Data about congenital anomalies over the last five decades have been reported to the World Health Organisation from 36 countries in Europe, North and South America, Asia (Japan), and Australasia (Aldo Rosano and colleagues.Journal of Epidemiology and Community Health2000;54:660–6).  In 1950–54, congenital anomalies were the cause of 9% of a total infant mortality rate of around 400 per 10 000 live births in these countries. By 1990–94, total infant mortality rate was around 120 per 10 000 and congenital anomalies caused 20% of these deaths. In the United Kingdom, congenital anomalies caused 16% of infant deaths (45.8 deaths from congenital anomalies per 10 000 live births) in 1950–54 and 21% (14.4 per 10 000 live births) in 1990–94. In 1990–94, the UK had the lowest rate of the 36 countries apart from France (13.7 per 10 000 live births). High rates were observed in South and central America, Greece, and some countries of eastern Europe. Overall, deaths from congenital anomalies decreased by a third over the study period although there have been recent increases in central and Latin America and eastern Europe. Compared with poorer countries, wealthy countries have fewer infant deaths from congenital anomalies but such deaths make up a greater proportion of total infant mortality. For example, in 1990–94, Sweden's infant mortality from congenital anomalies was 19.2 per 10 000 live births (35% of total infant mortality) whereas in Uruguay the rate was 36.3 per 10 000 live births (18% of total). Anomalies of the heart and central nervous system account for almost half of all infant deaths due to congenital anomalies.