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Infant Mortality in India
Sample Registration System (SRS) Statistical Report 2023
Context: The recently released Sample Registration System (SRS) Statistical Report 2023 observes that India’s infant mortality rate has declined sharply to 25 per 1,000 live births. Kerala has achieved the lowest, at 5—lower than even the US—highlighting improvements in healthcare access.
What is the Infant Mortality Rate (IMR) and how is it measured?
Infant Mortality Rate (IMR) refers to the number of deaths of infants under one year of age per 1,000 live births in a given year. In India, it is measured through the SRS conducted by the Office of Registrar General and Census Commissioner of India.
What is the status of infant mortality in India?
According to the report, India’s IMR has declined from 40 (2013) to 25 (2023), a 37% reduction. India fell below the world average (around 2021) but still lags behind Asia’s average of 17.4.
- State-wise: Kerala (IMR 5) is the lowest, comparable to developed nations and lower than the US (5.6 in 2022).
- Other achievers include Delhi, Himachal, and Karnataka with over 50% declines in a decade.
- States like Madhya Pradesh, Chhattisgarh, and Uttar Pradesh record the highest (37).
- Urban-rural gap: Kerala shows no rural-urban variation due to universal healthcare, whereas states like Chhattisgarh report stark differences (urban 19 vs rural 28).
What measures have been successful?
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- Institutional deliveries: Over 96% (rural) and 99% (urban) births in Kerala are institutional (SRS 2023).
- National Health Mission (2005), Janani Suraksha Yojana, and Laqshya (Labour Room Quality Improvement) ensured skilled birth attendance.
- Nutrition interventions: POSHAN Abhiyaan, ICDS.
- Constitutional backing:
- Article 21 – Right to life includes health. ( Paschim Banga Khet Mazdoor Samity v. State of West Bengal, 1996).
- Article 47 – Duty of the state to improve public health.
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- Article 45 – Directive to provide early childhood care and education for children below six years of age.
- Article 243G – Empowers Panchayats to function as institutions of self-government, including in health and sanitation, vital for rural IMR reduction.
- Gender gap: Kerala has the highest difference in IMR between boys (9) and girls (2).What are the causes of infant mortality in India?
- Neonatal complications: Prematurity, birth asphyxia, low birth weight.
- Infections: Pneumonia, diarrhea, sepsis.
- Maternal health factors: Malnutrition, anemia, inadequate antenatal care.
- Socio-economic issues: Poverty, poor sanitation, lack of safe drinking water and lack of literacy and awareness in mothers.
- Health system gaps: Limited neonatal ICU facilities in poorer states.
What challenges persist?
- Quality gaps in neonatal care infrastructure and maternal and child health services.
- Skilled Workforce Shortage: Lack of trained healthcare professionals like pediatricians, nurses, and midwives
- Incomplete Immunisation Coverage
- Inaccurate or delayed data reporting limits precise targeting and effectiveness of interventions.
- Traditional Beliefs like discarding colostrum, avoiding exclusive breastfeeding etc.
What more needs to be done?
- Strengthen primary healthcare: Expand neonatal ICUs in backward districts, targeted service delivery through Aspirational District Programme.
- Focus on equity: Address rural and gender disparities, replicate Kerala’s model of universal access.
- Global lessons:
- Japan’s strong maternal care and post-natal home visits.
- Sri Lanka’s success through free universal healthcare and near-total institutional births.
- Policy integration: Link Ayushman Bharat Health and Wellness Centres with child nutrition and maternal care for a continuum of services.
