Infant Mortality Rate
INFANT MORTALITY RATE
The infant mortality rate (IMR) is the ratio of the number of deaths among children less than one year old during a given year to the number of live births during the same year. An infant must adapt to a rapidly changing environment, and death may occur if this adaptation is not successful. Traditionally, this has been expressed by stating that the most dangerous times in the life of a human being are "the first day, the first week, the first month, the first year," in that order. In many regions of the world, the risk of dying within the first year of life will only be matched at the ages of eighty and beyond.
The death of an infant is often dependent on external factors, especially in developing countries. Poor water quality, an inadequate food supply, substandard health services, and a high level of infectious diseases such as malaria all contribute to a high IMR. The IMR is therefore considered a good indicator of the level of health in a community. The current worldwide average is just under sixty per thousand live births. In developed countries, IMR values as low as four deaths per thousand live births are recorded from Finland, Japan, Norway, Sweden, and Singapore. The United States has an IMR of seven per thousand (as of 1998), the same as Cuba and higher than the average for industrialized countries. In developing countries, however, the infant mortality rate can reach as high as 150 per thousand (see Table 1). The IMR is usually higher for male than for female infants. Within a given country or society, IMR values show marked differences among geographical, social, and economic subsets of the population. Table 2 shows IMR figures for urban and rural areas in selected countries.
Due to the correlation with external factors, the causes of infant death also vary by region. In developed countries, congenital anomalies, prematurity, and respiratory infections are the main contributors to infant mortality. In developing countries, however, infectious and preventable diseases such as malaria, neonatal tetanus, and
|IMR for selected regions and countries, 1998|
|Region or country||IMR per thousand live births|
|SOURCE: UNICEF (2000) The State of the World's Children.|
diarrheal diseases also play a major role in the death of infants. In these areas, efforts to reduce infant mortality are often difficult to implement, even though the underlying causes are easily identified. Programs to provide safe water, immunization against communicable diseases, improved health facilities, and health education are costly and face many internal obstacles.
High infant mortality rates are often associated with high levels of mortality in young children (two to five years of age). In some regions, up to half the children born alive die before their fifth birthday, and up to 40 percent of all deaths are of children under five years of age. Many decisionmakers in the developing world have been exposed to the traditional mental image of death in the West as associated with old age and the end of a long life—this may color their perceptions of mortality and the ensuing decisions. Perceptions of death may need to be re-evaluated to counter this instance of "cultural imperialism."
|Rural/urban differences in IMR, selected regions and countries, c 1998|
|Region or country||IMR rural (per 1000 live births)||IMR urban (per 1000 live births)|
|SOURCE: World Development report, 1997|
MICHEL C THURIAUX
UNICEF (2000). The State of the World's Children. New York: Author.
World Health Organization (1999). World Health Statistics Report. (1999). Geneva: Author.
—— (1998). World Health Statistics Report. (1998). Geneva: Author.