Factors Reducing the Infant Mortality Rate – Rwanda's Socio-Economic and Demographic Health Indicators (Senior 4 General and Religious Studies) | Ganzaa

Rwanda's Socio-Economic and Demographic Health Indicators

Lessons

Senior 4 · General and Religious Studies

Rwanda's Socio-Economic and Demographic Health Indicators

4 lessons

Lesson 4 of 4

Factors Reducing the Infant Mortality Rate

35 min

Forty babies, then and now

Picture 40 babies born alive in Rwanda in the year 2000, enough to fill one classroom later on. At the infant mortality rate measured that year, about 4 of them would have died before their first birthday. Forty babies born at the 2025 rate: about 1.

40 \times \frac{107}{1\,000} \approx 4.3 \qquad\qquad 40 \times \frac{27}{1\,000} \approx 1.1

The Rwanda Demographic and Health Survey (RDHS) recorded that fall, from 107 to 27 infant deaths per 1,000 live births in 25 years. It did not happen by chance. This lesson measures it, explains which factors drove it and asks what must happen next.

Definition

Infant mortality rate (IMR): the number of babies who die before their first birthday for every 1,000 live births.

Neonatal mortality rate (NMR): deaths in the first month of life per 1,000 live births. Post-neonatal mortality: deaths between one month and the first birthday.

Under-5 mortality rate (U5MR): deaths before the fifth birthday per 1,000 live births. Child mortality: deaths between the first and fifth birthdays.

Maternal mortality ratio: deaths of women from pregnancy or childbirth per 100,000 live births.

Antenatal care (ANC): health checks during pregnancy. Skilled provider: a doctor, nurse or midwife.

Exclusive breastfeeding: giving a baby only breast milk, no other food or drink, not even water, for the first six months.

Stunting: being too short for one's age, a sign of long-term undernutrition.

Measuring infant deaths

\text{IMR} = \frac{\text{deaths of babies under 1 year}}{\text{live births}} \times 1\,000

The rates fit inside each other. Infant deaths are neonatal deaths plus post-neonatal deaths, and under-5 deaths are infant deaths plus child deaths. The RDHS 2025 rates per 1,000 live births were: neonatal 17, post-neonatal 10, infant 27, child 9 and under-5 36.

Figure 6: trends in under-5, infant and neonatal mortality, Rwanda. Data: RDHS 2025 key indicators booklet, NISR. Chart drawn by Ganzaa.

Survey	2000	2005	2010	2014–15	2019–20	2025
Under-5 mortality	196	152	76	50	45	36
Infant mortality	107	86	50	32	33	27
Neonatal mortality	44	37	27	20	19	17

Deaths per 1,000 live births. The 2019–20 infant rate (33) is slightly above 2014–15 (32): a survey estimate has a margin of error, so read the long trend, not one step.

Worked example 1: how the rates fit together

Infant mortality is neonatal plus post-neonatal: $17 + 10 = 27$ per 1,000.

Under-5 mortality is not exactly infant plus child mortality, because child mortality is measured only among children who survived to age 1. Written as probabilities (27 per 1,000 is 0.027):

\text{P(die before 5)} = 1 - (1 - 0.027)(1 - 0.009) = 1 - 0.973 \times 0.991 \approx 0.036

That is 36 per 1,000, the published U5MR. Adding the two rates gives the same answer here only because both are small.

Worked example 2: where the remaining deaths are

Percentage fall in IMR from 2000 to 2025: $\frac{107 - 27}{107} \times 100\% \approx 75\%$ . For neonatal mortality: $\frac{44 - 17}{44} \times 100\% \approx 61\%$ .

Share of infant deaths that happen in the first month: in 2000, $\frac{44}{107} \approx 41\%$ ; in 2025, $\frac{17}{27} \approx 63\%$ .

Deaths after the first month fell much faster than newborn deaths. Today most infant deaths happen in the first four weeks, so the next gains depend on care around birth: skilled delivery, newborn checks and help for babies born too early or too small.

Why did infant deaths fall? Two levels of cause

Demographers explain child survival on two levels (Figure 7, after the framework of W. Henry Mosley and Lincoln Chen, 1984). Underlying factors, such as a mother's education or a family's income, do not kill or save a baby directly. They work through proximate factors: the mother's health, hygiene, nutrition, health care and safety.

Figure 7: underlying and proximate factors in child survival. Drawn by Ganzaa.

The table gives the evidence for Rwanda.

Factor	How it saves infants	Rwandan evidence
Antenatal care	Finds and treats problems in pregnancy (anaemia, high blood pressure, HIV, malaria) before birth	Women with 4+ ANC visits: 47% (2019–20) to 78% (2025); ANC from a skilled provider 95% (2025)
Skilled birth and newborn care	Manages complications in labour, resuscitates babies who do not breathe, keeps newborns warm	Births assisted by a skilled provider: 81% (2010) to 98% (2025); postnatal check within 2 days 68% (2025)
Vaccination	Prevents measles, whooping cough, pneumonia, diarrhoea from rotavirus and other killers	Children 12–23 months fully vaccinated (basic antigens): 76% (2000) to 94% (2025)
Breastfeeding and nutrition	Breast milk protects against infection; good nutrition helps a child fight illness	Exclusive breastfeeding 0–5 months 82% (2025); stunting 51% (2005) to 27% (2025)
Family planning and birth spacing	Spacing births gives the mother time to recover and the baby more care	U5MR 81 per 1,000 when the previous birth was under 2 years before (2019–20); modern method use 64% (2025)
Mother's education and household wealth	Educated mothers tend to use services earlier and better; income buys food, soap and transport	U5MR by wealth: 72 per 1,000 in the poorest fifth of households, 30 in the richest (2019–20); by education, Figure 8

Figure 8: under-5 mortality by mother's education. Data: RDHS 2019–20 Final Report, Figure 8.3 (NISR, Ministry of Health and ICF). The 17 is based on few births and is less precise. Chart drawn by Ganzaa.

The mother's age at birth matters too. In RDHS 2019–20, under-5 mortality was 69 per 1,000 for children born to mothers under 20 and 89 for mothers aged 40–49, against 47 for mothers aged 20–39. Preventing teenage pregnancy (Lesson 3) also saves babies.

Young children at the early child development centre of the Rutsiro tea factory in Western Province, with a caregiver. A sign on the wall marks a breastfeeding room, where working mothers can feed their babies. Photo: RebeccaRwanda, 13 April 2023, CC BY-SA 4.0, via Wikimedia Commons.

Warning

Common mistakes

IMR is not a percentage. An IMR of 27 means 27 deaths per 1,000 live births, which is 2.7%, not 27%.
Mixing up infant, neonatal and under-5. Infant: before age 1. Neonatal: first month. Under-5: before age 5.
"Educated mothers' babies survive because of the certificate." Education is an underlying factor: it works through what mothers know and can do, and is linked to wealth. Name the proximate factor it acts through.
Treating an association as one cause. Many factors improved together, so no single one explains the whole fall.

Tip

Explain a fall in mortality in three steps. State the change with numbers and years; name at least two proximate factors with evidence; link each to an underlying factor or policy. Finish by saying what remains: here, newborn deaths and gaps between rich and poor, rural and urban.

Important

Discuss. Infant mortality fell from 33 (2019–20) to 27 (2025), but neonatal mortality fell only from 19 to 17. If the Ministry of Health could fund one more programme to cut infant deaths further, should it be postnatal home visits in the first week, a campaign against teenage pregnancy, or nutrition support for poor families? Use the worked examples and the table to argue your case.

UNICEF UK: "Child survival in Rwanda: protecting the poorest children from the deadliest diseases", about 4 minutes. Note each proximate factor you see in the film and find it in Figure 7.

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Practice

Define infant mortality rate and state Rwanda's IMR in 2000 and 2025, with the source.
Calculate the percentage fall in under-5 mortality between 2000 and 2025.
In 2019–20, neonatal mortality was 19 and infant mortality 33 per 1,000. Calculate post-neonatal mortality and the share of infant deaths that were neonatal.
A district records 12,500 live births and 300 deaths of babies under one year in a year. Calculate its IMR and compare it with the national rate for 2025.
Distinguish an underlying factor from a proximate factor, with one example of each.
Explain two ways in which family planning reduces infant mortality.
"Rwanda's fall in infant mortality was caused by vaccination." Evaluate this statement.

Show answersHide answers

Deaths before the first birthday per 1,000 live births: 107 in 2000 and 27 in 2025 (RDHS, NISR key indicators booklet 2025).
$\frac{196 - 36}{196} \times 100\% \approx 82\%$ .
Post-neonatal $= 33 - 19 = 14$ per 1,000. Neonatal share $= \frac{19}{33} \times 100\% \approx 58\%$ .
$\text{IMR} = \frac{300}{12\,500} \times 1\,000 = 24$ per 1,000, slightly below the national 27.
An underlying factor acts through others and does not directly cause death, e.g. the mother's education or household wealth. A proximate factor acts directly on the child's health, e.g. vaccination, breastfeeding or skilled delivery.
Any two: it allows births to be spaced at least two years apart (U5MR 81 per 1,000 for intervals under 2 years); it helps prevent births to very young or older mothers; fewer children means more food and care for each.
Vaccination mattered: full coverage rose from 76% to 94% and prevents major killers. But many factors improved together: ANC, skilled delivery, breastfeeding, nutrition, family planning, education and income. Vaccines cannot prevent most newborn deaths, which are now 63% of infant deaths. So vaccination was one important cause, not the cause.

Quick check

Key points

IMR is deaths before age 1 per 1,000 live births. Rwanda's fell from 107 (2000) to 27 (2025); under-5 mortality fell from 196 to 36 (RDHS, NISR).
Newborn deaths fell more slowly and are now about 63% of infant deaths, so care around birth is the next priority.
Proximate factors (ANC, skilled delivery, vaccination, breastfeeding, nutrition, birth spacing) act directly; underlying factors (mother's education, wealth, residence, policy) work through them.
Big gaps remain: under-5 mortality was 62 per 1,000 for mothers with no education and 72 in the poorest households, against 17 and 30 at the top (2019–20).

1Forty babies, then and now

2Measuring infant deaths

3Why did infant deaths fall? Two levels of cause

Forty babies, then and now

Measuring infant deaths

Why did infant deaths fall? Two levels of cause