Introduction: Infant mortality indicators are core public health measures and criteria for the wellbeing as well as the quality of healthcare within a country. Despite the significant decline of infant mortality in Bulgaria between 1990 and 2020 (from 14.8 to 5.1‰), the country remains at the penultimate position among the 27 European member states. We are investigating the causes behind this unfavorable position of the country looking into the regional inequalities in infant mortality rates across the six regions in Bulgaria during the period 2000–2019.
Materials and Methods: Data on still and live births, early, late, and postnatal deaths by region for the period 2000–2019 were obtained from the Bulgarian Statistical Institute. Infant mortality rates were calculated using conventional definitions for each of the 6 regions. Comparisons were made by estimating rate ratios (RR) between regions with highest and lowest rates.
Results: All of the six regions experienced a decline of all infant mortality indicators between 2000–2019, albeit at a varying degrees and rates. The most significant disparity between regions was observed in early neonatal mortality (ENM), with RR of 2.6 in 2019, followed by post-neonatal inequality, with RR of 2.5. The smallest difference between regions was observed in fetal mortality, with RR of 1.7, and late neonatal mortality (LNM) with a 90% difference between the region with highest and lowest LNM rates. The southwestern region (including the capital Sofia) demonstrated permanent advantage with all infant mortality rates comparable to the lowest rates in EU countries. Conversely, the northwestern and the southeastern regions consistently exhibited disadvantaged outcomes worse than the lowest rates in Europe.
Conclusion: Significant regional disparities in infant mortality, indicative of health and well-being disparities, have existed in Bulgaria over the past two decades. The widening regional disparities underscore the need for both a more cohesive regional policy framework and urgent interventions proportionate to the regional needs.
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