What is Infant Mortality?
What is infant mortality?
Infant mortality is a universal indicator for the overall health of a population. Health Canada describes it as the “single most comprehensive measure of health in a society” (Health Canada – Government of Canada, 2011). It is measured using the infant mortality rate, calculated as the number of deaths of infants less than one year of age per 1,000 live births.
Although the infant mortality rate in Saskatchewan has decreased since 2005, as of 2009 it was still well above the Canadian average and the highest among all the provinces in Canada. In 2009, the rate of infant mortality in Canada was 4.9/1,000 live births. The rate in Saskatchewan in the same year was 6.7/1,000 live births (Statistics Canada, 2012).
The infant mortality rate of a given population can provide valuable information about the health of that population. It can speak to the behavioural and social factors affecting the population and the interventions that may be required. The leading causes of infant mortality in Saskatchewan are:
- Congenital anomalies (birth defects)
- Preterm birth
- Sudden Infant Death Syndrome (SIDS)
This report outlines some promising practices to reduce infant mortality. A report from Health Canada, titled Healthy Canadians – A Federal Report on Comparable Health Indicators 2010, is also a valuable source of information on this very important topic.
Modifiable Risk Factors for Infant Mortality
What are the Modifiable risk factors for infant mortality in Saskatchewan?
The following modifiable risk factors were compiled from several different resources, including publications and consultations with provincial health professionals. They were developed for use by the Youth Advisory Council for the Infant Mortality Youth Project. The categories represent the various behaviours during the preconception period that not only impact infant mortality but can also be changed through personal intervention and consultation with health professionals.
Diabetes, circulatory diseases, and respiratory diseases are three conditions that can impact infant mortality. In 2011, 5.7% of people in Saskatchewan were living with diabetes, compared to 6.1% of Canadians with diabetes that same year. From 2005-2007, the rates of circulatory and respiratory diseases for the three Northern health regions in Saskatchewan were higher than the averages of both Saskatchewan and Canada.
Impact of medications:
Medications that are known to cause harm usually do so within the first few weeks of pregnancy, when the baby’s major body systems are forming — and often before many know that they are pregnant. Before individuals start taking any type of prescription or non-prescription medication or herbal remedy, it is very important that they speak with a health-care professional.
Lack of vaccinations:
Hepatitis B vaccinations, for example, are critical. If Hepatitis B is contracted by the mother, it can be passed on to the baby at birth.
Although decreasing from 4x to 1.5x the provincial rate, cervical cancer rates in Northern Saskatchewan, for which there is a vaccination, are still much higher than the rest of the province.
Depression and other mental health disorders:
The mental health of the mother has been found to impact the health of her baby. Depression and other psychological issues have been associated with delivering a preterm or low birth weight infant. These are predisposing factors to infant mortality.
Sexually transmitted infections, including HIV, cervical and uterine infections, and asymptomatic bacterial vaginosis are all recognized as increasing the risk of preterm delivery and may be important factors in explaining higher preterm birth rates.
Insufficient vitamin and mineral intake:
Taking 0.4 mg of folic acid supplement before and during pregnancy can decrease the risk of having a baby with a neural tube defect by 50% in most women. It is therefore very important that all women of childbearing age take folic acid supplements, even if they are not planning a pregnancy, as neural tube defects can occur before a woman even knows that she is pregnant.
In northern Saskatchewan, 41% of people reported eating fruit or vegetables five or more times per day. This is higher than the Saskatchewan rate of 38.5% and lower than the Canadian rate of 44.2%. Adequate intake of vitamins and nutrients are critical to personal health and the health of an unborn child.
In 2008, the rate of new and relapsed tuberculosis cases in Northern Saskatchewan was almost 30 times greater than the rate for all of Canada.
From 2005-2009, there were 175 reported new and relapsed cases of tuberculosis in on-reserve Saskatchewan populations and 118 cases for off-reserve Saskatchewan populations.
Multiple reports have highlighted the link between periodontal disease (oral disease) and adverse pregnancy outcomes. There is evidence for the association between maternal periodontal disease and risk of preterm birth and low birth weight, and while the evidence is mixed, it generally points to a positive association. Further, periodontal disease and preterm birth share many common risk factors. Other potential risks cited in studies include preeclampsia, gestational diabetes, perinatal mortality, and miscarriage; however, the evidence here is less conclusive.
Research has shown a link between maternal obesity and still birth (i.e., the birth of a dead fetus), as well as early neonatal death (i.e., death of a live-born baby within the first seven days of life). It has also been suggested that maternal obesity is associated with a more than doubled risk of stillbirth and perinatal death.
Other potential outcomes of maternal obesity for the newborn include reduced energy expenditure, very-low-birth-weight babies, and early neonatal death. In addition, because of various infant complications, the percentage of babies admitted at the intensive care department is 3.5 times higher in the case of maternal obesity.
Infertility/adverse past pregnancy outcomes:
Multiple births are associated with increased risk of preterm delivery, low birth weight, and intrauterine growth restriction and their associated consequences. Women who use assisted reproductive technology and other fertility treatments have greater rates of preterm and low birth weight in both multiple and single births.
Preterm birth is one of the most important risk factors associated with increased infant mortality. One of the most important predictors of preterm birth is a previous preterm birth.
Lack of social support:
Babies born to mothers with low social support in the early part of pregnancy weighed an average of 200g less than babies born to mothers with adequate support. The physical and emotional impacts of low social support have been reported to increase maternal stress, anxiety, and depression.
Infant mortality rates for unmarried mothers have been shown to be 1.8 times higher than for married mothers.
Unhealthy Relationships – Domestic violence:
Indirectly, violence during pregnancy can lead to maternal suicide, postpartum depression, poor nutrition, and the use of alcohol, tobacco and other drugs as coping mechanisms. Directly, it can lead to injury to mother and baby as well as infant death.
Being abused as a child or witnessing intimate partner violence during childhood has been linked with poorer health status and higher prevalence of depression, as well as greater use of both medical and mental health services in adult women.
High levels of stress:
Chronic stress associated with poverty and discrimination is now thought to be an important cause of adverse pregnancy outcomes. Stress may be an important determinant of preterm birth as it leads to reduced immune functioning and increases susceptibility to infections.
Stress may have both direct and indirect effects on birth outcomes through biological and behavioural pathways.
Environmental tobacco smoke, pesticides, and other environmental toxins have been shown to increase the risk of low birth weight and preterm births.
Lack of planned pregnancies and preconception care:
An unplanned pregnancy can result in a woman not knowing that she is pregnant and therefore continuing to engage in risky behaviours that may harm the unborn child. Reducing these harmful behaviours can play a significant role in one’s health.
Lack of adequate health care and testing:
Regular testing by a physician will help ensure that both parents are healthy and the baby will be provided with the best conditions in which to grow.
Maternal smoking is the principal cause of low birth weight and has been associated with preterm births, sudden infant death syndrome, and respiratory distress syndrome. While pregnant, smoking can impact the growing fetus. Following birth, second hand smoke from the mother or father can harm the baby’s breathing.
The lifestyle choices a woman makes prior to becoming pregnant and in the first few weeks of pregnancy can affect her health and the health of her baby. What a woman eats, drinks, or ingests can affect her unborn baby.
Alcohol is the most frequently used drug in Saskatchewan. In 2004, over 78% of Saskatchewan residents, age 15+ reported drinking alcohol in the past year.
Illicit drug use:
Babies born to substance abusing mothers run the risk of being born addicted to the same drugs themselves and need intensive acute care support early in the postnatal period to wean them off the effects of these drugs.
Teen mothers are more likely to deliver low birth weight babies, have preterm births, and have lower rates of prenatal care than mothers in older age groups, increasing the risk of adverse health outcomes including infant death and poorer health throughout childhood in general.
Saskatchewan trends show a continual increase in adolescent pregnancies from 2002 to 2009, while national figures show a decrease.
Unplanned pregnancies are at higher risk of resulting in preterm or low birth weight newborns. Women involved in multiple high risk activities such as injection drug use and alcohol abuse risk unplanned pregnancies and are more likely to be lower socioeconomic status, suffer greater food insecurity, and often delay accessing prenatal care.
Why is Education About Infant Mortality Important?
Why is education about infant mortality important?
As a universal health indicator, the rate of infant mortality predicts the overall health of a population and allows for comparisons between different populations on national (eg. Canada vs. USA), provincial (eg. Saskatchewan vs. Alberta) and municipal (eg. Saskatoon vs. Moose Jaw) levels. Educating youth and adults allows for a discussion of the risk factors that can lead to infant mortality. By bringing awareness to the issue of infant mortality, we can work together to reduce the occurrence of these risk factors and improve the health of our population in Saskatchewan.
Although the risk factors for infant mortality are both behavioural and social, social factors such as income, education, and housing typically require a collaborative approach between government and its citizens, including changes at the policy level. Behavioural risk factors, on the other hand are, for the most part, those behaviours and actions that individuals engage in that can be modified in some way. Unplanned adolescent pregnancy, for example, is a major risk factor for infant mortality that is highly modifiable by the couple. They may choose to abstain from sex, use highly effective methods of birth control, or make a plan to become pregnant and consult with their primary healthcare provider.
Why should we focus on health of men and women before pregnancy?
Typically, when discussing preconception health and infant mortality, the focus is centred on the female. The reason why is very straightforward – the female carries the baby and her actions directly impact the baby’s health. At the same time, we all know that in order for the female to become pregnant, a male needs to be involved.
The effects of a male’s health on the health of an unborn child are not as profound as the effects of the female’s health. At the same time , there are indirect effects that a male who fathers a child can have on the baby. Among others, social support, violence, and smoking are three behaviours that can impact the baby’s health and the health of the mother.
By making positive, healthy choices before pregnancy, future complications and adverse infant health outcomes may be avoided.
What is the Saskatchewan Prevention Institute doing to reduce the rate of infant mortality in Saskatchewan?
As part of a provincial initiative to reduce the occurrence of infant mortality in Saskatchewan, the Saskatchewan Prevention Institute has formed a Youth Advisory Council (YAC) that represents the knowledge, influence, and creativity of youth throughout the province. The young members of our communities from across the province are integral to making educated and lasting changes to their health and the health of their future families. They are an inspired group of individuals capable of making profound recommendations that will improve the overall health outcomes of Saskatchewan’s population.
Currently, YAC team members are developing a new prevention activity through the use of social media campaigns, interactive projects, and inspiring videos. Supported by youth in Sandy Bay, Pelican Narrows, Creighton, Stony Rapids, Black Lake, and Fond du Lac, YAC members are well on their way to creating an impactful set of promotional videos. Their enthusiasm, knowledge, and creativity are most certainly playing significant roles in making this project a success!
Your Choices Matter Video
Your Choices Matter Video
Your Choices Matter is a video focused on raising awareness about the impacts of youth’s early life choices on the health of their future children. The video addresses choices about: drug and alcohol use, diet and exercise, relationships, vaccinations and regular health care checkups, and sexual activity. Saskatchewan youth were involved in the creation of the video content and presentation through the Saskatchewan Prevention Institute’s Infant Mortality Youth Advisory Committee. It is hoped that this video will be used to engage youth and communities in conversations about choices youth can make now to ensure the best health outcomes for their future children.
Your Choices Matter: How Your Health Today Impacts Your Health Tomorrow Facilitator’s Guide
In conjunction with the Your Choices Matter video, the Facilitator’s Guide can be used to engage youth and communities to have conversations about health and behaviour choices that they are making today to ensure the best health outcome for themselves and their future children. The guide provides background information and several lesson plans, which can be used in the classroom or in a group setting, to address the various topics introduced in the video.
Your Choices Matter: How Your Health Today Impacts Your Health Tomorrow Lesson Plans
While the Your Choices Matter video is meant to introduce the topic of infant mortality and health behaviours, the lesson plans are a way to take this a step further. Each lesson addresses common risk factors for infant mortality and can help guide discussion about the impact of these risk factors for youth today and in the future, and for their future children. Each lesson has been linked to the Saskatchewan Curriculum and, where applicable, includes marking rubrics.
- Irvine, J., Quinn, B., & Stockdale, D. (2011). Northern Saskatchewan Health Indicators Report 2011. Retrieved from www.athabascahealth.ca
- Health Canada. (2011). Healthy Canadians – A Federal Report on Comparable Health Indicators 2010. Retrieved from www.hc-sc.gc.ca
- Opondo, J. & Marko, J. (2012). Medical Health Officer Report: Reducing Infant Mortality in Saskatoon Health Region. Retrieved from www.saskatoonhealthregion.ca
- Saskatchewan Prevention Institute. (2009). Infant Mortality in Saskatchewan: Evidence to Inform Public Health Practice.
- Statistics Canada. (2012). Infant mortality rates, by province and territory. CANSIM, table 102-0504. Retrieved from www.statcan.gc.ca