Infant Mortality Rate: Major Factors in its Reduction

August 25, 2015

Author: Surendra

Infant mortality Rate (IMR) is considered a primary and important indicator of a geographic area’s (country/state) overall health status or quality of life. Reduction of infant and child mortality has been an important tenet of the health policy of the Government of India and it has tried to address the issue right from the early stages of planned development. The National Population Policy (NPP) 2000, the National Health Policy 2002 and National Rural Health Mission (NRHM – 2005 to 2012) have laid down the goal. Reduction in IMR is also included in one of the Millennium Development Goals adopted by the United Nations in 2000.

The study analyses the impact of female literacy, health facilities and vaccination on infant mortality in India. The variables considered are indicators of Infant Mortality Rate (IMR), health facilities in terms of Vaccination and Institutional Delivery.

As inferred from the empirical analysis of the data, it is evident that female literacy has significant impact on Infant Mortality Rate (IMR). The analysis also points out that male literacy also plays a positive role particularly in the households where the nursing mother is illiterate. The other major variable which plays a major role in reducing Infant Mortality Rate (IMR) is availability of health facilities. It has to be taken into thoughtful consideration that the availability of health institutions and quality of service are major factors that have significant impact.

As revealed by the data given below, IMR has shown a long term declining trend:-

Year	All India-Total	All India-Male	All India-Female
1980	114	113	115
1981	110	110	111
1982	105	106	104
1983	105	105	105
1984	104	104	104
1985	97	96	98
1986	96	96	97
1987	95	96	96
1988	94	96	94
1989	91	92	90
1990	80	78	81
1991	80	81	80
1992	79	79	80
1993	74	73	75
1994	74	75	73
1995	74	73	76
1996	72	71	73
1997	71	70	72
1998	72	70	73
1999	70	70	71
2000	68	67	69
2001	66	64	68
2002	63	62	65
2003	60	57	64
2004	58	58	58
2005	58	56	61
2006	57	56	59
2007	55	55	56
2008	53	52	55
2009	50	49	52
2010	47	46	49
2011	44	43	46
2012	42	41	44

(http://data.gov.in/catalog/infant-mortality-rate-india#web_catalog_tabs_block_10 – : Title – Infant Mortality Rate by Sex-1980 to 2012)

India witnessed a declining trend in the Infant mortality rate over the years. Infant mortality rate has declined by 70% from 139 in 1972 to 42 in 2012. A consistent decreasing trend has been observed from 1998 onward. During 1998-2012, Infant mortality rate has decreased by 42%.

Analysing the gender wise figures of IMR, it is revealed that IMR is higher for female infants vis-à-vis male infants. This is a reflection of the society’s preference for male child and consequent attention given to their day to day care, nutrition and medical & other facilities for the male infants. The data given above evidenced this concerning phenomenon.  The difference between the male and female infant mortality rate is more accentuated in the recent years particularly between 2001 to 2003. For example, the IMR for male infant was 64; while it was 68 for female infant in 2001. Similarly, the IMR for male infant was 57; while it was 64 for female infant in 2003.

We have examined the correlation of infant mortality in India using state level data from Census of India etc., which shows a lot of variability across different states as shown in the maps below indicating IMR of various states in 2004 and 2012:-

It is clear from the map that 12 states out of 28 states had high levels of IMR in excess of 50 in 2004 viz. Madhya Pradesh (79); Odisha (77); Uttar Pradesh (72); Rajasthan (67); Assam (66); Bihar (61); Haryana (61); Chhattisgarh (60); Andhra Pradesh (59); Meghalaya (54); Gujarat (53) and Himachal Pradesh (51). IMR of India as a whole in 2004 was 58.

It is clear from the map that 4 states out of 28 states had high levels of IMR in excess of 50 in 2012 viz.  Madhya Pradesh (56); Assam (55); Odisha (53) and Uttar Pradesh (53) in 2004 – however they have made progress in reducing IMR and their IMR have reduced during the period. Thus there is a reduction of 8 states which had high levels of IMR in excess of 50 in 2004.

While infant mortality rates are showing declining trend and have dropped across states over the years, there still remains a lot of variability across the states. This analysis seeks to determine which socio-economic factors play important role in reduction of infant mortality rates. The explanatory variables used are literacy (male/female), health facilities, level of poverty, urbanization and other socio-economic variables.

The detailed year-wise data of IMR of various states in 2004 and 2012 is as under:

States/UTs	2004	2005	2006	2007	2008	2009	2010	2011	2012
Andhra Pradesh	59	57	56	54	52	49	46	43	41
Assam	66	68	67	66	64	61	58	55	55
Bihar	61	61	60	58	56	52	48	44	43
Chhattisgarh	60	63	61	59	57	54	51	48	47
Gujarat	53	54	53	52	50	48	44	41	38
Haryana	61	60	57	55	54	51	48	44	42
Jharkhand	49	50	49	48	46	44	42	39	38
Karnataka	49	50	48	47	45	41	38	35	32
Kerala	12	14	15	13	12	12	13	12	12
Madhya Pradesh	79	76	74	72	70	67	62	59	56
Maharashtra	36	36	35	34	33	31	28	25	25
Odisha	77	75	73	71	69	65	61	57	53
Punjab	45	44	44	43	41	38	34	30	28
Rajasthan	67	68	67	65	63	59	55	52	49
Tamil Nadu	41	37	37	35	31	28	24	22	21
Uttar Pradesh	72	73	71	69	67	63	61	57	53
West Bengal	40	38	38	37	35	33	31	32	32
Arunachal Pradesh	38	37	40	37	32	32	31	32	33
Delhi	32	35	37	36	35	33	30	28	25
Goa	17	16	15	13	10	11	10	11	10
Himachal Pradesh	51	49	50	47	44	45	40	38	36
Jammu & Kashmir	49	50	52	51	49	45	43	41	39
Manipur	14	13	11	12	14	16	14	11	10
Meghalaya	54	49	53	56	58	59	55	52	49
Mizoram	19	20	25	23	37	36	37	34	35
Nagaland	17	18	20	21	26	26	23	21	18
Sikkim	32	30	33	34	33	34	30	26	24
Tripura	32	31	36	39	34	31	27	29	28
Uttarakhand	42	42	43	48	44	41	38	36	34
Andaman & Nicobar Islands	19	27	31	34	31	27	25	23	24
Chandigarh	21	19	23	27	28	25	22	20	20
Dadra and Nagar Haveli	48	42	35	34	34	37	38	35	33
Daman and Diu	37	28	28	27	31	24	23	22	22
Lakshadweep	30	22	25	24	31	25	25	24	24
Puducherry	24	28	28	25	25	22	22	19	17
ALL INDIA	58	58	57	55	53	50	47	44	42

(Dataset URL : http://data.gov.in/catalog/infant-mortality-rate-india#web_catalog_tabs_block_10 – : Title – State wise Infant Mortality Rate(IMR) of India from 1971 to 2012)

Increases in literacy and health facilities significantly reduce infant mortality. Improvements in male employment and reductions in poverty also reduce infant mortality, but their quantitative impact is weak in comparison to the improvement in the women’s characteristics like literacy, workforce participation etc.

The analysis shows that the states that have higher literacy rate also have lower IMR. It is evident from the table given below:-

States/UTs	IMR 2011	Literacy 2011
ALL INDIA	44	74.04
Andaman & Nicobar Islands	23	86.60
Andhra Pradesh	43	67.00
Arunachal Pradesh	32	65.40
Assam	55	72.20
Bihar	44	61.80
Chandigarh	20	86.00
Chhattisgarh	48	70.30
Dadra and Nagar Haveli	35	76.20
Daman and Diu	22	87.10
Delhi	28	86.20
Goa	11	88.70
Gujarat	41	78.00
Haryana	44	75.60
Himachal Pradesh	38	82.80
Jammu & Kashmir	41	67.20
Jharkhand	39	66.40
Karnataka	35	75.40
Kerala	12	94.00
Lakshadweep	24	91.80
Madhya Pradesh	59	69.30
Maharashtra	25	82.30
Manipur	11	76.90
Meghalaya	52	74.40
Mizoram	34	91.30
Nagaland	21	79.60
Odisha	57	72.90
Puducherry	19	85.80
Punjab	30	75.80
Rajasthan	52	66.10
Sikkim	26	81.40
Tamil Nadu	22	80.10
Tripura	29	87.20
Uttar Pradesh	57	67.70
Uttarakhand	36	78.80
West Bengal	32	76.30
Correlation	-0.71

(http://data.gov.in/catalog/literacy-rate#web_catalog_tabs_block_10 – : Title – State level Literacy rate in % from 1951-2011)

There is a strong negative correlation (r = -0.71) between literacy rate and IMR i.e. the higher the literacy rate of a state, the lower the IMR of the state. For example, the literacy rate of Goa is high at 88.70 and IMR is lowest at 11. Similarly in case of Manipur, the literacy rate is 76.90 and IMR is lowest at 11. Though in case of Kerala, the literacy rate is 94.00, which is higher in comparison to the literacy rate of Goa and Manipur; yet the IMR is higher at 12. This point out the role of other variables like availability of health facilities etc. In this case, the compactness of the two states of Goa and Manipur vis-à-vis Kerala and concomitant geographical proximity of health facilities as well as income levels of the citizens have a role to play. On the other hand, the literacy rate of Bihar is lowest at 61.80 and IMR is high at 44. Similarly, Madhya Pradesh has the low literacy level at 69.30 and the highest level of IMR at 59.

Institutional Delivery

Increasing trend has been seen in India in Percentage of Institutional Deliveries from 70.62% in 2008-09 and 82.86% in 2012-13. Lakshadweep has highest Percentage of Institutional Deliveries i.e. 100% in both the years 2008-09 and 2012-13. Meghalaya has lowest Percentage of Institutional Deliveries at 51.13% in 2012-13.

(Dataset URL : http://data.gov.in/catalog/information-relating-maternal-health#web_catalog_tabs_block_10  –   : Title – State-wise Information relating to Maternal Health (ANC- Institutional and Home Delivery) – 2008-09 to 2012-13)

Fourteen States/UTs viz. Assam (80.17); Bihar (78.5); Chhattisgarh (57.62); Dadra and Nagar Haveli (67.84); Himachal Pradesh (71.34); Jharkhand (63.67); Manipur (77.64); Meghalaya (49.23); Mizoram (80.91); Nagaland (68.96); Punjab (77.66); Uttar Pradesh (61.71); Uttarakhand (62.39) and West Bengal (71.69) were below the National average of 81.66% in 2011-12.

Eleven States/UTs viz. Bihar, Chhattisgarh, Jharkhand, Punjab, Uttar Pradesh, West Bengal, Himachal Pradesh, Manipur, Meghalaya, Nagaland and Uttarakhand were below the National average of 82.86% in 2012-13.

DPT immunisation for children (III dose)

India has witnessed a fluctuating trend in DPT3 Immunisation Achievement during 2008-2011. In 2008-09, percentage of DPT3 Immunisation Achievement was 96.25% across the country, which decreased to 84.12% in 2012-13. Andhra Pradesh, Karnataka, Maharashtra, West Bengal, Goa, Himachal Pradesh, Manipur, Meghalaya, Mizoram and Tripura achieved more than 100% vaccination in 2012-13. The lowest percentage of DPT3 Immunisation Achievement was observed in Daman and Diu (63.9%) in 2012-13 and 13.6% in Lakshadweep in 2008-09 as compared to other states.

Fifteen States/UTs viz. Andaman & Nicobar Islands (83.13); Arunachal Pradesh (51.09); Bihar (74.62); Chhattisgarh (87.84); Dadra and Nagar Haveli (78.98); Daman and Diu (57.74); Delhi (79.75); Jharkhand (82.88); Madhya Pradesh (85); Nagaland (69.24); Puducherry (73.45); Rajasthan (82.87); Sikkim (81.97) and Tamil Nadu (81.99) were below the National average of 89.56% in 2011-12.

The lowest percentage of DPT3 Immunisation Achievement was observed in Arunachal Pradesh (51.09) and Daman and Diu (57.74) in 2012-13 and 13.6% in Lakshadweep in 2008-09 as compared to other states.

Fourteen States viz. Bihar, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu, Uttar Pradesh, Arunachal Pradesh, Delhi, Nagaland, Sikkim, Andaman and Nicobar Islands, Dadra and Nagar Haveli, Daman and Diu and Puducherry below the National average (84.12%) in 2012-13.

(Dataset URL : http://data.gov.in/catalog/dt-5dpt-5dpt-immunisation-children#web_catalog_tabs_block_10    – : Title – State-wise achievement of need assessed – DPT immunisation for children (III dose) (2008-09 to 2012-13)

Facilities of Institutional Delivery and vaccination/ immunisation play a very significant role in reducing IMR. Over the years, Facilities of Institutional Delivery and vaccination/ immunisation have been showing an increasing trend. The Government is also spending a lot of resources for their provision and also increasing awareness among the masses for Institutional Delivery and vaccination/ immunisation.

We have analysed the availability of facilities of Institutional delivery and vaccination/ immunisation. We have taken the Percentage of Institutional Delivery to Total Deliveries and State-wise achievement of need assessed – DPT immunisation for children (III dose) % Achieved for the assessment and their impact on IMR.

The analysis shows that the states that have higher literacy rate also have lower IMR. It is evident from the table given below:-

States/UTs	IMR 2012	% of Institutional Delivery to Total Deliveries 2011-12	State-wise achievement of need assessed – DPT immunisation for children (III dose) 2011-12*-% Achieved
ALL INDIA	42	81.66	89.56
Andaman & Nicobar Islands	24	93.06	83.13
Andhra Pradesh	41	95.05	102.68
Arunachal Pradesh	33	95.07	51.09
Assam	55	80.17	92.54
Bihar	43	78.50	74.62
Chandigarh	20	92.24	101.23
Chhattisgarh	47	57.62	87.84
Dadra and Nagar Haveli	33	67.84	78.98
Daman and Diu	22	92.63	57.74
Delhi	25	95.26	79.75
Goa	10	99.67	117.95
Gujarat	38	93.66	96.36
Haryana	42	83.42	99.24
Himachal Pradesh	36	71.34	102.76
Jammu & Kashmir	39	84.49	97.18
Jharkhand	38	63.67	82.88
Karnataka	32	97.10	101.47
Kerala	12	99.81	89.69
Lakshadweep	24	93.36	98.1
Madhya Pradesh	56	86.12	85
Maharashtra	25	94.37	103.86
Manipur	10	77.64	121.98
Meghalaya	49	49.23	99.9
Mizoram	35	80.91	115.66
Nagaland	18	68.96	69.24
Odisha	53	84.84	91.19
Puducherry	17	99.92	73.45
Punjab	28	77.66	96.59
Rajasthan	49	90.63	82.87
Sikkim	24	84.25	81.97
Tamil Nadu	21	99.65	81.99
Tripura	28	85.38	104.26
Uttar Pradesh	53	61.71	85.09
Uttarakhand	34	62.39	101.54
West Bengal	32	71.69	100.04
Correlation with IMR		-0.44	-0.08

There is a significant negative correlation (r = -0.44) between Percentage of Institutional Delivery to Total Deliveries and IMR i.e. the higher the Percentage of Institutional Delivery to Total Deliveries of a state, the lower the IMR of the state. For example, the Percentage of Institutional Delivery to Total Deliveries of Goa is high at 99.67 and IMR is lowest at 10. Similarly in case of Manipur, the Percentage of Institutional Delivery to Total Deliveries is 77.64 and IMR is lowest at 10.

On the other hand, the Percentage of Institutional Delivery to Total Deliveries of Meghalaya is lowest at 49.23 and IMR is high at 49.

There is a negative correlation (r = -0.08) between State-wise achievement of need assessed – DPT immunisation for children (III dose) % Achieved and IMR. For example, the State-wise achievement of need assessed – DPT immunisation for children (III dose) of Manipur is high at 121.98 and IMR is lowest at 10.

Conclusion

It is evident from the foregone analysis that literacy level, institutional delivery and immunisation have a very positive impact on Infant Mortality Rate (IMR). In the states where literacy level, institutional delivery and immunisation are high, the IMR is low.

Among the above mentioned variables Literacy Rate, which increases the awareness level and health consciousness among the people particularly women, show a very strong impact in reducing IMR. This is evident from the fact that is a strong negative correlation (r = -0.71) between literacy rate and IMR.

Similarly, institutional delivery shows a very significant impact in reducing IMR. This is evident from the fact that is a strong negative correlation (r = -0.44) between institutional delivery and IMR.