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Infant Mortality Rate: Major Factors in its Reduction

August 25, 2015

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:-

View in Visualization Tool

Source: Department of Health and Family Welfare

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.

View in Visualization Tool

Source: Department of Health and Family Welfare

(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.

View in Visualization Tool

Source: Department of Health and Family Welfare

(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.

 

 

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