The Infant Mortality Rate (IMR) – number of infant deaths per 1,000 live births – has gone up significantly over the past five years in urban areas in most states, National Family Health Survey-5 (NFHS-5) data released earlier this month shows. While rural areas showed a decrease in IMR, the situation was different for urban regions.
The increase in IMR was highest in the states of Tripura, Andhra Pradesh, Bihar, and Meghalaya. Out of the 15 states for which the urban IMR is available for both 2015-16 and 2019-20, there was an increase in urban IMR in seven states, while most of the other states barely showed any significant improvement. The only states which showed a significant improvement were (erstwhile) Jammu and Kashmir, Mizoram and Kerala, where the IMR almost halved over the past five years.
According to a recent study by Jean Dreze, Aashish Gupta, Sai Ankit Parashar, and Kanika Sharma, based on the Sample Registration System (SRS) data, there has been a slowdown, and reversals in infant mortality in large parts of India in 2017 and 2018 – the last two years for which SRS data on child mortality is available.
The study pointed out that in urban areas, the infant mortality rate stagnated at 23 deaths per 1,000 births between 2016 and 2018. Worse, overall infant mortality increased in the poorer states of Chhattisgarh, Jharkhand, Madhya Pradesh, and Uttar Pradesh during the period.
“This occurred despite sustained improvements in household access to sanitation and clean fuel. One possible interpretation of these findings is that, in addition to their impact on unemployment and poverty, the demonetisation experiment in late 2016 and the subsequent economic slowdown had an adverse effect on child health. In any case, these trends reinforce earlier evidence of faltering human development in India in recent years,” the study said.
While there has been a stagnation in urban IMR at the national level, a state-level analysis done by the authors revealed an even more worrying picture—11 out of 20 bigger states and 15 out of 20 urban regions within those states did not show any improvement in IMR between 2016 and 2017 or between 2017 and 2018. The study concluded that the IMR decline slowed down, stagnated, or was reversed in many parts of India, more so in urban areas. However, rural populations fared slightly better with 9 out of 20 bigger states showing a stagnation in IMR.
The NFHS-5 data does not only support the findings of this study, but also gives rise to more concern as it is based on even more recent data. “Hopefully, the decline of infant mortality picked up again in 2019, but another setback is likely to take place this year, in 2020, due to the COVID-19 crisis. The national lockdown in April-May 2020 led to mass unemployment and a major disruption of public services, including routine health services such as antenatal care and child immunization. As the end of the year approaches, economic recovery is still far from complete. In short, there is a distinct possibility that three of the last four years will turn out to be bleak times for infant mortality decline in India, particularly in urban areas,” the study said.