In a recent story titled “The biggest story in the UK is not Brexit. It’s life expectancy” published this week in “the Correspondent” author Danny Dorling (Geographer at the University of Oxford) points out that infant mortality is on a slow rise in England and Wales but declining in Scotland he says
There has also been a rise in infant mortality. In England and Wales, this rise was concentrated in those same years of maximum public spending cuts. In 2014, 3.6 babies died for every 1,000 born. That rose to 3.7 in 2015, 3.8 in 2016, and 3.9 in 2017 (which sadly is the latest year for which we have data, as funding for ONS has also been cut).
Though the change appears to be minuscule, according to the ONS, each rise was statistically significant. It means that enough extra babies died to increase that statistic by an amount that almost certainly did not occur by chance. Policy played a part – most importantly, policy concerning the funding of maternity units, the training of midwives, and the social services available to pregnant women. Most of the additional infant deaths each year occurred in the first few days or weeks of the child’s life.
Scotland, by contrast, had the same infant mortality rate as England and Wales in 2014, but by 2018 it had been reduced to 3.2 per 1000 births. This too did not happen by chance. Having decided to invest in mothers and babies, the Scottish government diverted funds from other areas to ensure it did so.”
It is very interesting that he puts the fall in infant mortality down to the Scottish Government “investing” in mothers and babies. One of the investments he is talking about is the establishment of the Maternity and Children Quality Improvement Collaborative (MCQIC), which enacted a quality standard that all maternity care providers have a documented conversation about the importance of fetal movements with pregnant women in the middle of pregnancy and at each antenatal visit thereafter. Supported by this MCQIC, Scotland has achieved a 22.5% improvement in the rate of Stillbirths since 2014.
So, Dorling’s story rang some alarm bells for me because this year the Australian Government has invested a significant amount of money (over 5 million by some accounts) in the NHMRC funded Stillbirth CRE and their “Safer baby bundle” this is loosely modelled on England’s “Safe baby bundle v1”. A strategy that saw up to 20% decrease in stillbirth rate in some of the participating hospitals. Our Government has made this investment in the hope that we will see a similar decline in Stillbirth in hospitals that participate in our bundle. But if the infant mortality rate is slowly rising in England and declining in Scotland at a population level then surely we need to be also looking to what Scotland are doing to make change at a population level? This is particularly because the Scottish drop was NOT due to a bundle of care, that may or may not have been adopted by maternity care providers at the coal face, but a mandated quality and safety initiative enacted at Government level.
Now I am not suggesting for one minute that the Safer baby bundle is not worth the Australian Governments investment. But these figures from the UK surely give us all cause to pause and consider what else needs to be done? These figures indicate that in order to achieve population level change that the SBB should NOT be the only thing the Australian Government does to try to reduce Stillbirth and that alongside the Bundle roll out urgent consideration also needs to be given to enacting Quality and safety standards just as Scotland did, because this seems to have been effective in reducing mortality at a population level rather than only at an individual hospital level. 

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