Background/Objectives: Long-run facility-level perinatal data from Central Asia are scarce. We described eleven years of stillbirth, neonatal, infant and perinatal mortality at one tertiary maternity center in Kazakhstan, and used the Birthweight and Age-at-death Boxes for Intervention and Evaluation System (BABIES) matrix to locate where feto-infant deaths concentrated. Methods: Retrospective ecological analysis of aggregated annual institutional records, 2015–2025: 102,481 total births, 101,544 live births, 937 stillbirths and 489 infant deaths. Rates were modeled by Poisson regression with the log birth denominator as offset, refitted as quasi-Poisson and negative binomial. Composite feto-infant mortality (antenatal and intrapartum stillbirth plus death at 0–27 days, per 1000 total births in each birthweight band) was examined by direct standardization and Kitagawa decomposition, using the nine years whose matrix cells reconciled with the registry. The study was not preregistered. Results: Infant mortality fell from 7.07 to 3.57 per 1000 live births (rate ratio 0.50, 95% CI 0.33–0.77) and stillbirth from 10.07 to 5.42 per 1000 total births (0.54, 0.38–0.76), an average annual decline near 8% for neonatal and infant mortality. Antenatal stillbirth declined; no clear change was detected for intrapartum stillbirth (1.11 to 1.04 per 1000; 0.94, 0.38–2.32). Births below 2500 g were 5.9% of all births but 71.1% of composite feto-infant deaths (rate ratio 39). Decomposition placed the reduction within birthweight bands rather than in the birthweight distribution, in single-year and pooled-period versions. Conclusions: The design is ecological and descriptive: it shows where feto-infant deaths are concentrated, not why. Intrapartum stillbirth and births below 2500 g are the groups in which any further reduction would have to be found.

Background: Longitudinal evidence on perinatal and infant mortality in Central Asia remains limited. We described prematurity, the liveborn birthweight distribution, survival of extremely low birthweight (ELBW, 500–999 g) infants, and mortality at a tertiary perinatal center in Turkistan, Kazakhstan. Methods: This single-center ecological study used annual aggregate data for 2016–2025, covering 94,337 births, including 93,482 live births. Poisson models estimated trends; risk ratios (RRs) compared 2025 with 2016. Results: The stillbirth rate was 9.06 per 1000 total births (95% confidence interval [CI] 8.47–9.69) and infant mortality was 4.62 per 1000 live births (95% CI 4.20–5.08). Between 2016 and 2025, perinatal mortality fell from 12.58 to 6.99 per 1000 (RR 0.56, 95% CI 0.41–0.75), stillbirth from 9.29 to 5.42 per 1000 (RR 0.58, 95% CI 0.41–0.82), and infant mortality from 7.66 to 3.57 per 1000 (RR 0.47, 95% CI 0.31–0.70). Preterm births made up 7.1% of births but 66.2% of stillbirths; ELBW infants accounted for 50.2% of infant deaths. Recorded ELBW survival was 21.9% (7/32) in 2016 and 53.8% (28/52) in 2025, but the pooled five-year comparison was not significant (39.9% vs. 47.0%, p = 0.180), and the annual trend lost significance when the 2025 cohort, whose follow-up was incomplete, was excluded. Deaths after discharge were not systematically ascertained. Conclusions: Mortality was lower at the end of the decade, and deaths remained concentrated among preterm and ELBW infants. The ELBW survival findings are hypothesis-generating.

Kazakhstan has reduced perinatal and child mortality over the past decade, but much less is known about the health of the children who now survive. We analysed national routine health statistics for 2019–2025 covering 15 demographic, pregnancy, mortality and registered morbidity indicators, plus the lowest and highest regional values for six paediatric disease groups in 2025. Trends were estimated by ordinary least squares with HC3 robust standard errors, Theil–Sen slopes and Kendall’s tau. Possible changes in slope were explored with single-joinpoint regression and checked by leaving out one year at a time, and associations were examined after removing the linear calendar trend. Sensitivity analyses excluded the pandemic years 2020–2021 and the provisional year 2025. Stillbirth fell from 8.8 to 6.4 per 1000 total births (−27.3%), perinatal mortality from 11.4 to 8.0 (−29.8%), infant mortality from 8.37 to 5.85 (−30.1%) and under-5 mortality from 10.69 to 8.10 per 1000 live births (−24.2%). Registered neonatal morbidity rose every year, from 113.5 to 187.9 per 1000 live births (+65.6%; slope 13.45 per year, 95% CI 10.26 to 16.64), with little change when 2020–2021 were excluded. Registered disease rates among children under 5 reached a low point in 2021–2022 and then rose again, a pattern that changes in the share of infants could not explain. Seven annual observations could neither confirm nor exclude a link between falling mortality and rising registered morbidity. Recorded regional values differed several-fold. The cause of this variation is unclear: the published data cannot separate registration practice from real differences in morbidity, age structure, migration or chance.