Publication:

Infant mortality in India: a statistical study using survival and regression methods based on national family health survey data

Background Although infant mortality in India has declined substantially over the past three decades, large social and regional inequalities persist. This study examines long-term trends in infant mortality and quantifies caste-based differentials in infant survival, with special focus on Uttar Pradesh, Madhya Pradesh, and Maharashtra.

Methods Data from all five rounds of the National Family Health Survey (NFHS-1 to NFHS-5; 1992-2021) were used to assess trends in infant mortality. Survival and regression analyses were conducted using NFHS-5 (2019-21). The study included live births occurring in the five years preceding the survey. Infant survival was examined using Kaplan-Meier estimates and log-rank tests. Binary logistic regression models assessed the association between caste and infant mortality after adjusting for socio-economic, demographic, and healthcare factors, accounting for survey design.

Results At the national level, infant mortality in 2019-21 was higher among Scheduled Tribes (ST) (41.6 per 1,000) and scheduled castes (SC) (40.7 per 1,000) than among non-SC/ST infants (32.8 per 1,000). Survival analysis showed significant caste differences in infant survival (χ²=15.02, p<0.001), with higher hazards concentrated in the early months of life. In unadjusted models, SC infants had significantly higher odds of death (OR=1.26; 95% CI: 1.19-1.33), which remained modest but significant after full adjustment (OR=1.09; 95% CI: 1.01-1.18). ST disadvantage was attenuated after adjustment. Maternal education, household wealth, ≥4 antenatal care visits (OR≈0.65), and institutional delivery were strongly protective. Uttar Pradesh and Madhya Pradesh showed persistently high infant mortality, while Maharashtra exhibited lower overall risk but residual tribal disadvantage.

Conclusions Despite sustained declines in infant mortality, caste and regional inequities remain pronounced in India. Strengthening equitable access to quality maternal and newborn care is essential for further reductions.