Unequal start: why a baby's chances of survival depend on the region of birth
Over the past 10 years, infant mortality in Russia has more than doubled. In 2025, the indicator was only 3.6 ppm (for comparison, in 2015 it was 6.5). The downward trend has persisted in the country throughout the 21st century. However, the situation in the regions is not uniform: the number of deaths is directly affected by the availability of modern perinatal centers, patient routing, and a shortage of medical personnel. How to reduce infant mortality in Russia and whether it is realistic to reach the figure of 3 ppm — in the material of Izvestia.
Which regions have higher infant mortality rates
At the end of 2025, the infant mortality rate in Russia was only 3.6 ppm, which is a historical minimum. In 15 regions of the Russian Federation, it was even lower than 2.5 ppm. However, there are still regions in the country where the indicator exceeds the national average. An analysis of the information provided on the website of the unified interdepartmental information and statistical system conducted by Izvestia showed that it is mainly in the range of 4-5 ppm, but there are also higher values, up to 11 ppm.
In particular, in the Central Federal District, the indicator exceeded the national average in five regions. These are Tver (6.7), Orel (5), Bryansk (4.7), Vladimir (4.6) and Yaroslavl (4.2) regions.
In the Northwestern Federal District, the highest level was found in the Komi Republic — 5.5. Next are the Novgorod Region with an indicator of 5.2 ppm, the Nenets Autonomous Okrug (Astrakhan Region, 5 ppm), the Republic of Karelia (4.6), as well as Murmansk (4.6), Pskov (4.3) and Kaliningrad (3.9) regions.
In the Southern Federal District, infant mortality exceeded the average in three regions. These are the Republic of Crimea with an indicator of 4.1 ppm, the Krasnodar Territory and the Astrakhan region, where the level was 4 ppm each.
There are five such regions in the North Caucasus Federal District, which is traditionally characterized by a high birth rate: the Republic of North Ossetia-Alania (5.5), the Republic of Dagestan (5.4), the Republic of Ingushetia (4.7), the Chechen Republic (4) and the Stavropol Territory (3.9).
In the Volga Federal District, the indicator above 3.6 ppm was detected in Penza (5.6), Ulyanovsk (4.8) and Samara (4.1) regions, as well as in Perm Krai (4).
There are three regions with an infant mortality rate higher than the average for the Russian Federation in the Ural Federal District. In particular, in the Kurgan Region, the indicator was 4.1 ppm, in the Tyumen Region (excluding autonomous regions) — 3.9, and in the Yamalo-Nenets Autonomous District — 3.8.
In turn, in the Siberian Federal District, the value was above average in six regions at once. We are talking about the Novosibirsk (4.8) and Irkutsk (4.6) regions, the Krasnoyarsk Territory (4.5), the Republic of Tyva (4.4), as well as the Tomsk Region and the Altai Republic (3.9 ppm each).
In the Far Eastern Federal District, according to statistics, there were eight regions at once with an index above 3.6 ppm. It also records the highest values in Russia in general. The absolute anti-leader was the Chukotka Autonomous Okrug, where the infant mortality rate was 11 per million at the end of the year. The indicator is relatively high in the Magadan region — 7.2 ppm. This is followed by the Kamchatka Territory (6), the Trans-Baikal Territory and the Amur Region (4.6 each), the Khabarovsk Territory (4.5), as well as the Republic of Buryatia and the Jewish Autonomous Region (4.4 each).
However, such statistics are collected by the date of registration with the registry office and are not final. The final annual data generated by the date of death will be published in June 2026.
How do they reduce the number of infant deaths in Russia
The Ministry of Health of the Russian Federation told Izvestia that the infant mortality rate has decreased in the vast majority of subjects (59) of the country. This was achieved through a set of measures taken at the state level. In particular, the coverage of pregnant women with early registration (up to 12 weeks) is growing, which makes it possible to diagnose fetal pathologies in a timely manner. In 2025, this figure reached almost 88%. At the same time, the proportion of timely prenatal diagnostics has increased (coverage is more than 90%).
In addition, early diagnosis for congenital and hereditary diseases has been carried out in the country since 2023. To date, they have been identified in more than 2,100 children who have been treated on time.
The development of a network of perinatal centers has made a significant contribution to reducing infant mortality, the press service of the department added. Work is underway to route pathologies of pregnant women and women in labor to medical organizations with highly qualified personnel and modern equipment. This, in particular, allows for high-tech surgical intervention for congenital malformations of the fetus.
The participation of specialized specialists also helps to reduce the indicator. In 2025, according to the Ministry of Health, more than 34.4 thousand intensive care anesthesiologists and more than 5 thousand neonatologists provided medical care. However, the level of provision of these specialists varies regionally.
The Ministry of Health also told about plans to further improve the quality and accessibility of medical care for women and children. The main measures are provided for by the federal project "Protection of Motherhood and Childhood" of the national project "Family", for the implementation of which more than 198 billion rubles are provided. In total, 466 women's clinics are planned to be established by 2030, 147 perinatal centers and 185 children's hospitals are planned to be equipped.
How regions save newborns
Systemic progress in the field of maternal and child health is currently being observed in many Russian regions. The historical minimum of infant mortality (3.1 ppm) was recorded last year in the Yamalo-Nenets Autonomous District. This was reported to Izvestia by the Department of Health of the region.
This result was achieved thanks to a clear routing of patients: pregnant women and children from remote parts of the Far North are promptly delivered to the medical organizations of the district. About 1.5 thousand pregnant women and about 200 children under one year of age are transported annually by the sanaviation.
Modern perinatal centers equipped with cuvettes, ventilators and ultrasound diagnostics help to reduce the infant mortality rate. Work continues after discharge: newborns with extremely low body weight are provided with monitors to monitor the baby's breathing at home. And all medical and obstetric centers and outpatient clinics in rural areas are equipped with fetal monitors to assess the condition of the fetus.
A set of measures to reduce the number of newborn deaths is also being carried out in the Kamchatka Territory. In particular, perinatal diagnostics of disorders of intrauterine development of a child in the early stages of pregnancy has been organized, the Ministry of Health of the region said.
Other measures include continuous monitoring of fetal heartbeat during childbirth and dynamic monitoring of fetal cardiotocography after 33 weeks of pregnancy. The region has also established a professional development system for obstetricians and gynecologists, neonatologists and intensive care specialists.
A steady downward trend in infant mortality is also observed in the Altai Territory. The Ministry of Health of the region reported that in 2025 the figure was 3.4 ppm compared to 3.8 in 2024. The three-level obstetric care system, which has been operating in the region since 2016, has allowed to reduce the number of deaths.
— Intensive care and advisory units have been established on the basis of the Maternity and Childhood Care Center and the DAR Perinatal Center, which include visiting neonatology teams. They allow doctors to travel urgently to any corner of the Altai Territory. The teams are equipped with a specialized intensive care vehicle for delivering newborns to hospitals in the region, and air ambulance is also actively used for these purposes," the department noted.
The Ministry of Health of the Chechen Republic also pointed to a decrease in the infant mortality rate. The value of 4 ppm, although higher than the average for the Russian Federation, is 17.5% lower than the level of 2024. The retrofitting of the Republican Perinatal Center, which is an anchor obstetric hospital of the third level, contributed to the achievement of this result. It focuses on premature births from all over the republic and all pregnant women with severe obstetric pathology.
The big problems of small territories
Sergey Rybalchenko, Director General of the Institute of Scientific and Public Expertise, Chairman of the Commission on Demography, Family and Child Protection of the Russian Federation, considers the finding of the infant mortality rate in Russia at a historical minimum to be one of the most important achievements of recent years related to the implementation of maternal and child health policy.
The construction of modern perinatal centers has significantly contributed to this, experts interviewed by Izvestia agree. The presence of such a medical facility makes it possible to organize better medical care, requiring the involvement of specialized specialists, says Leila Latifova, a leading obstetrician and gynecologist at the Major Beauty clinic.
In perinatal centers, doctors can perform neonatal resuscitation, connect children weighing 500 g to ventilators, or operate on a child urgently, says Olesya Motorina, an obstetrician-gynecologist and reproductologist.
The presence of such a center in the region plays an organizational role, allowing to build a full-fledged obstetric care system, Rybalchenko admits. However, world practice shows that it is possible to achieve a low infant mortality rate using other mechanisms, including through a system of prevention and control of pregnancy.
"I believe that such measures can significantly reduce infant mortality even in regions where the construction of perinatal centers is considered economically impractical," the expert emphasizes.
Patient routing remains one of the key issues facing the healthcare system today. The main problem is that perinatal centers are usually located in regional capitals and it is difficult to get to them from a remote area, said Saniy Koval, member of the State Council of the Russian Federation for Family, member of the commission of the General Council of the United Russia Party for the protection of motherhood, childhood and family support.
— In Moscow or Kazan, the nearest perinatal center is 20 minutes away by car. In Yakutia or Chukotka — sometimes for a day, and then if the weather allows you to raise a helicopter, — Motorina draws attention.
By the time an ambulance takes a woman with placental abruption or a premature newborn in serious condition from the village to the right medical facility 100-200 km away, irreparable things can happen, Koval says. Therefore, building fast logistics remains one of the most important issues.
The problem of patient routing has always existed, since Russia is the largest country in the world, Rybalchenko believes. Often, this difficulty is solved by moving a pregnant woman closer to the perinatal center shortly before giving birth, if there are no necessary conditions in the place of residence. However, moving can create additional difficulties for the family, so it needs to be supported.
Another option is to bring the maternity care system closer to the place of residence, adds the Izvestia interlocutor.
— It is necessary to create comfortable conditions for pregnant women to have a baby in their place of residence. And for this, we need to improve the skills of specialists in paramedic and obstetric centers and women's consultations in small towns and villages," he is convinced.
The human factor
The issue of staffing of medical institutions has a serious impact on infant mortality statistics, experts admit. The number of neonatologists varies from region to region: one may have three such doctors per thousand births, while the other may have none, says Olesya Motorina.
— At the same time, if a baby is born at the 28th week weighing 900 g, the first minutes decide everything. We need a specialist who knows how to properly intubate the tiny airways, inject surfactant, and adjust the ventilator for a specific child. If there is no such specialist, the chances drop dramatically," the doctor warns.
The shortage of neonatologists and pediatric intensive care specialists limits the possibility of providing qualified medical care for two interrelated reasons, Leila Latifova believes. The main problem is that the shortage of staff places a heavy burden on a particular doctor. And this increases the risk of medical errors, which can lead to emotional burnout of already scarce specialists.
In turn, Sergey Rybalchenko believes that the more serious problem in Russian regions is not with doctors of a narrow profile, but with the shortage of mid-level specialists and junior medical staff. And it is in the fight against their shortage that the main efforts are required.
In any case, it is necessary to address the issue of staff shortages as a matter of priority, Motorina is convinced. We need to expand targeted training programs, provide doctors with decent salaries, and provide housing for specialists in the regions, because without people, no high-tech equipment can save lives.
Parental influence
However, infant mortality depends not only on the health system, but also on the age of the mother. The trend towards late delivery increases the number of deaths due to acquired chronic diseases, general deterioration of the woman's body and increased risks of malformations and chromosomal mutations, said Maria Sorvacheva, a leading obstetrician and gynecologist, head of the department of the IAC IVF clinic.
But it is important to take into account that older women in labor usually take a more responsible approach to pregnancy, says Olesya Motorina. They are regularly monitored by a doctor, do all the necessary screenings and monitor their health, which partially compensates for biological risks.
The problem is that a late first pregnancy is often the result of infertility treatment and IVF, says the reproductologist. Often, such a pregnancy turns out to be multiple, which in itself is considered a risk factor.
Recent studies show that the age of the father also affects the occurrence of pathologies in the child, draws attention to Saniy Koval. Therefore, in order to reduce the infant mortality rate, it is necessary to motivate citizens to have a child at a younger age, she is sure.
However, the maternity care system should be focused on providing assistance at the birth of a child to women of any age, emphasizes Sergey Rybalchenko. The number of women of late reproductive age in Russia is now quite high, while many are not talking about their first pregnancy.
— The average age of a mother at the birth of her third child is now 32 years old. And we must focus on this. The maternity care system should be ready to provide assistance in this case, the expert is convinced.
The biological limit
In the next 10 years, while maintaining the trend towards the development of high technologies, the infant mortality rate in Russia will fluctuate around 3-3.5 ppm, expects Saniy Koval, although without solving the problem of personnel shortage and transport accessibility, there is a risk of hitting the ceiling quite quickly.
In addition, there is a natural limit to reducing newborn mortality, warns perinatal psychologist Maria Todorova. Even in the most developed countries, the indicator rarely falls significantly below 2-3 ppm.
— There will always be a certain percentage of children with defects incompatible with life, or extremely premature - at 22-23 weeks, weighing 400-500 g. They can't always be saved," Koval agrees.
Infant mortality will continue to exist, because there is a possibility of complications and the influence of external factors, confirms Sergey Rybalchenko. The state of reproductive health in general is also deteriorating. Therefore, Russia's policy should be guided by the best international practices, given that due to the spatial structure, it is impossible to rely on the birth of children only in perinatal centers, it is necessary to establish a high-quality obstetric care system directly on the ground.
It is also important to understand that reducing the infant mortality rate hides one significant but not obvious risk, Todorova argues.
— The development of technology leads to the care of heavy children, which, on the one hand, reduces mortality, and on the other hand, increases the number of children with disabilities. This is an objective payment for the progress of medicine," the Izvestia interlocutor points out.
Chasing an indicator below 3 ppm can be a path to manipulation, cautions Koval. In her opinion, it is better to recognize the ceiling level of 3-3.2 ppm and focus on saving everyone who can really be saved, because "honest statistics are more important than beautiful ones."
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