asked the Minister for Health the plans he has to establish the cause of the significant increase in the number of deaths of infants under 12 months during the first six months of 1988, especially as the overall trend in such deaths has been downward in recent years; if he intends to investigate any possible link between poverty and the deaths of babies; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Infant Mortality.
6.
The current issue regarding the purported significant increase in the number of infant deaths during the first two quarters of 1988 has arisen as a result of a failure to exercise caution in the interpretation of registration data. The quarterly reports on vital statistics from which these figures have been taken do not provide information on the numbers of infants actually dying during that quarter but only on the number of infant deaths which were registered during that quarter. Since infant deaths are relatively infrequent, the timing of the registration of these events can cause considerable fluctuations in the quarterly data. The fact that a high proportion of these deaths occur in large maternity hospitals where a number of registrations may be submitted together would tend to exacerbate these variations. My Department are currently endeavouring to ensure that maternity hospitals are prompt in registering infant deaths and that they do not submit registrations in batch form. It is hoped that some of the fluctuations in quarterly data may in future be avoided in this way.
In relation to the 282 infant deaths which were registered during the first six months of 1988, the Central Statistics Office have confirmed that 124 of these deaths actually occurred during 1987. Furthermore, the total number of registrations so far processed by the Central Statistics Office relating to occurrences of infant deaths during 1987 gives a total of 459. This figure could increase somewhat with the addition of registrations received during the last half of 1988, but there is certainly no basis for concluding that there has been any underlying increase in the level of infant deaths in recent months.
The Deputy is quite correct in his statement that the trend in infant mortality has been downward in recent years. The reduction in infant deaths has in fact been very rapid. The infant mortality rate is now only a quarter of what it was 25 or 30 years ago and compares favourably with the levels experienced in most developed countries. This is an achievement which should not be underestimated reflecting, as it does, quite marked improvements in overall health and health care.
Would the Minister agree that an increase on our infant mortality rate while the international level is dropping must be a matter of grave concern? Does the Minister intend to investigate any possible link between poverty and infant mortality? Does he intend examining the possibility of health cuts having this type of effect on the infant mortality rate?
The Deputy is certainly expanding the scope of this question.
As I pointed out in my reply, there is absolutely no evidence that there is any increase in the incidence of infant mortality in this country. For example, the figures available represent the number of deaths registered during the quarter, not the number of infants who actually died. As I pointed out also, in replying, in relation to 282 infant deaths which were registered in the first six months of 1988, the Central Statistics Office have confirmed that 124 of those deaths actually occurred during 1987. It will be seen that almost half of the deaths registered in the first half of 1988 had occurred in the year 1987. Therefore, it is not correct to draw a conclusion that there has been an increase in the infant mortality in this country.
To answer the second part of Deputy Sherlock's question on the links between poverty and infant mortality, obviously we are always concerned — and this is not new — that there is a higher risk of morbidity and mortality in the lower income groups. We are constantly addressing this and we would hope, through the health promotion unit, to do some studies to see what can be done to reduce the incidence of both sickness and death in the less well off groups.
Would the Minister be a little more forthcoming about the action he proposes to take to avoid batch registration of deaths? I think it makes a bit of a cod of the figures if we find that the interpretation is liable to be so misleading as they have been in this instance. Further, is the Minister satisfied with the registration of the causes of infant mortality maintained by his Department to identify possible different sources that may be arising?
I will deal with the second part of the question first. Yes, I am satisfied that they are accurate in so far as certification of deaths generally is. I am satisfied that the causes of death in infant mortality cases are accurately registered and there has never been any suggestion otherwise.
On the question of registration, as I pointed out in my reply, the registration per quarter is recorded by the Central Statistics Office. If one wants statistics fairly rapidly, it is difficult to know how one can ensure that one will get just the deaths that are recorded, because as the Deputy is aware the requirement under law is that registration must be effected within 12 months of a death so there is time available for the person registering the death. As I pointed out in my reply, sometimes in the large maternity hospitals they may register a number of deaths that occurred in the previous quarter together.
Could the Minister by regulation require a much shorter period than has occurred in this instance so that at least we could have an assurance that a death would be registered within seven days?
I can look into that matter. From memory, I believe that under the 1876 Act it would be necessary to amend the legislation to reduce the time limit in which deaths must be registered from the current 12 months. However, I will undertake to write to the maternity hospitals in regard to infant mortality. It would be more difficult where persons die outside hospital to have the deaths registered.
Would the Minister tell us briefly from the statistics available to him what is the main cause of infant deaths in this country?
I do not have that information as it was not requested in the question.