A comparison of perinatal and infant mortality rates in British Columbia and Finland: Similarities and differences


Introduction: Despite similarities, perinatal and infant mortality rates between British Columbia, (BC) Canada and Finland differ. Key variables that may influence stillbirth, early neonatal, perinatal and infant mortality rates in BC and Finland were studied. Methods: After standardizing definitions, data for all births between 2001 and 2009 from provincial and national registries were used to compare perinatal outcomes between BC and Finland. Annual change was evaluated with regression analyses. Results: Births before 22 weeks gestation were excluded. All mortality rates per 1000 were lower in Finland vs BC (perinatal: 5.1 vs 6.2, stillbirth: 3.4 vs 3.9, early neonatal 1.7 vs 2.4, infant 2.9 vs 4.0; all p < 0.0001). Multiple and preterm births were higher in BC with lower mean birth weight. Annual mortality rates decreased in both countries during the study period. Prenatal visits were more frequent in Finland. Caesarean section rates were markedly lower and stable in Finland but higher and increasing in BC. Discussion: Differences in perinatal mortality rate definitions were found. Higher multiple birth and preterm birth rates in BC are affecting mortality rates. Finland’s policy of single embryo transfer is a potential explanation. It is possible to have good perinatal outcomes and low caesarean section rates. Conclusions: The Finnish health care system may suggest possible solutions for improved perinatal outcomes. Lower per capita health care expenditures in Finland do not appear to have adversely affected perinatal outcomes.

Share and Cite:

Rautava, P. , Synnes, A. , Claydon, J. , Matomäki, J. and Gissler, M. (2013) A comparison of perinatal and infant mortality rates in British Columbia and Finland: Similarities and differences. Open Journal of Pediatrics, 3, 35-41. doi: 10.4236/ojped.2013.31007.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] OECD (2010) Health at a Glance: Europe 2010. OECD Publishing. doi:10.1787/health_glance-2010-en
[2] Perinatal Services BC. Perinatal Database Registry. http://www.perinatalservicesbc.ca/Perinatal%20 Database% 20Registry.htm
[3] Rautava, L. (2010) The effect of the birth hospital and the time of birth on the outcome of Finnish very preterm infants. Ph.D. Thesis, University of Turku, Turku. http://urn.fi/URN:ISBN:978-951-29-4279-4
[4] Malin, M. and Gissler, M. (2009) Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health, 9, 84. doi:10.1186/1471-2458-9-84
[5] OECD Health Data (2011) Frequently requested data. http://www.oecd.org/document/16/0,3746 ,en_2649_37407_ 2085200_1_1_1_37407,00.html
[6] Joseph, K.S., Liu, S., Rouleau, J., Lisonkova, S., Hutcheon, J.A., Sauve, R., et al. for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System (2012) Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: Population based retrospective study. British Medical Journal, 344, e746. doi:10.1136/bmj.e746
[7] British Columbia Perinatal Database Registry—Overview. http://www.perinatalservicesbc. ca//sites/bcrcp/files/Perinatal/ OverviewBCPDRPamphlet.pdf
[8] Gissler, M., Teperi, J., Hemminki, E. and Meril?inen, J. (1995) Data quality after restructuring a nationwide medical birth registry. Scandinavian Journal of Social Medicine, 23, 75-80.
[9] Artama, M., Gissler, M., Malm, H., Ritvanen, A. and The Drugs and Pregnancy—Pilot Study Group (2011) Nationwide register-based surveillance system on drugs and pregnancy in Finland 1996-2006. Pharmacoepidemiology and Drug Safety, 20, 729-738. doi:10.1002/pds.2159
[10] Kurinczuk, J.J., Hollowell, J., Brocklehurst, P. and Gray, R. (2009) Inequalities in infant mortality project briefing paper 1. Infant mortality: Overview and context. National Perinatal Epidemiology Unit, Oxford. https://www.npeu.ox.ac.uk/files/downloads/infant-mortality/Infant-Mortality-Briefing-Paper-1.pdf
[11] Slattery, M.M. and Morrison, J.J. (2002) Preterm delivery. Lancet, 360, 1489-1497. doi:10.1016/ S0140-6736(02)11476-0
[12] Refuerzo, J.S. (2012) Impact of multiple births on late and moderate prematurity. Seminars in Fetal & Neonatal Medicine, 17, 143-145. doi:10.1016/j.siny.2012.01.012
[13] Beemsterboer, S.N., Homburg, R., Gorter, N.A., Schats, R., Hompes, P.G. and Lambalk, C.B. (2006) The paradox of declining fertility but increasing twinning rates with advancing maternal age. Human Reproduction, 21, 1531-1532. doi:10.1093/humrep/del009
[14] Thurin, A., Hausken, J., Hillensjo, T., Jablonowska, B., Pinborg, A., Strandell, A., et al. (2004) Elective singleembryo transfer versus double-embryo transfer in vitro fertilization. New England Journal of Medicine, 351, 2392-2402. doi:10.1056/NEJMoa041032
[15] Van Montfoort, A., Fiddelers, A., Janssen, J., Derhaag, J., Dirksen, C., Dunselman, G., et al. (2006) In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: A randomized controlled trial. Human Reproduction, 21, 338-343. doi:10.1093/humrep/dei359
[16] Thurin-Kjellberg, A., Olivius, C. and Bergh C. (2009) Cumulative live-birth rates in a trial of single-embryo or double-embryo transfer. New England Journal of Medicine, 361, 1812-1813. doi:10.1056/NEJMc0907289
[17] Van Montfoort, A.P., Dumoulin, J.C., Land, J.A., Coonen, E., Derhaag, J.G. and Evers, J.L. (2005) Elective single embryo transfer (eSET) policy in the first three IVF/ICSI treatment cycles. Human Reproduction, 20, 433-436. doi:10.1093/humrep/deh619
[18] Veleva, Z., Vilska, S., Hydén-Granskog, C., Tiitinen, A., Tapanainen, J.S. and Martikainen, H. (2006) Elective single embryo transfer in women aged 36 -39 years. Human Reproduction, 21, 2098-2102. doi:10.1093/humrep/del137
[19] Nyboe Andersen, A., Goossens, V., Gianaroli, L., Felberbaum, R., de Mouzon, J. and Nygren, K.G. (2007) Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE. Human Reproduction, 22, 1513-1525. doi:10.1093/humrep/dem053
[20] Gissler, M. and Heino, A. (2010) Assisted fertility treatments 2009-2010. Official Statistics of Finland/Health, National Institute for Health and Welfare, Helsinki. http://www.stakes.fi/tilastot/ tilastotiedotteet/2011/Tr15_11.pdf
[21] Janvier, A., Spelke, B. and Barrington, K.J. (2011) The epidemic of multiple gestations and neonatal intensive care unit use: The cost of irresponsibility. Journal of Pediatrics, 159, 409-413. doi:10.1016/j.jpeds.2011.02.017
[22] Kolas, T., Saugstad, O.D., Daltveit, A.K., Nilsen, S. and oian, P. (2006) Planned cesarean versus planned vaginal delivery at term: Comparison of newborn infant outcomes. American Journal of Obstetrics and Gynecology, 195, 1538-1543. doi:10.1016/j.ajog.2006.05.005
[23] Declercq, E., Barger, M., Cabral, H.J., Evans, S.R., Kotelchuck, M., Simon, C., et al. (2007) Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstetrics and Gynecology, 109, 669-677. doi:10.1097/01.AOG.0000255668.20639.40
[24] Villar, J., Carroli, G., Zavaleta, N., Donner, A., Wojdyla, D., Faundes, A., et al., World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group (2007) Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study. British Medical Journal, 335, 1025. doi:10.1136/bmj.39363.706956.55
[25] MacDorman, M.F., Menacker, F. and Declercq, E. (2008) Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clinics in Perinatology, 35, 293-307. doi:10.1016/j.clp. 2008.03.007
[26] MacDorman, M.F., Declercq, E., Menacker, F. and Malloy, M. (2008) Neonatal mortality for primary cesarean and vaginal births to low-risk women: Application of an “intention-to-treat” model. Birth, 35, 3-8. doi:10.1111/j.1523-536X.2007.00205.x
[27] Field, D., Petersen, S., Clarke, M. and Draper, E.S. (2002) Extreme prematurity in the UK and Denmark: Population differences in viability. Archives of Disease in Childhood. Fetal and Neonatal Edition, 87, F172-F175. doi:10.1136/fn.87.3.F172
[28] Evans, D. and Levene, M. (2001) Evidence of selection bias in preterm survival studies: A systematic review. Archives of Disease in Childhood. Fetal and Neonatal Edition, 84, F79-F84. doi:10.1136/fn.84.2.F79
[29] Draper, E.S. (2010) Evaluating and comparing neonatal outcomes. Archives of Disease in Childhood. Fetal and Neonatal Edition, 95, F158-F159. doi:10.1136/adc.2008.148213

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.