Fetal and infant mortality in Norway: A steady rate of decline over time

BACKGROUND: Fetal and infant mortality rates have declined dramatically world-wide. On a scale of absolute risk, the declines are diminishing and perhaps even plateauing, raising concerns about public health progress. METHODS: We use Norway's national Medical Birth Registry to describe rates of declining stillbirth and infant mortality from 1967 to 2025. RESULTS: For nearly six decades, stillbirth mortality in Norway has declined at an annual rate of about 2.8%, and neonatal mortality has declined by 3.7% a year. Neither rate of decline shows signs of slowing. Postneonatal mortality (28 days to one year) presents a contrasting picture. A steady decline of 3.5% was interrupted in 1973-2000 by a marked excess of deaths coinciding with an epidemic of sudden infant death syndrome (SIDS). This epidemic had resulted from clinical recommendations to place infants to sleep on their stomachs (prone position). After recommendations on sleep position were reversed beginning in the early 1990s, postneonatal mortality rapidly returned to an underlying declining baseline rate of 3.5%. Using the estimated constant declining risk as a benchmark, we calculate that 1367 infants in Norway died due to recommendation of prone sleep position. DISCUSSION: Stillbirth and neonatal mortality have declined in Norway at steady rates. Baseline rates of decline may be useful in detecting the emergence of harmful effects on fetal or newborn survival. The rates of decline observed in Norway during nearly 60 years of national social stability and prosperity may also provide a benchmark for what is possible to achieve in other settings.