Abstract

PIP: The ability of infant mortality and health indicators to monitor health conditions in early infancy and their broader use as indicators of the general level of socioeconomic development was discussed from three points of view: 1) the increasing impact of differences in legal definitions of live and stillbirths on the comparability of the infant mortality figures produced by vital statistics; 2) the validity of mortality measures to monitor health; and 3) the comparability of social inequalities in infant health and mortality over time and across countries. The infant mortality rate is defined as the risk of a live born child dying before its first birthday and is known as one of the most sensitive indicators of socioeconomic development of the population. Infant mortality rates consist of postneonatal early days or hours of life, early neonatal during the first week, late fetal or stillbirths, and perinatal mortality. Regarding live and stillbirth comparability all over Europe, legal definitions of vital events are significant: stillbirths, live births, and deaths. The problems of definition also impact the lack of international comparability of perinatal and infant mortality figures, whereby collapsing of stillbirths and early neonatal deaths may bias comparisons over time. Therefore, these two rates should be separated. The question also arises whether mortality measures health as a negative indicator. With respect to birth weight and gestational age, very low birth weight (1500 g) tends to replace the concept of low birth weight (2500 g). Another issue is birth weight specific mortality rates, which could enable the comparison of infant mortality levels to eliminate discrepancies derived from underregistration. The sociodemographic characteristics routinely included in vital registration beginning in the 1970s have shown that the children of unmarried, less educated, and unemployed mothers are at higher risk of perinatal mortality with a relative risk of 1.5 from the lowest to the highest social class.