According to official statistics, 20 out of every 1,000 infants born in India do not survive to celebrate their first birthday. The government’s Sample Registration System (SRS) has reported that the country’s Infant Mortality Rate (IMR) was 20 in 2020, meaning that out of 1,000 babies born in the country, 20 die within 12 months of their birth.
IMR, defined as the number of infant deaths (under one year) per thousand live births in a given time period, is widely acknowledged as a measure of a country’s overall health situation. However, in India, while the IMR situation has improved since 1971, when the country’s IMR was an abysmal 129, it is still patchy across the country.
As expected, the IMR in rural India (31) in the latest survey is much higher than in urban India (19). While richer states like Kerala (IMR of 6), Mizoram (3), and Goa (5) have the lowest levels of IMR, less developed states like Uttar Pradesh (38), Madhya Pradesh (43), and Assam (36) are still scrambling to reduce infant deaths. In the northeastern states, Assam has the highest infant mortality rate of 36, followed by Meghalaya at 29. and Arunachal Pradesh at 21.
While government officials are celebrating the SRS report by pointing out how Prime Minister Narendra Modi government’s policies have helped bring about a lower national IMR, experts say individual Indian states need to do much more to achieve the Sustainable Development Goal target of 25 or fewer deaths per 1,000 live births by 2030.
As per the World Health Organization, the IMR in India – Asia’s third largest economy, after China and Japan – is better only than Pakistan (57) and Myanmar (35), its immediate neighbors. Smaller and less prosperous countries like Sri Lanka (6), Bangladesh (24), and even tiny Nepal (24) and Bhutan (23), have lower infant mortality rates than India.
Among the BRICS (Brazil, Russia, India, China, and South Africa) countries, Russia’s IMR was 4, China’s 6, Brazil’s 13, and South Africa’s 26. Developed countries like Singapore, Japan, Norway, Sweden, Finland, and Estonia are far ahead with an IMR of 2. The IMR of the U.K. is 4, and the United States’ is 5.
Currently, India ranks among the highly vulnerable countries for IMR also because it is the world’s second-most populous country, with a population of 1.37 billion people. In India, an estimated 26 million children are born every year. As per the 2011 census, children 6 years old or younger accounted for 13 percent of the total population in India.
Health professionals say that focusing on better nutrition for mothers, upgrading the national medical infrastructure that has taken a hit due to the pandemic, and public sensitization campaigns to educate mothers about childbirth can go a long way in helping augment India’s infant health outcomes.
“It is now well established that child survival cannot be addressed in isolation as it is intricately linked to the health of the mother, which is further determined by her health and development as an adolescent,” pointed out Dr. Kirti Saxena, a gynecologist and obstetrician at Apollo Hospital in New Delhi.
“We need more inclusive and holistic health programs to address the needs of the mothers and infants as well as a host of related factors to improve our IMR.”
The doctor added that the child health program under the government-run National Health Mission integrates interventions that improve child survival and addresses factors contributing to infant and under-five mortality. “But we need to ensure that critical services are made available at home, especially in villages and semi-urban areas where institutional deliveries are still not the norm,” Saxena emphasized. “Community outreach and health facilities at primary and tertiary levels need to be bolstered as child health is now recognized as the key pillar of reproductive, maternal, and adolescent health.”
The major causes of infant mortality in India as per the SRS reports (2010-13) are: prematurity & low birth weight (35.9 percent), pneumonia (16.9 percent), birth asphyxia & birth trauma (9.9 percent), other noncommunicable diseases (7.9 percent), diarrheal diseases (6.7 percent), known or ill-defined causes (4.6 percent), congenital anomalies (4.6 percent), acute bacterial sepsis and severe infections (4.2 percent), injuries (2.1 percent), and fever of unknown origin (1.7 percent).
Economists say that a nation’s health has a direct bearing on the country’s wellbeing. “Economic growth and equitable social development are intrinsically linked,” said economist Anand Mehta. “In particular, education of women and their health as well as their family’s health have a multiplier effect on the nation’s development parameters. This has been borne out the world over and is now being validated in India too.
“The benefits of economic growth must not only be reflected in aggregate national indicators, but must also be well distributed across all sections and both genders of the population.”
Activists opine that along with economic growth, improvement in health and social services is foundational to address the national IMR. When improved access to better healthcare and good nutrition improve child survival, there is no compulsion to produce many children to compensate for possible child deaths and seek security for support in old age, they say.
Also, maternal and infant health awareness, especially in villages and tier 2 and 3 cities, is still low, a prime reason for a high IMR in the country, according to Anubhuti Pershad, a health supervisor with Child Health Foundation in Mumbai. “This is also the reason why the underprivileged end up having large families, as they’re insecure about how may of their kids will survive,” she stated.
Kamla Kumari, 30, a mother based in the northern Indian city of Noida, said that three of her children died within months of being born as she was too poor to take of her health during pregnancy. “I had traumatizing pregnancies, was constantly sick, and there were no hospitals in our village circa 2000,” she recounted. “It was then that a health worker advised me to live with my mother in the city, where I ate better and also had access to good government hospitals. It was only after this, that I was able to give birth to my four kids who survived.”
While a young population like India’s provides a demographic dividend for economic growth, it is also essential that infants and children be healthy and well-nourished to improve national wellness parameters. “Else, it’ll be a classic case of overpopulation combined with suboptimal national productivity leading to below par economic growth and a drain on the country’s exchequer,” said Pershad.