Agenda item

The Health Scrutiny Committee received a report of the Director of Public Health that updated members on infant mortality in Oldham and on actions being taken to reduce these deaths. The submitted report provided an overview of the work being undertaken to reduce infant mortality across the Borough of Oldham, with specific focus on the work to reduce smoking in pregnancy, and on advice regarding safe sleeping.  

Infant mortality has a devastating impact on the lives of the affected families of the Borough. Infant mortality was defined as the death of a child aged under one year. The highest priority for the long-term health of the population was to ensure that children are given the best start in life. 

Oldham’s infant mortality rate had been higher than the North West region and England rates consistently for over a decade. Oldham’s most recent rate for 2018 - 2020 was 6.2 per 1,000, making it significantly higher than the national figure, in the same period, of 3.9 per 1,000. This was therefore a key priority to improve the health of the Borough.

Oldham ranked as the 19^th most deprived out of 317 English local authorities in 2019 Indices of Deprivation (IMD) data. National research had demonstrated that there was a correlation between child poverty and the rates of deaths in children, including infants.  The report on this issue from the National Child Mortality Database, which was based on data for children who died between April 2019 and March 2020 in England, finds a clear association between the risk of child death and the level of deprivation (for all categories of death except cancer).

Key contributing causes of death locally and nationally included congenital abnormalities, babies that were small for gestational age, and extreme preterm births. To reduce the prevalence of these, public health approaches should be focusing on those women that resided in the Borough’s poorest areas, and work to reduce smoking, unplanned pregnancies, maternal obesity and better engagement with those with maternal disorders such as diabetes.  In addition, wider determinants of health were found to be factors identified in deaths of children who lived in poverty including overcrowded housing, lack of access to interpreting services, and poor maternal health in pregnancy.

Smoking and exposure to second hand smoke during pregnancy was responsible for an increased rate of stillbirths, miscarriages and birth defects. Encouraging pregnant smokers to stop smoking was one of the most effective ways to reduce infant mortality and still births. Stopping smoking would not only benefit women who smoked and are planning a pregnancy, are already pregnant or have an infant aged under 12 months but it would also benefit the unborn child of a woman who smoked, any infants and children she may have.

In terms of genetic causes, all the cases reviewed by the Oldham Bury and Rochdale CDOP last year that related to chromosomal, genetic and congenital abnormalities were children of Black, Asian or minority ethnicity.  In addition, overall, there were higher rates of child deaths in Black, Asian or minority ethnicity groups across the Borough of Oldham. This was consistent across Greater Manchester and it was important that this inequality should be addressed. Consanguinity was a known risk factor for congenital abnormalities and therefore an important risk factor when addressing child deaths. As a response to this, Oldham Council had commissioned a genetic outreach service, that has been operating since 2015.  The service aimed to raise genetic literacy and awareness in affected communities in Oldham in order to support informed marriage and reproductive choices.  The service was recommissioned last year and is provided by HomeStart.

The Safe Sleeping initiative saw the completion of a local case review on the sudden and unexpected death of a baby in Oldham the Children’s Safeguarding Partnership agreed to undertake a piece of work relating to safer sleep. This work was later reinforced following the publication of the National Child Safeguarding Practice Review of Sudden and Unexpected Deaths in Infancy (SUDI). Both local and national reviews identified challenges relating to the application of safe sleep guidance in the home.

The Committee scrutinised the report in some detail and a member noted that there were higher still birth rates in Pakistani and Bangladeshi patients. In this regard the Director of Public Health highlighted a number of the risks factors, adding that there was evidence to suggest that there were changes within the control of the maternity services which could be made to improve outcomes in this regard.

Resolved:

1.    That the Committee notes the data on infant mortality, detailed in the report and supports the ongoing actions to reduce infant mortality across the Borough of Oldham.

2.    That a further update report on this matter be submitted to the Committee in approximately 12 months.