Infant Mortality as an Indicator of Healthcare System Performance


Measuring healthcare system performance and its direct effect on population health is important for the evaluation of healthcare management. One of the most widespread proxy measures of doing so is the infant mortality rate (IMR). It stands for the number of deaths in children aged 12 months or below per 1000 live births during the same year (Bollyky et al., 2019). As such, it has been considered an effective way to gauge population health. Population health revolves around more factors than just the state of the local healthcare system and includes the state of economic development, living conditions, illness rates, and the environment (Tavares 2017). IMR is particularly sensitive to the quality of healthcare administered within hospitals and other medical facilities, thus enabling accurate measurements of healthcare performance.

Leading Causes of IMR

Some of the primary leading causes of IMR increase are birth defects. These defects are largely involved with environmental factors that can be connected to the overall state of healthcare. Infection, drug exposure, and pollution are among the reasons for causing birth defects (Bollyky et al., 2019). Thus, a high number of birth defects points toward poor preventative care and a lack of community welfare programs that inform the population about the dangers of drugs and unsafe environments (Bollyky et al., 2019). Other factors, such as pneumonia, neonatal infection, malaria, diarrhea, and exposure to other diseases, may indicate a lack of early vaccination efforts, sterilization, general professionalism of the staff, and unsafe hospital environments (Lambert et al., 2018). All of these factors can be improved within the scope of a healthcare system.

Low birth weight is another important factor that often leads to increased child mortality. According to the statistics, children weighing between 3 and 3.5 kilograms are at the least risk of death, whereas those around 1 kilogram when born are most likely to die (Bollyky et al., 2019). Those in-between still are in increased danger from health complications resulting from low weight. Some of the reasons for the condition include teen and late pregnancies, as well as poor health and malnutrition in mothers (Bollyky et al., 2019). While hospitals and healthcare systems are not directly responsible for low birth weight in children, a high IMR may indicate a lack of preparation for such events (Tavares, 2017). Therefore, IMR can be used as a proxy measure for hospital readiness to deal with complicated births.

Utilizing IMR to Improve System Performance

Healthcare managers can utilize IMR as an important measure to identify any potential problems within their systems. The presence of a high IMR, especially in comparison to other hospitals in the region, may indicate a presence of one or more critical failures that need to be addressed. Upon learning of increased mortality rates, an investigation into the reasons for such should be undertaken in order to identify potential problems that need to be solved quickly and efficiently. Usually, the factors that contribute to high IMR have a negative effect on the entire hospital system. For example, poor sterilization protocols among nurses, which cause infection in newborns and an increased percentage of deaths, also contribute to hospital-acquired infections (HAI) in other areas of healthcare (Bollyky et al., 2019). As a result, there are more deaths in other patients as well, more expenses for treating HAI, longer hospitalization times, and greater workloads on the staff. This is only one of the many examples that could be made, demonstrating the usefulness of IMR for improving healthcare.


IMR is a highly-sensitive proxy measure for evaluating hospital performance and overall population health. Despite its limitations, it is widely accepted by healthcare managers and policy-makers alike. Some of the leading causes of IMR include birth defects, infection, pollution, drug exposure, and low birth weight. Hospitals have a direct and indirect influence on how these parameters affect child death as well as other determinants of healthcare for other patient groups. Healthcare managers can use IMR to gauge their systems’ current performance and formulate measures for improving medical care delivery.


Bollyky, T. J., Templin, T., Cohen, M., Schoder, D., Dieleman, J. L., & Wigley, S. (2019). The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: An observational analysis. The Lancet, 393(10181), 1628-1640.

Lambert, A. B. E., Parks, S. E., & Shapiro-Mendoza, C. K. (2018). National and state trends in sudden unexpected infant death: 1990–2015. Pediatrics, 141(3), e20173519

Tavares, A. I. (2017). Infant mortality in Europe, socio-economic determinants based on aggregate data. Applied Economics Letters, 24(21), 1588-1596.