Background-After unification, the gap in infant mortality rates between the
two parts of Germany widened until 1996 before converging. The reasons for
these changes have not, so far, been apparent.
Objectives-To investigate trends in neonatal and postneonatal mortality in
the eastern (the new Lander) and western (the old Lander) part of Germany a
fter unification in 1990 and to identify the scope for further improvement.
Design-Examination of trends in birth weights, birth weight specific neonat
al mortality and cause specific postneonatal mortality in the two parts of
Germany from 1990 to 1996 and 1997 by analysing routinely available vital s
tatistics data.
Results-In both parts of Germany, neonatal mortality fell. considerably, by
33 per cent in the east and 17 per cent in the west, from 4.5 and 3.5 per
thousand live births in 1990 to 3.0 and 2.9 in 1997, respectively This was
attributable to an improvement in survival of infants at all birth weights
but especially among those with very low birth weights, accounting for an e
stimated 83 to 85 per cent of the overall improvement. The birth weight dis
tribution showed a slight worsening in the new and the old Lander with an i
ncrease in the proportion of those under 1500 g and, in the east, a 24 per
cent increase in the proportion of high birthweight infants of 4000 and mor
e grams. Trends in postneonatal mortality revealed a worsening of about 32
per cent in the east from 1990 to 1991 followed by a decline of over 50 per
cent up to 1997, leading to comparable mortality rates of 1.8 per thousand
live births in the east and 2.0 in the west. While both parts experienced
a decrease of 40 to 48 per cent in deaths from all diseases, the decline in
deaths because of accidents and injuries was markedly higher in the new La
nder although they are still exceeding the western rate by 3.7 per 100 000
live births in 1997.
Conclusions-Since unification, the two parts of Germany underwent a complex
process that has led finally to convergence of parameters of infant health
that are most likely to have been because of improvements in the quality o
f perinatal care. To improve infant mortality in Germany, policy measures s
hould focus on preventive rather than curative measures as the proportion o
f very low birthweight babies is increasing in both parts of Germany.