Countries with the Lowest Infant Mortality Rates (2025)

Infant mortality — the number of deaths in the first year of life per 1,000 live births — is one of the most sensitive indicators of a society's overall health, economic development, and governance quality. It captures prenatal care, childbirth conditions, postnatal support, nutrition, sanitation, and medicine access all in a single number. Iceland's rate sits at approximately 0.9. The Central African Republic's sits at 79. A child born in the CAR is roughly 88 times more likely to die before their first birthday than a child born in Reykjavik. No other global statistic captures the inequality of life chances more starkly.

What infant mortality actually measures

Infant mortality rate (IMR) — defined as the number of deaths occurring in the first 365 days of life per 1,000 live births in a given year.

This is distinct from two related metrics that often cause confusion:

Neonatal mortality — deaths in the first 28 days of life. Neonatal deaths now account for approximately 47% of all under-5 deaths globally, making the first month the highest-risk window of childhood.

Under-5 mortality — deaths before a child's fifth birthday per 1,000 live births. This is the broader metric used in tracking the Sustainable Development Goals; infant mortality is its most concentrated component.

The IMR functions like a stress test for a health system. It simultaneously requires good access to contraception and reproductive health (preventing unintended high-risk pregnancies), quality antenatal care during pregnancy, skilled attendance at birth, immediate newborn care, postnatal home visiting, infant nutrition support, vaccination, and rapid treatment of common childhood infections. A country that fails in any of these domains shows up in its IMR.

Source: UN Inter-agency Group for Child Mortality Estimation (UN IGME) — Levels and Trends in Child Mortality Report 2024. Led by UNICEF in partnership with WHO, World Bank, and UN DESA.

How we measure it: methodology note

The IMR figures in this article draw primarily from the UN IGME's 2024 Levels and Trends in Child Mortality report, which applies statistical modelling to reconcile civil registration data, household surveys (DHS, MICS), and vital statistics systems across 195 countries. For high-income countries with complete civil registration (Iceland, Finland, Japan), figures are essentially direct counts. For low-income countries, estimates carry wider confidence intervals.

The CIA World Factbook (drawing on country reports and UNICEF data) is used as a secondary source where IGME estimates lag by more than one year. All figures are the most recent available as of early 2025.

A note on comparability: Small countries like Iceland (~4,500 births/year) or Monaco (~1,000 births/year) show more statistical volatility than large countries. Iceland's 0.9 rate can fluctuate by ±0.5 in any given year purely from small-number effects. The ranking of the bottom ten positions should be treated as approximate; the directional story — that Nordic countries and Japan consistently outperform — is robust.

Countries with the lowest infant mortality (per 1,000 live births)

Rank	Country	Deaths/1,000 live births	Key healthcare features
1	Iceland	0.9	Universal care, small population, midwife-led home visiting
2	Monaco	1.8	Wealth concentration, tiny territory, excellent access
3	Japan	1.9	Universal health insurance, intensive prenatal culture
4	Finland	2.0	Neuvola system — universal maternal/child health
5	Norway	2.0	Universal healthcare, high income equality
6	Singapore	2.1	Advanced healthcare system, rigorous obstetric standards
7	Sweden	2.2	Universal care, generous parental leave
8	Estonia	2.2	Post-Soviet reform; strong maternal care infrastructure
9	Slovenia	2.3	Universal healthcare, high medical coverage
10	South Korea	2.4	National health insurance, intensive prenatal care
11	Denmark	2.5	Universal care, midwife-led system
12	Czech Republic	2.5	Universal healthcare, community-based antenatal care
13	Portugal	2.6	Strong primary care network, social safety nets
14	Germany	3.1	Universal insurance, high-standard hospital obstetrics
15	France	3.2	Universal care; PMI maternal/child network
20	United Kingdom	3.7	NHS universal; significant regional variation
25	Australia	3.1	Universal Medicare; Indigenous gap remains
40	United States	5.4	No universal coverage; stark racial disparities
50	China	5.6	Rapid improvement, but persistent rural-urban gap

Source: UN IGME Levels and Trends in Child Mortality 2024; CIA World Factbook (2024 edition) for country-level estimates.

Where this data comes from

The UN Inter-agency Group for Child Mortality Estimation (IGME) — a collaboration of UNICEF, WHO, World Bank, and UN DESA — maintains the most authoritative global infant mortality dataset. For high-income countries with complete civil registration systems (Iceland, Japan, Nordic countries), figures are direct counts of registered deaths. For low-income countries with incomplete vital registration, IGME applies statistical models combining household surveys (Demographic and Health Surveys, MICS), census data, and whatever national data is available to estimate IMR. All figures in this ranking represent 2023-24 data, the most recent available as of early 2025. Small-country volatility is real — Iceland's 0.9 can shift to 1.1 or 0.7 in any given year purely from the small number of annual births (~4,500); the ranking's directional patterns (Nordic dominance, sub-Saharan Africa concentration of burden) are robust across time.

Why the Nordic model leads

The dominance of Iceland, Finland, Norway, Sweden, and Denmark across infant mortality rankings reflects not one policy but a cluster of reinforcing factors working together. Universal healthcare without financial barriers to prenatal or delivery care means every pregnant woman receives at minimum basic antenatal surveillance and attended delivery. Low income inequality — Nordic Gini coefficients cluster around 0.25-0.28 — ensures that even lower-income families have adequate nutrition, housing, and healthcare access throughout pregnancy and infancy. Midwifery-led care reduces unnecessary medical intervention while increasing continuity of care; paid parental leave enables breastfeeding and close postpartum monitoring during the highest-risk period. Small, homogeneous populations with strong social cohesion and high institutional trust create conditions where health system capacity translates reliably into population-wide outcomes. None of these factors alone is sufficient — each requires the others to work. But together, they create systems that approach the theoretical floor of infant mortality, defined by unavoidable congenital anomalies and extreme prematurity that even the best systems cannot prevent.

Countries with the highest infant mortality

Rank	Country	Deaths/1,000	Region
1	Central African Republic	79.4	Sub-Saharan Africa
2	Sierra Leone	76.1	Sub-Saharan Africa
3	Somalia	65.5	Sub-Saharan Africa
4	South Sudan	63.1	Sub-Saharan Africa
5	Chad	71.4	Sub-Saharan Africa
6	Mali	57.2	Sub-Saharan Africa
7	Nigeria	55.2	Sub-Saharan Africa
8	Guinea	54.5	Sub-Saharan Africa

Source: UN IGME 2024; World Bank Health Nutrition and Population data.

Historical context: how far the world has come

In 1800, infant mortality in what is now England and Wales ran at approximately 150–200 per 1,000 live births — meaning roughly one in six infants died before their first birthday. By 1900, it was still around 140 in England and over 200 in parts of southern and eastern Europe. In sub-Saharan Africa today, the comparable figure for the worst-performing countries sits at 60–80: devastating, but half of what European cities experienced a century ago.

The 20th century's transformation in infant survival is one of the most consequential achievements in human history, though it rarely receives the attention it deserves.

1880s–1920s: The sanitation era. The understanding that infant deaths from diarrhoeal disease were linked to contaminated water and milk drove the first wave of decline. Pasteurisation of milk supplies (widely adopted in European cities from the 1890s) alone reduced infant deaths dramatically. Municipal sewage systems and clean water infrastructure cut the diarrhoeal disease burden that had killed millions of infants in previous centuries.

1920s–1950s: The healthcare infrastructure era. Antenatal clinic networks were established across Europe and North America. Finland's neuvola system (1944), the UK's National Health Service (1948), and similar institutions elsewhere created universal contact with pregnant women and newborns for the first time. Penicillin (available from the mid-1940s) transformed survival from neonatal sepsis and pneumonia.

1950s–1990s: The vaccination era. The WHO's Expanded Programme on Immunization (launched 1974) systematically brought measles, polio, tetanus, diphtheria, and pertussis vaccines to populations with no previous access. Measles alone had killed approximately 2.6 million children per year worldwide; vaccination has reduced measles deaths by over 99% since the 1980s.

1990–present: The oral rehydration and scale-up era. Oral rehydration therapy (ORT) — a simple mixture of salts, sugar, and water that treats dehydration from diarrhoeal disease — was scaled globally from the 1980s and is estimated to have saved over 50 million lives since its widespread adoption. Combined with insecticide-treated bed nets (reducing malaria deaths), pneumococcal vaccines, and antiretroviral therapy reducing mother-to-child HIV transmission, global infant mortality has fallen from approximately 65 per 1,000 in 1990 to around 27 today — a 58% reduction in 35 years.

Source: WHO Global Health Observatory; UNICEF Progress for Children series (multiple years).

Why Nordic countries dominate the rankings

The consistent dominance of Iceland, Finland, Norway, Sweden, and Denmark across infant mortality rankings reflects not a single policy but a systemic cluster of interacting factors. Think of it as a chain: every link must hold, and these countries have spent decades reinforcing each one.

Universal healthcare without financial barriers. In every Nordic country, a pregnant woman faces no out-of-pocket cost for any component of maternity care — antenatal visits, hospital delivery, postnatal follow-up, or newborn specialist care. In the US, by contrast, an estimated 11% of women of childbearing age are uninsured; prenatal care initiation is correlated with insurance status. The first antenatal visit often occurs later, and emergency complications go undertreated.

Income equality as a health buffer. Nordic countries consistently rank among the world's most equal by Gini coefficient. Income inequality predicts infant mortality strongly, independent of average income — a poor family in an equal society still has access to healthcare, decent housing, and adequate nutrition in ways that a poor family in an unequal society does not. Think of income equality as a floor: it prevents the worst outcomes, even when averages are similar across countries.

Midwifery as the backbone of maternity care. In Iceland, Finland, and the Netherlands, midwives manage the majority of routine births; obstetricians are reserved for high-risk cases. Midwife-led care is associated with lower rates of unnecessary intervention (caesarean sections have their own mortality risks), higher rates of continuity of care, and better postnatal support. The UK's NHS midwifery model similarly underpins its relatively good performance despite significant regional disparities.

Paid parental leave and its downstream effects. Finland and Norway offer the most generous parental leave in the OECD — up to a year at near-full pay. This enables breastfeeding (strongly protective against infant infection and sudden infant death), reduces maternal stress (a risk factor for preterm birth), and ensures continuous parental monitoring of infant health during the highest-risk period.

Population homogeneity and geographic manageability. Iceland's 4,500 annual births are equivalent to a single medium-sized hospital's caseload. Maintaining quality across every delivery when volume is this low is more tractable than managing across a large country with regional disparities. This is a genuine structural advantage, not simply a healthcare policy choice.

Finland's neuvola: the model the world should copy

Finland's infant mortality rate of approximately 2 per 1,000 is achieved in large part through the neuvola system — a universal, free, voluntary maternal and child health network established in 1944. The name means "advice centre" in Finnish.

Every pregnant woman in Finland is assigned a neuvola nurse who acts as a continuous point of contact throughout pregnancy and until the child starts school at age seven. The neuvola nurse:

• Conducts home visits before and after birth
• Provides parenting education and practical health support
• Monitors developmental milestones at regular intervals
• Offers mental health screening for postpartum depression
• Coordinates specialist referrals when developmental concerns arise

Coverage exceeds 99% of Finnish families — participation is voluntary but universal in practice, partly because access to the "baby box" (a government-provided starter kit of baby supplies worth approximately €35 in goods) is conditional on registering with neuvola before the fourth month of pregnancy.

Finland drove its infant mortality from approximately 65 per 1,000 in the 1930s to under 2 today largely through this system. Multiple countries — including parts of the UK, Scotland's named person programme, and Australia's maternal health visiting — have attempted to adapt the neuvola model. None has replicated its combination of early contact, continuity, and universal reach as successfully.

Source: Finnish Institute for Health and Welfare (THL); WHO case study on the Finnish neuvola system.

Iceland: why the world's smallest population wins

Iceland's 0.9 rate — the world's lowest — reflects several compounding advantages.

The country has approximately 370,000 people and roughly 4,500 births per year. This means the entire obstetric system concentrates expertise and resources on a caseload that, in most countries, would serve a single large city. Landspítali University Hospital in Reykjavik handles the majority of complex deliveries; transfer times are short; continuity of care is high.

Iceland also benefits from near-complete civil registration (its data is essentially exact counts, not estimates), very low income inequality (Gini ~0.26), near-universal prenatal care uptake, and cultural norms in which attending every recommended antenatal appointment is treated as a given rather than an aspiration. Midwifery care is the default; obstetric intervention rates are lower than most comparable countries.

One structural note: Iceland's 0.9 figure is vulnerable to small-number variability. In a year with five infant deaths instead of four, the rate moves to 1.1; in a year with three, it falls to 0.7. The directional message — that Iceland performs at the frontier of human achievability — is correct, but the exact decimal should be treated as an average over several years rather than a precise annual value.

Japan: discipline, coverage, and culture

Japan's 1.9 IMR reflects a distinctive combination of universal insurance coverage (since 1961), intensive prenatal care culture, and some of the world's lowest preterm birth rates.

Japan's national health insurance system (Kokumin Kenkō Hoken) covers all residents, including the substantial costs of childbirth. The government provides a childbirth lump-sum grant (josan-ikuji-ichijikin) of approximately ¥500,000 (around $3,400) to offset delivery costs — effectively making childbirth free or near-free for most families.

Prenatal care norms in Japan are notably intensive by global standards. The Ministry of Health provides a maternal handbook (boshi techō) to every pregnant woman, which documents all antenatal visits, developmental milestones, and vaccination records from pregnancy through adolescence. This creates a continuous medical record and simultaneously reinforces the expectation of complete antenatal attendance.

Japan's low preterm birth rate — approximately 5.6% of births are preterm, compared with 10.5% in the US — is a major factor in its low IMR. Preterm birth is the leading direct cause of neonatal death globally; Japan's lower rate reflects both healthcare access and lower rates of some risk factors (lower rates of multiple pregnancies from fertility treatment in some cohort groups, lower obesity rates, lower rates of smoking in pregnancy).

The United States anomaly

The US infant mortality rate of approximately 5.4 is the most-studied anomaly in global health. The US spends more on healthcare per capita than any other nation — approximately $12,500 per person per year — yet its IMR is higher than Slovenia, Czech Republic, Cuba, and most of Western Europe. It is comparable to rates in some upper-middle-income countries.

The causes are documented extensively in the peer-reviewed literature:

No universal health coverage. Approximately 11% of American women aged 18–64 lack health insurance. Uninsured women initiate prenatal care later, attend fewer visits, and have higher rates of complications going untreated. Medicaid covers a large share of low-income pregnancies but with variable quality of affiliated providers.

Racial disparities. Black infant mortality in the US runs at approximately 10.4 per 1,000 live births — more than double the national average, and higher than the rates in Cuba, Sri Lanka, and multiple middle-income countries. The disparity persists even when controlling for maternal education and income, suggesting that exposure to structural racism itself — chronic stress, differential treatment by providers, residential environment — is a causal factor independent of poverty. This is not a gap that higher average spending explains.

Preterm birth rates. The US preterm birth rate (approximately 10.5%) is high by wealthy-country standards and is the leading proximate cause of the elevated IMR. Preterm birth is associated with inadequate prenatal care, chronic stress, tobacco and substance use, and high rates of medically indicated preterm delivery driven by maternal conditions like obesity and hypertension.

Geographic fragmentation. Obstetric care quality varies enormously across states. Mississippi's IMR (~8.3) is higher than China's national average; Massachusetts' (~3.8) approaches Western European levels. The US is not one healthcare system — it is 50 overlapping ones with wildly variable outcomes.

Source: CDC National Center for Health Statistics, Infant Mortality in the United States: Provisional Data 2023; MMWR (Morbidity and Mortality Weekly Report).

Eastern European outliers: Estonia, Slovenia, Czech Republic

One of the ranking's most instructive surprises is the strong performance of Estonia (2.2), Slovenia (2.3), and Czech Republic (2.5) — all outperforming France, UK, Australia, and the US by substantial margins.

These countries are post-communist transitions with GDP per capitas of roughly $25,000–35,000 — well below Western European peers. Their strong IMR performance reflects the durable infrastructure of communist-era healthcare systems, which achieved universal vaccination, universal hospital birth, and universal prenatal care attendance as political objectives long before Western Europe had equivalent coverage.

The communist systems also drove significant healthcare utilisation norms: prenatal visits were not optional but expected; hospital delivery was the universal default; postnatal visiting was systematic. These infrastructure-embedded norms survived the transition to market economies and private insurance systems, maintaining coverage rates that outperform wealthier but more fragmented systems.

Estonia is a particularly striking case — after independence in 1991, it rebuilt its healthcare system under significant fiscal pressure while simultaneously driving IMR from ~15 in the early 1990s to ~2.2 today. Its success reflects not only inherited infrastructure but also deliberate post-independence investment in maternal and child health as a state priority.

The global achievement: 58% reduction since 1990

The numbers deserve to be stated plainly: in 1990, approximately 9 million children under five died annually. In 2023, that figure was approximately 4.9 million — still a crisis, but a dramatically smaller one. Over this period, an estimated 60–70 million children who would have died under 1990 conditions are alive today.

The interventions that drove this:

Oral rehydration therapy (ORT): Simple salt-sugar-water solution treating the dehydration caused by diarrhoeal disease. ORT is estimated to have saved over 50 million lives since its global rollout in the 1980s. The Lancet called it "potentially the most important medical advance of the 20th century" — extraordinary for something cheaper than a cup of coffee per treatment.

Vaccination scale-up: Measles deaths have fallen by over 99% from pre-vaccine levels. Pneumococcal vaccine (introduced widely post-2000) has substantially reduced deaths from pneumonia — the leading infectious cause of child death. Haemophilus influenzae type b (Hib) vaccine has nearly eliminated Hib meningitis.

Insecticide-treated bed nets (ITNs): Malaria kills hundreds of thousands of children under five annually, predominantly in sub-Saharan Africa. Universal ITN distribution in high-burden areas has reduced under-5 malaria mortality by approximately 50% in countries with high coverage.

Prevention of mother-to-child HIV transmission (PMTCT): Antiretroviral prophylaxis in pregnancy has reduced mother-to-child HIV transmission from ~30% without treatment to under 2% with optimal treatment. In high-prevalence countries (South Africa, Zimbabwe, Zambia), this has directly reduced infant deaths from AIDS.

Skilled birth attendance: The proportion of births attended by a skilled health worker rose from approximately 60% globally in 1990 to over 80% by the 2020s, with the greatest gains in South Asia and sub-Saharan Africa.

Source: WHO Global Health Observatory; UNICEF Levels and Trends in Child Mortality 2024; Lancet series on child survival.

The remaining challenge: sub-Saharan Africa's preventable burden

Sub-Saharan Africa contains 57% of global infant deaths despite having approximately 15% of global population. The causes are overwhelmingly preventable — not unavoidable biological limits, but failures of access to known, cheap interventions.

The leading causes of infant death in sub-Saharan Africa are:

• Neonatal complications (preterm birth, birth asphyxia, neonatal sepsis): ~40% of infant deaths
• Pneumonia: ~15%
• Diarrhoeal disease: ~10%
• Malaria: ~8% (in high-transmission areas)
• Malnutrition as an underlying or contributing cause: ~45%

Every one of these causes has proven, low-cost interventions. Kangaroo mother care (skin-to-skin contact for preterm infants) reduces preterm mortality by 40% and requires no equipment. Chlorhexidine applied to the umbilical cord at birth costs pennies and reduces neonatal sepsis mortality by 23% in high-burden settings. Zinc supplementation with ORT for diarrhoeal disease costs less than $1 per treatment course and reduces mortality by 46% in children under five.

The gap between the best and worst countries is not, primarily, a knowledge gap. It is a delivery gap — the distance between effective interventions being known to exist and those interventions reaching the infants who need them.

Frequently asked questions

Q: What's the difference between infant mortality and child mortality? A: Infant mortality counts deaths in the first year of life (under 1 per 1,000 live births). Child mortality, or under-5 mortality, counts deaths in the first five years. Neonatal mortality counts deaths in the first 28 days. The neonatal period is now the highest-risk window — approximately 47% of all under-5 deaths occur in the first month, most in the first week.

Q: Why is Iceland consistently the best performer? A: Iceland combines near-universal prenatal care attendance, a midwife-led delivery system, very high income equality (Gini ~0.26), small population (allowing concentrated obstetric expertise), and a complete civil registration system. With only ~4,500 births per year, Iceland can maintain extremely high care standards per birth. Geographic isolation has historically driven strong self-sufficiency in healthcare delivery.

Q: Why do some Eastern European countries score better than the United States? A: Czech Republic, Estonia, and Slovenia inherited universal healthcare infrastructure from the communist era — mass vaccination, hospital birth, prenatal care attendance, and postnatal visiting are embedded defaults. Despite lower GDPs than the US, they achieve better outcomes through high coverage and low inequality. The US, despite higher per-capita spending, lacks both universal coverage and the low inequality that prevent worst-case outcomes.

Q: Is infant mortality the best measure of healthcare quality? A: It is among the most useful population-level indicators because it is relatively well-measured, captures multiple healthcare domains simultaneously, and is resistant to gaming (unlike some reported statistics). Its limitation is that it conflates healthcare quality with social determinants — poverty, diet, and inequality — that are not purely healthcare-system variables. The US example illustrates this: the US's high IMR partly reflects high inequality, not simply healthcare system failure. Nonetheless, IMR remains the most widely used summary health indicator in international comparisons.

Q: Has the racial gap in US infant mortality narrowed? A: Modestly. Black infant mortality in the US has fallen from approximately 18 per 1,000 in 1985 to approximately 10.4 today. The gap relative to white infant mortality (~4.4) has also narrowed slightly, but remains dramatic — Black infants are still more than twice as likely to die in their first year as white infants. Progress has been slower than for overall national IMR reduction, and the disparity has widened in some states.

Q: What is "neonatal tetanus" and why was it historically significant? A: Neonatal tetanus — caused by Clostridium tetani infecting the umbilical cord stump, typically from non-sterile cutting instruments or traditional birth practices — killed approximately 800,000 neonates per year in the 1980s. Maternal tetanus vaccination (two doses protect mother and infant) and hygienic cord care have reduced this to under 30,000 deaths annually today. It is one of the cleaner success stories in global health — a single intervention with near-complete effectiveness.

The takeaway

Iceland and Finland are approaching the biological floor of infant mortality — the remaining deaths are largely from unavoidable congenital anomalies and extreme prematurity that no health system can yet prevent. The worst-performing countries carry a burden that is overwhelmingly preventable: deaths from infection, diarrhoeal disease, and prematurity that known, cheap interventions could address at scale. The 58% global decline since 1990 proves what is possible when interventions reach populations. The remaining gap between an IMR of 0.9 and 79 is not a gap in medical knowledge — it is a gap in political will, institutional capacity, and the basic infrastructure of delivery that connects effective interventions to the infants who need them most.

Sources

• UN IGME — Levels and Trends in Child Mortality 2024
• WHO Global Health Observatory — Infant mortality data
• UNICEF DATA — Child Survival
• CDC NCHS — Infant Mortality in the United States
• Finnish Institute for Health and Welfare (THL) — Neuvola system
• World Bank Health Nutrition and Population data

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