A taskforce is being set up to tackle baby deaths in Birmingham, after a report revealed infant mortality rates in the city are nearly twice the national average, with families from Pakistani backgrounds disproportionately affected.
Councillors described the situation as “distressing” and said the report made for uncomfortable reading after it highlighted deprivation, ethnicity and health inequalities as key factors in the stubbornly high numbers, which equate to more than 100 babies dying before their first birthday in the city every year.
“Something is going wrong. We need to act to put it right,” said the councillor Rob Pocock, the chair of the health and social care scrutiny committee, which produced the report. “This is a tragedy that can and must be reduced.”
The infant mortality rate in Birmingham is seven deaths per 1,000 live births, compared with 3.9 deaths in England as a whole, and numbers have not declined in recent years as they have done nationally.
Death rates are highest in the areas of the city with the worst deprivation, a key issue in Birmingham where 28.1% of children live in low-income families compared with 17% nationally.
On Tuesday, councillors voted in favour of establishing a new multi-agency taskforce with the goal of reducing infant mortality in the city by at least 50% by 2025, and working with community groups and faith leaders to help minimise risk factors.
The report said data from Birmingham’s 2011 census showed Pakistani, black African and Afro-Caribbean populations were overrepresented in child deaths, and analysis from the city’s Child Death Overview Panel highlighted Pakistani families as being particularly affected.
Nationally, stillbirth and neonatal mortality rates (death within 28 days of birth) are 60% higher for babies of Asian and Asian British ethnicity compared with babies of white ethnicity, and 45% higher for babies of black or black British ethnicity.
This equates to one in 188 Asian or Asian British babies being stillborn compared with one in every 295 babies of white ethnicity.
“Really, more work does need to be done to understand why there is such a significant and frankly unacceptable variation among different communities,” said Josie Anderson, the policy, research and campaigns manager at Bliss, the leading UK charity for babies born premature or sick.
“Research has shown women living in the most deprived areas had an 80% higher risk of stillbirth and neonatal deaths compared to women living in the least deprived areas. And of course there is quite a lot of intersection between women living in deprived areas and also ethnicity as well.” She advocated the use of continuity of care practices where women are treated by either the same midwife or a very small group of midwives throughout their pregnancy to boost trust and communication.
The report said a fifth of infant deaths in Birmingham were caused by abnormalities at birth, the risk of which is doubled by consanguineous marriage (marriage between couples related as second cousins or closer), a study has shown. Pocock said the report “sought not to exaggerate this issue but we have also not ignored it. It is part and parcel of the range of complex factors that we face in attempting to deal with the problems of infant mortality.”
The report said the challenge in tackling the potential risk of consanguinity was “complicated by cultural sensitivities and misconceptions […] as well as inadequate knowledge and skills among healthcare professionals and low levels of trust among communities that have past experience of discrimination”.
Shabana Qureshi, the wellbeing manager at Ashiana Community Project in Sparkbrook, an inner-city area with the second-highest non-white population in Birmingham, was one of the contributors to the report. “In terms of the scientific rationale as to why intermarriage is such a risk, I think there’s some awareness but it’s limited,” she said.
“There is awareness that when you marry a closer relative, there is a higher risk that your child may have some complications surrounding its birth. But I think that’s often dismissed because the communities we are working with are predominantly of Pakistani origin and in Pakistan 50% or more of the population practice consanguinity. It’s something that’s quite normalised.”
She said “consistent and culturally sensitive” messaging was crucial to improving genetic literacy in the community, but stressed that child poverty was still the main factor that needed addressing. “Across all of the ethnic groups, including Pakistani, Bangladeshi and black communities, you’re more likely to experience higher levels of perinatal death or stillbirth due to socioeconomic deprivation,” she said.
“We need to address that blatant inequality so a baby born in a particular area to a person of a particular ethnicity has just as much a chance of survival as a baby being born in an affluent area.”