Inequalities in infant mortality rate in India from 1999-2020

Satya S. Tripathy; Priyanka Behera; Subrat K. Pradhan; Sanjeeb K. Mishra

doi:10.18203/2394-6040.ijcmph20252851

Authors

Satya S. Tripathy Department of Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, Odisha, India https://orcid.org/0009-0007-5453-4568
Priyanka Behera PG Resident, Department of Community Medicine, VIMSAR, BURLA, ODISHA
Subrat K. Pradhan Department of Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, Odisha, India https://orcid.org/0000-0003-4647-8467
Sanjeeb K. Mishra Department of Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, Odisha, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20252851

Keywords:

Infant mortality, Gender inequalities, Economic disparities in health

Abstract

Background: Infant Mortality Rate is a key indicator of child survival and overall health system performance. Gender inequality in IMR, particularly in low and middle-income countries like India, reflects broader disparities in access to health care and societal preferences. The aim of this study is to assess the magnitude and trends of gender inequalities in infant mortality in India from 1999 to 2020.

Methods: This study utilized data from DHS and other related surveys, analysed through the WHO’s health equity assessment toolkit (HEAT). IMR was disaggregated by gender and other equity stratifies (economic status, maternal age, place of residence and education). Inequality was assessed using simple (difference, ratio) and complex (population attributable risk [PAR], population attributable fraction [PAF]) measures.

Results: IMR remained consistently higher among males compared to females. However, the PAR and PAF values for gender inequality were consistently zero. Disparities were found across economic, educational, and residential dimensions. The poorest households, rural populations, mothers with no education, and younger mothers (15-19 years) exhibited higher IMR. Over time, these inequalities have declined but still remain significant, especially in wealth and education dimensions.

Conclusions: India has seen a decline in infant mortality over the past two decades, persistent inequalities - particularly along socio-economic and educational lines continue to challenge equity in child survival. Addressing these disparities requires targeted public health interventions and socio-economic reforms. The use of both simple and complex inequality metrics provides valuable insight for policymakers in prioritizing efforts towards more equitable health outcomes.

Metrics

Metrics Loading ...

References

IMR definition. Available at: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/1. Accessed 18 June 2025.

World Infant Mortality Rate (1950-2025). Available at: https://www.macrotrends.net/global-metrics/countries/WLD/world/infant-mortality-rate. Accessed on 19 June 2025.

National Family Health Survey (NFHS - 5), 2019-21 INDIA report. Available at: https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf. Accessed on 18 June 2025.

Gender and health. Available at: https://www.who.int/health-topics/gender#tab=tab_1. Accessed on 18 June 2025.

Hay K, McDougal L, Percival V, Henry S, Klugman J, Wurie H, et al. Gender Equality, Norms, and Health Steering Committee. Disrupting gender norms in health systems: making the case for change. Lancet. 2019;393(10190):2535-49. DOI: https://doi.org/10.1016/S0140-6736(19)30648-8

United Nations. Department of Economic and Social Affairs. Sustainable Development. The 17 GOALS. Available at: https://sdgs.un.org/goals. Accessed on 18 June 2025.

Fikree FF, Pasha O. Role of gender in health disparity: the South Asian context. BMJ. 2004;328(7443):823-6. DOI: https://doi.org/10.1136/bmj.328.7443.823

Mortality rate, Infant (per 1000 live births). Available at: https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?end=2020&start=1999&view=chart. Accessed on 19 June 2025.

Infant mortality rate by 2025. https://worldpopulationreview.com/country-rankings/infant-mortality-rate-by-country. Accessed on 19 June 2025.

Aghai ZH, Goudar SS, Patel A, Saleem S, Dhaded SM, Kavi A, et al. Gender variations in neonatal and early infant mortality in India and Pakistan: a secondary analysis from the Global Network Maternal Newborn Health Registry. Reprod Health. 2020;17(Suppl 3):178. DOI: https://doi.org/10.1186/s12978-020-01028-0

Mukhopadhyay J, Gender differentials in infant and under-five mortality in India. J Community Health Manag. 2024;11(4):197-203. DOI: https://doi.org/10.18231/j.jchm.2024.034

Chowdhury R, Taneja S, Mazumder S, Bhandari N, Strand TA. Gender differences in infant survival: a secondary data analysis in rural North India. BMJ Open. 2017;7(8):e014179. DOI: https://doi.org/10.1136/bmjopen-2016-014179

Zegeye B, Shibre G, Haidar J. Socioeconomic, urban‐rural and sex‐based inequality in infant mortality rate: evidence from 2013 Yemen demographic and health survey. Arch Public Health. 2021;79:64. DOI: https://doi.org/10.1186/s13690-021-00589-1

Osborne A, Kamara H, Bangura C. Socio-economic and geographical inequalities in infant mortality rates in Sierra Leone, 2008–2019. BMC Public Health. 2025;25:1697. DOI: https://doi.org/10.1186/s12889-025-22952-5

Shibre G. Social inequality in infant mortality in Angola: Evidence from a population based study. PLoS One. 2020;15(10):e0241049. DOI: https://doi.org/10.1371/journal.pone.0241049

Bhatia M, Dwivedi LK, Ranjan M, Dixit P, Putcha V. Trends, patterns and predictive factors of infant and child mortality in well-performing and underperforming states of India: a secondary analysis using National Family Health Surveys. BMJ Open. 2019;9(3):e023875. DOI: https://doi.org/10.1136/bmjopen-2018-023875

Child Health. National Health Mission. Available at: https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=819&lid=219. Accessed on 19 June 2025.