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HEALTH

Child mortality rate 1.5 times higher in England than Sweden – and poverty is a key factor, researchers argue

UPDATED: Children born in England are one-and-a-half times more likely to die before they reach the age of five than those born in Sweden, according to a new study published in The Lancet.

Child mortality rate 1.5 times higher in England than Sweden – and poverty is a key factor, researchers argue
This Swedish baby is 52 percent more likely to make it to four years old than one born in England. Photo: Christine Olsson/TT
Researchers from University College London and Sweden's Karolinska Institute found that while 19 out of 10,000 children born in Sweden between 2003 and 2012 died, in England the figure was 29 out of 10,000. They investigated children between the ages of two days old and four years old.
 
Around 77 percent of the difference came down to low birth weight, premature birth and congenital defects, such as heart problems, which were far more common in the UK.
 
According to Anders Hjern, a professor at Karolinska who helped carry out the study, this was largely because English mothers were more likely to be poor. 
 
“Some people say we should blame Margaret Thatcher for this, because she took away much of the welfare state that there was, so poor families in the UK have a much tougher situation than Sweden,” Hjern told The Local. 
 
In 2003-2005, the most deprived 20 percent of the UK's population had a seven-fold lower income than the least deprived 20 percent, while the gap in Sweden was only four times lower.
 
“The main message from our study is actually that it’s not the NHS,” Hjern said. “This study shows that the main explanations for the differences in child mortality rates between England and Sweden are systemic.” 
 
In a statement he said: “The key factors here are likely to include Sweden's broader welfare programmes that have provided families with an economic safety net for over 50 years, the free and accessible educational system, including early child care, and public health policies for many lifestyle issues such as obesity, smoking and alcohol use.”
 
 
“Being poor brings chronic stress,” Hjern told Sweden's TT newswire. “There's a lot of interesting research on how that sort of stress affects a pregnant woman.” 
 
“In addition, older children in Sweden go to kindergarten,” he added. “That's not nearly as common in England. It's much more common for the children of poor people to stay home with their unemployed mothers instead.” 
 
The lead author Dr Ania Zylbersztejn, from UCL Great Ormond Street Institute of Child Health, said that the best route to reducing infant mortality would be fight social disadvantage more broadly, and also to work to improve the health of mothers before and during pregnancy. 
 
“Families need to be better supported before and during pregnancy to improve maternal health, and in turn to give all children a healthy start in life,” she said. 
 

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FAMILY

How does the cost of childcare in Sweden compare to other countries?

Parents in Sweden benefit from a cap on childcare costs, with parents paying different fees based on their household's income. But how does the generous scheme compare to other countries?

How does the cost of childcare in Sweden compare to other countries?

Preschool childcare is not free in Sweden, but fees are income-based, with a maximum fee across the country 1,572 kronor (€145) per child per month (fees for 2022).

There are also deductions for each child if you have multiple children attending preschool at the same time – in this case the maximum fee would be 1,048 kronor for the second child and 503 kronor for the third, with parents paying no fee for any further children.

Children over three are entitled to 15 hours of free preschool education per week, so these are deducted from your fee once your child reaches this age.

To get an idea of how much you would have to pay based on your income, you can use this calculator (in Swedish – similar calculators exist for other municipalities). These fees are adjusted yearly by the Swedish school authorities and are applicable to all municipalities. If your child has a preschool place, you have to pay even if you do not use it – over summer or during holidays, for example.

School meals and preschool meals are free in Sweden, meaning you don’t need to pay extra for your child’s lunch, breakfast, or any snacks served during the day.

Denmark

The exact amount parents pay for childcare in Denmark depends on the municipality. In Copenhagen Municipality, the cost of nursery (vuggestue up to 2 years and 10 months) is 4,264 kroner a month including lunch (roughly €573). For kindergarten (børnehave from 2 years and 10 months to 6 years) it is 2,738 kroner a month including lunch (roughly €368).

The government pays 75 percent of the cost of a place or even more if your household income is below a certain threshold. 

If you have more than one child using childcare, you pay full price for the most expensive daycare and half-price for the others.

Norway

The cost of nursery and kindergarten is capped at 3,050 Norwegian kroner, regardless of the hours attended or whether that facility is state-run or private. This means you’ll never pay more than roughly €295 a month per child in childcare costs.

Germany

The costs for daycare centres (Kindertagesstätte, or Kita for short) can differ greatly depending on where you live in Germany, as the fees are set by the local government.

In Schleswig-Holstein in the far north, parents pay on average nine percent of their after-tax income on childcare costs. In Hamburg, 4.4 percent of parent’s income goes on childcare as every child in entitled to five hours of free care a day. In Berlin, daycare is completely free. 

Spain

Costs can vary depending on whether it is a  private or public guardería or centro infantil (as nurseries are called in Spanish).

Public ones are heavily subsidised by the government and cost around €100-260 per month, depending on where you live in Spain and your situation. Private nurseries cost between €150 and €580 per month. There is also a fixed yearly fee called a matrícula or enrolment fee, which is around €100.

There is a 50 percent discount for large families and single parents don’t have to pay anything for childcare.

There’s also a deduction of up to €1,000 (cheque guardería) that is applied to the income tax return and works out at around €100 to €160 per month which is aimed at working mothers and is available up until the child is three years old.

France

In France, crèches tend to be the most affordable option and the cost is based on the family’s income. High earners might pay up to a maximum of €4.20 an hour (€33.60 for an 8-hour day), whereas low-income families might pay €0.26 an hour (€2.08 for an 8-hour day) at a crèche collective, which is for three months to three year olds. At the age of three, compulsory education begins in France.

The cost of a childminder is around €10.88 an hour and up to 50 percent of the costs of a nanny or professional childminder can be reimbursed by the government.

The OECD calculations on the percentage of income spent on childcare – based on two parents both working full time – is 13 percent in France. This is roughly similar to Spain and Italy.

Austria

Public nurseries and kindergartens are heavily subsidised and in some cases free, depending on where you live. For example in Vienna, parents only need to pay €72.33 a month to cover meal costs, with low income families being exempt from that fee.
 
Vienna also subsidises private kindergartens, paying up to €635.44 a month directly to the institution. 
 
In other provinces, kindergarten is free for part-time hours. It is mandatory for all children in Austria to attend part-time kindergarten from the age of five. They start school aged six.

Switzerland

The average Swiss family spends a massive 41 percent of their net income on childcare, three times the OECD average of 13 percent.

The average cost of childcare in Switzerland is CHF130 a day (€136). Due to tax breaks and subsidies paid out in the cantons, many parents will pay between 30 and 80 percent of this cost, depending on income. This equates to paying between €41 and €108 a day, roughly €902 to €2,376 a month. 

It’s even more expensive to hire a nannie, which will cost between CHF3,500 (€3,678) and CHF5,000 (€5,255) a month, including mandatory pension contributions.

United Kingdom

According to charity Coram in their Childcare Survey 2022, the average cost of full-time nursery is £1,166 (around €1,304 a month), which is even higher in some parts of London. There are some government subsidies available for low-income families and those receiving benefits and every parent is entitled to 15 or 30 free hours of childcare the term after their child turns three years old.

Childcare conclusion

The cost of childcare varies within each country, depending on family circumstances. However, for guaranteed low childcare costs for every parent, Sweden comes out best, with a maximum of €145 a month.

Average monthly cost of state-run childcare:

Sweden: €145 maximum

Norway: €295 maximum

Austria: €72.33 – roughly €500

Spain: €100 – €260 

Germany: €0 –  €368

Denmark: €368 – €573

France: €45,76 – €739.20 

Switzerland: €902 – €2,376 

U.K. €1,304 which reduces the term after the child turns three.

By Emma Firth and Becky Waterton

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