L.P. Sukhanova¹, N.N. Bushmelyova², Z.Kh. Sorokina^3
1Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow
²State Medical Academy of the city of Izhevsk, city of Izhevsk
³Academician V.Yi.Kulakov Memorial Research Center for obstetrics, gynecology and perinatal studies

Summary. Evaluation of recent two decades tendencies in infantile mortality shows rather a favorable situation when based on indicators from official statistics: the rates of overall infantile mortality has decreased from 17.8 deaths upon 1000 newborns in 1991 to 7.4 (that is 2.4-foldly) in 2011, neonatal mortality has decreased from 11.0 ‰ in 1991 to 4.2 ‰ in 2011 (61.8% less in 2011), the mortality of infants of first week after birth has decreased from 8.9‰ to 2.8‰ (68.5% less in 2011‰) – mainly contributing to neonatal mortality improved rates, post-neonatal mortality has decreased from 6.8 in 1991 to 3.3 in 2011 (51.5% less in 2011). Interestingly enough, the fastest rates of diminishment of the infantile mortality were pertaining to the second decade of the period studied – from 15.3 in 2000 to 7.4 in 2011.

Noteworthy, infantile mortality is generally considered to be a rather steady and persistent demographic indicator not quite susceptible to drastic or just rapid changes, thus, a strong doubt arises as to the verified nature of these statistical data. Analysis of the dynamics of these changes, of the age structure of dead-borns and the structure of newborns’ deaths along body (at-birth) weight categories only but gave growth to these doubts.

A peculiar feature of infantile mortality age structure in Russia presented in official statistics was the steady diminishment of the proportion of neonatal mortality with simultaneous growth of post-neonatal mortality (the so called ageing of infantile mortality), while in the EU, for instance, the tendencies are quite opposite to these ones: more late fatalities are not so prominent in comparison, and the overall decreased infantile mortality here comes mainly from the decreased post-neonatal mortality.

The whole nuisance with Russian peculiar features in the dynamics of the statistically presented infantile mortality could be accounted for merely by factual under-registration of dead infants.

Two evasion pathways involved in under-calculated indicators of infantile mortality in Russia were identified in this study: first, the statistical transfer of a infant dead in early neonatal period to the category of stillborn, which was quite possible before the new regulations for the official statistics on this point; secondly, entering the fact of dead infant (or stillborn) into the pool of fetus phenomena specifically including miscarriage with no official registration (on the ground that it was a fetus phenomenon) which was also quite possible before the new regulations of 2011 for the official statistics on that point. Peculiar enough was that before these new regulations, the very discontinuation of pregnancy prior to 27 full weeks of gestation had been often considered as a miscarriage only.

First, the structural discrepancies in the statistical pool between the number of life-born and still-born infants are quite obvious from the official statistics presentations, and these discrepancies were due to unjustified transfer of infants dead in early neonatal period to a stillborn category. Secondly, a mythical ablation of a whole category of newborns (and that was the category with the weight-at-birth of 1000-1499 g) not rarely occurring in statistics of registered infantile mortality, indicated the existence of great lacunae in this respect. These insufficiencies to a great extent were due to referring dead infants to unborn fetes not intended for official registration as dead-borns.

The first evasion pathway when a life-born, then dead infant was entered into the category of a stillborn was being very clearly identified judging from not rare statistical absence or unrealistically small numbers of the infants dead in the primary 24 hours after birth.

Conclusions: Infantile mortality, or more specifically neonatal mortality, was artificially under-estimated and under-calculated in Russia in the past two decades, mainly due to sharp under-registration - through various evasion pathways - of the infants dead in the PB (post-birth) neonatal period (0-6 days after birth). Post-neonatal losses has proved to be of more verified character compared to neonatal mortality presented by official statistics. Moreover, numerical relationship between neonatal and post-neonatal losses in the official statistics of the EU has proved to be much more appropriate, presuming the possible implementation of the established there proportion for the correction of the biased statistics in our country - for the indicators of early neonatal (1^st day) and post-birth (0-6 days) neonatal mortality, in particular.

This presumed correction could be done on the way of artificially reconstructed infantile mortality rates with specified consideration to the officially registered post-neonatal mortality as much more reliable in this context – with due correction - on this basis - of early neonatal figures that were, most probably, unreliable ones.

Keywords. Infantile mortality, neonatal mortality, verification of registered newborns mortality, infants of 1^st year after birth.

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