Determinants of Infant Mortality in India: Evidence from a District Level Household Survey.

Author:Bakshi, Swati


A country's infant mortality rate (IMR) is a measure of the health status of its people. It is also a vital indicator of human development. Despite advancements in technology and medical science, IMR remains a marked concern around the globe, including India. As a nation that is growing increasingly aware of its ability to control its destiny, India joined the United Nations' effort to achieve eight Millennium Development Goals (MDGs) that were established around the premise of creating a life of dignity for all. Child mortality is at the forefront of the MDGs, and India is making steady progress. However, there is still much work to be done because the IMR in India is thirty-eight per one thousand live births (Government of India, 2014).

Since 1990 the number of children throughout the world who die each year has fallen sharply. The number of children who die before the age of five has been reduced by half, from 12.7 million to 6.6 million (UNICEF, 2015). This achievement has been impressive, particularly given that populations in the least developed countries have grown by 70 percent during this period. Progress in tackling child mortality has been achieved by expanding measures such as immunization, distribution of insecticide-treated bed nets, treatment of childhood illnesses, and family planning.

Strong economic development in certain countries where child mortality was once very high, such as Vietnam and China, has also been key, as have investments in education and literacy, particularly for women. Despite these advances, child mortality still remains one of the great wrongs of our modern world, with eighteen thousand children under five dying every day, mostly from preventable causes. Although the world has undoubtedly made progress in reducing mortality among children under five, death rates among the most vulnerable group --newborn babies--have failed to decrease at the same speed. We are still failing to prevent the deaths of millions of newborn babies who die within twenty-eight days of their birth, including those who die on their first and only day of life, as well as stillbirths that occur during labor.

The infant mortality rate is defined as the number of deaths of children less than one year of age per one thousand live births. The rate for a given region is calculated as the annual number of children dying under one year of age divided by the annual number of live births and multiplied by one thousand. Infant mortality and under five mortality rates determine the level of child health and overall development. The infant mortality rate is also a component of the Human Development Index (HDI), which is amenable to direct interventions by the welfare state. It is universally regarded as the most important indicator not only of the health status of a community but also of the standard of living in general and the effectiveness of maternal and child health (MCH) services. The IMR is used to compare the health and well-being of populations across and within countries. Preventing infant deaths is a high priority among the international health agencies. In the past century, the IMR has been used for intercountry comparisons that reflect health, economics, nutrition, and social status. As stated before, it is a useful indicator of a country's level of health or development and is used as a component of the physical quality of life index. India currently has an IMR of thirty-eight per one thousand live births according to World Bank estimates (2015) whereas the MDG target was set at twenty-six per one thousand live births.

Literature on infant mortality has established a number of individual and socioeconomic characteristics that influence the probability of early childhood death. These determinants can be grouped into three categories: personal and biological characteristics of the child, behavioral characteristics of the child's mother, and socioeconomic household and community characteristics.

This article will determine the role of socioeconomic; demographic; and mother-, child-, and program-related factors affecting infant mortality in India. This study is intended to provide program managers, policy makers, academicians, and researchers who wish to understand the issues with useful insights as to how they can galvanize evidence-based action for improving the IMR.

Data and Methods

Data Source

The data used to find the various determinants of infant mortality were taken from the third round of the nationally representative District Level Household and Facility Survey (DLHS-3; International Institute for Population Sciences & Macro International, 2007). Fieldwork was conducted between December 2007 and December 2008, gathering information from 720,320 households across India. The survey covered 611 districts in India. The total number of households representing a district varied from one thousand to fifteen hundred. The DLHS was initiated in 1997 to assess the utilization of services provided by government health care facilities and people's perceptions about the quality of services. The DLHS-3 is the third in the series of district surveys, preceded by DLHS-1 in 1998-1999 and DLHS-2 in 2002-2004. The survey is designed to provide estimates on important indicators of maternal and child health, family planning, and other reproductive health services. In addition, the DLHS-3 provides information on important interventions of the National Rural Health Mission.

The study used pregnancy history files containing interview data for ever married woman in the fifteen- to forty-nine-year-old age group. During the interviews, these women were asked questions related to pregnancy outcomes and the births and deaths of each of their children born from January 2004 until the date of survey.


To identify the role of various determinants of infant mortality, various socioeconomic, demographic, and program variables were chosen. Table 1, which appears in the "Results" section of this article, lists the socioeconomic and demographic variables, including household, demographic, mother- and child-related, and program variables. Community level variables such as state and place of residence were also included. States were categorized into six regions: north, west, east, central, south, and northeast. The northern region included Jammu and Kashmir, Himachal Pradesh, Punjab, Chandigarh, Uttrakhand, Delhi, and Haryana. The western...

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