A MAJOR new analysis has revealed stark inequalities in neonatal mortality across England and Wales, with babies born to mothers from deprived areas or ethnic minority backgrounds facing a significantly higher risk of death. Despite advances in neonatal care, progress towards equitable outcomes remains uneven.
Between 2012 and 2022, more than 709,000 babies were admitted to NHS neonatal units, and 11,257 (1.6%) died before discharge. Researchers found that babies born to mothers living in the most deprived areas were 63% more likely to die than those from the least deprived areas. Even after accounting for factors such as ethnicity and clinical characteristics, the risk remained 23% higher.
Neonatal Mortality and Socioeconomic Deprivation
Of the 678,550 babies with complete data, more than 15% were born to mothers in the most deprived decile, compared with just 6.5% in the least deprived. The data underline a persistent social gradient in neonatal outcomes, where deprivation continues to shape the chances of survival for newborns requiring specialised care.
The study also found notable differences by maternal 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. After adjusting for deprivation and clinical factors, disparities were reduced but not eliminated, indicating that other systemic or in-hospital factors may contribute to these differences.
Addressing Inequalities in Neonatal Outcomes
Researchers suggest that while some inequalities can be explained by differences in case-mix, such as gestational age, birthweight, and congenital anomalies, residual disparities point to potential variations in care practices or access to treatment. The study emphasises the need for further research into how neonatal care is delivered across hospitals, as well as broader policy action to address the social determinants of health affecting expectant mothers.
Efforts to reduce neonatal mortality have achieved overall improvements in survival over the past decade, but this work highlights that these benefits are not evenly distributed. Addressing inequalities, both inside neonatal units and in the communities they serve, remains crucial to improving outcomes for all newborns.
Reference
Saberian S et al. Inequalities in neonatal unit mortality in England and Wales between 2012 and 2022: a retrospective cohort study. Lancet Child Adolesc Health. 2025;9(12):857-67.
