expectant mothers from disadvantaged backgrounds.
2. Residual Systemic Disparities: The inequalities that persist after adjusting for clinical and socioeconomic factors point towards potential variations in the quality of care, access to treatment, or other in-hospital factors. This suggests that the universal health coverage goal within SDG 3 is not being uniformly applied.
3. Social Determinants of Health: The findings underscore the critical impact of broader social and economic conditions on maternal and neonatal health. Addressing these root causes is essential for achieving both SDG 3 and SDG 10.

Recommendations for Advancing SDG Commitments

To address these findings and accelerate progress towards the SDGs, a multi-faceted approach is required. The following actions are critical for ensuring no newborn is left behind:

• Integrate SDG 10 into Health Policy: Implement targeted policies that explicitly aim to reduce health inequalities by addressing the social determinants of health for expectant mothers in deprived areas and from ethnic minority communities.
• Enhance Healthcare Equity (SDG 3): Conduct further research into the delivery of neonatal care across different hospitals and demographics to identify and eliminate systemic biases or variations in practice.
• Strengthen Data Monitoring for Equity: Improve data collection and analysis to monitor progress on reducing neonatal mortality inequalities, ensuring accountability for achieving SDG 3 and SDG 10.
• Community-Centred Interventions: Develop and fund interventions that support vulnerable mothers and newborns both within healthcare settings and in their communities to mitigate the impacts of deprivation.

Analysis of the Article in Relation to Sustainable Development Goals

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s central theme is neonatal mortality, a key component of child health. It discusses the survival rates of newborns in neonatal units, directly aligning with the goal of ensuring healthy lives and promoting well-being for all at all ages.
2. SDG 10: Reduced Inequalities
   • The analysis explicitly reveals “stark inequalities” in neonatal outcomes. It highlights significant disparities based on socioeconomic status (deprivation) and ethnicity (Black and Asian mothers), which are core concerns of SDG 10.
3. SDG 1: No Poverty
   • The article establishes a direct link between socioeconomic deprivation and a higher risk of neonatal death. It states that babies from the “most deprived areas were 63% more likely to die,” connecting the issue of poverty to critical health outcomes.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.2: End preventable deaths of newborns and children under 5 years of age.
   • The entire article is focused on neonatal mortality, which is the death of a newborn. The study’s aim to understand the factors contributing to these deaths is directly related to the global effort to reduce and ultimately end preventable newborn deaths.
2. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
   • The article’s findings that babies born to mothers from deprived areas or specific ethnic backgrounds (Black and Asian) face a significantly higher mortality risk demonstrate a lack of equitable health outcomes. Addressing these disparities is essential for achieving the social inclusion and equality promoted by this target.
3. Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions.
   • The article identifies socioeconomic deprivation as a primary driver of inequality in neonatal mortality. The call to address the “social determinants of health” implies that tackling poverty and deprivation is a necessary step to improve survival rates for newborns, aligning with the goal of poverty reduction.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator for Target 3.2 (Implied: 3.2.2 Neonatal mortality rate)
   • The article provides a clear statistic that functions as this indicator: “11,257 (1.6%) died before discharge” out of the babies admitted to NHS neonatal units. This is a direct measurement of the neonatal mortality rate within this specific cohort.
2. Indicators for Target 10.2 (Disaggregated health data)
   • The article provides data disaggregated by socioeconomic status and ethnicity, which serves as a powerful indicator of inequality. Specific implied indicators include:
     • The relative risk of neonatal mortality based on deprivation: “babies born to mothers living in the most deprived areas were 63% more likely to die.”
     • The relative risk of neonatal mortality based on ethnicity: “Babies born to Black mothers faced an 81% higher risk of death compared with those born to White mothers, while babies born to Asian mothers had a 48% higher risk.”
3. Indicator for Target 1.2 (Socioeconomic deprivation level)
   • The article uses the “deprivation decile” of the mother’s residence as a key variable. The finding that “more than 15% [of babies] were born to mothers in the most deprived decile, compared with just 6.5% in the least deprived” acts as a proxy indicator for the concentration of health risks among populations experiencing poverty.

SDGs, Targets, and Indicators Identified in the Article

Source: emjreviews.com