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.