A new study using data from all NHS neonatal units in England and Wales has found that mortality rates among babies admitted for specialist care vary significantly depending on socio-economic background and ethnicity.
The analysis, published in The Lancet Child & Adolescent Health and led by the University of Liverpool, examined data on more than 700,000 babies admitted between 2012 and 2022. Supported in part by funding from the NIHR, it is the first UK study to assess both socio-economic and ethnic inequalities in neonatal units at all stages of pregnancy, while also accounting for maternal and birth-related factors such as preterm birth and illness severity at admission.
The study found that babies born to mothers in the most deprived areas had a 63% higher risk of dying before discharge compared with those from the least deprived areas and even after accounting for deprivation and maternal/birth factors, the risk remained elevated. Babies born to mothers of Black ethnicity had the highest mortality rates most years of the study period, facing an 81% higher risk of death compared with babies of White mothers, which – again – remained elevated even after adjusting for deprivation and maternal/birth factors. Babies of Asian mothers also had a 36% higher risk of death than those of White mothers. The study showed that deprivation and ethnicity each had their own impact on new-born survival within neonatal units – meaning one could not explain away the effect of the other.
The authors emphasise that these findings have major implications for policy and practice. Action is urgently needed to address both the upstream social determinants of health and clinical care pathways. Recommended strategies include improving socio-economic conditions for women during the perinatal period, support to reduce smoking in pregnancy, strengthening the maternity and neonatal workforce, and embedding culturally sensitive interventions for groups at higher risk of adverse neonatal outcomes.
Lead author Samira Saberian, PhD student in the Health Inequalities Policy Research Group (HIP-R) at the University of Liverpool said: “Our analysis shows that socio-economic and ethnic inequalities independently shape survival in neonatal units and maternal and birth factors explain only over half of the socio-economic and ethnic inequalities. To reduce these inequalities, we need integrated approaches that strengthen clinical care while also tackling the wider conditions affecting families. By improving services and addressing the root drivers of inequality, we can give the most vulnerable babies a better chance of survival.”
David Taylor-Robinson, Professor of Public Health and Policy in the Institute of Population Health and W.H. Duncan Chair in Health Inequalities added: “Our Labour Government has pledged to create the healthiest generation of children in our nation’s history. Yet our findings reveal, in stark detail, that even in 2025, too many children face significant challenges from birth – and for some, even before they are born. I hope this evidence drives real action to address the wider factors that shape health outcomes. Our research also highlights how existing biases and injustices in society are reflected in clinical settings, disproportionately affecting women and babies. These are inequalities we cannot afford to ignore.”
This research has been funded by the Hugh Greenwood Legacy Fund, University of Liverpool, and National Institute for Health and Care Research (NIHR).
The paper, ‘Inequalities in neonatal unit mortality in England and Wales. A retrospective cohort study, 2012-2022’ was published in The Lancet Child & Adolescent Health.