Infant Mortality in Moscow: the Perils of Progress in Russia's World City

Abstract

This paper examines changes in infant mortality (IM) in Moscow, Russia's largest and most affluent city. Along with some remarkable improvements in Moscow's health system over the period between 2000 and 2014, the overall IM rate for Moscow's residents decreased substantially between 2000 and 2014. There remains, however, substantial intra-city variation across Moscow's 125 neighborhoods. Our regression models suggest that in higher-income neighborhoods measured by percent of population with rental income as a primary source, the IM rate is significantly lower than in lower-income neighborhoods measured by percent of population with transfer income as primary source (housing and utility subsidies and payments to working and low-income mothers, single mothers and foster parents). We also find that the density of physicians in a neighborhood is negatively correlated with the IM rate, but the effect is small. The density of nurses and hospital beds has no effect. We conclude that overall progress on health outcomes and measures of access does not, in itself, solve the challenge of intra-urban inequalities.

Keywords: Infant mortality; Intra-city health inequalities; Moscow.

Fig. 1

Infant mortality rates in Moscow: 2000–2014. Notes: (a) IM measured as the number of infant deaths per 1000 live births. Note that in April of 2012, the Russian Federation revised its definition of live births and stillbirths. The increase in the IM rate between 2010 and 2014 is related to a transition to the new definition [25]. (b) These data are based on the 125 rayons of Moscow covered in this study. We did not include infant births and deaths of Moscow’s non-resident mothers

Fig. 2

Variation in Moscow’s Infant Mortality Rates by Rayon, 2010

Fig. 3

Boxplots of infant mortality rates in Moscow by Quartile, 2010. Note: The common vertical axis is the neighborhood quartile infant mortality rate. The thick middle horizontal line across the full rectangle is at the median neighborhood rate on the vertical axis. The upper and lower horizontal lines of the full rectangle are at the 75th and 25th percentile rates, respectively. The remaining 2 horizontal lines, the whiskers, are at the largest and smallest rates of the distribution on the vertical axis