What Explains the Decline in Infant Mortality in Demographically Underdeveloped States in India?

Uttar Pradesh and Madhya Pradesh have the highest infant mortality rate both in NFHS-3 (2005–06) and NFHS-4 (2015–16); but there has been a noticeable decline in IMRs in both the states during 2005–06 and 2015–16. The study endeavours to explore the factors that explain the decline in infant mortality in these two states. Findings from multiple regression and decomposition analysis attribute low birth weight, age of the mother at birth, mother’s educational attainment, mother’s use of cooking fuel and wealth status as the major contributing factors for the decline in infant mortality between NFHS-3 and NFHS-4.

In the northern and central regions of India, Uttar Pradesh (UP) and Madhya Pradesh (MP) are the two economically backward states and have the dubious distinction of having the highest infant mortality rate (IMR) in the country. As per the figures of IMR from the different rounds of the National Family Health Surveys (NFHS), namely NFHS-1 (1992–93), NFHS-2 (1998–99), NFHS-3 (2005–06), and NFHS-4 (2015–16), IMRs in UP were 100, 89, 73, 64 per 1,000 live births respectively and the corresponding figures for MP were 85, 88, 70, and 51 per 1,000 live births, while at all India, the figures were 79, 68, 57, and 41 per 1,000 live births, respectively. It is evident that over the years, IMRs in both the states have declined appreciably but the pace of decline lags behind the national rate of decline. Among the states in NFHS-3 and the recent NFHS-4, IMR is the highest in UP and MP. In order to fasten the pace of decline of IMR in the country, it is important to assess the magnitude and direction of socio-economic and demographic factors deterrent in reducing IMR in UP and MP.

Infant mortality is a health outcome which is closely linked with several socio-economic, demographic and health backgrounds of both the mother and child. Children born to literate women are found to have higher chances of surviving infanthood than those of non-literate women. Using the Demographic and Health Surveys (DHS) for each country in sub-Saharan Africa, Shapiro and Tenikue (2017) provided the evidence of reduction in infant and child mortality with the increase in mother’s educational level. The other variables usually found to support the survival of infanthood are urban residence, the number of preceding children she had given birth to, work outside of the household, preceding birth interval, sex of the child, etc, besides other childcare factors. Studies that support one or the other propositions are found in Whitworth and Stephenson (2002), Kishore (1993), Jatrana (2004), Pebley et al (1996), Sear et al (2002), Das Gupta (1990), Basu and Basu (1991), Pradhan (2003) and Tarai (2007). There are also studies that emphasise on community-level backgrounds, such as education (Kravdal 2004; Ladusingh and Singh 2006), poor community water and sanitation (Sastry 1996), family and community (Bolstad and Manda 2001), proximity to urban centres and distance to the coast (Balk et al 2004).