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    Just the beginning


    India has done well on infant mortality rate, but there is a long road ahead

    India’s life expectancy at birth (LEB) has doubled since Independence, largely due to efforts on ensuring access to nutrition, healthcare, and pharmaceutical innovation. But there is no room for complacency as this is just the beginning of a long road ahead. India’s LEB at 69.7 years as per data from the Sample Registration Survey for 2015-2019 is still below the global average of 72.6 years. It took a decade to raise it by just two years at the latest instance. While the gap with developed nations is quite large—LEB in Organisation for Economic Cooperation and Development (OECD) nations in 2019 stood at 81 years—India is doing poorly against even Bangladesh (72.59 years). Rema Nagarajan’s analysis in the Times of India shows India must tackle early-years mortality to push up LEB; states with a high infant mortality rate (IMR) showed the biggest gains in terms of change in life expectancy at years zero, one, and five.

    While India has done admirably on beating down IMR, defined as the number of deaths of children under one year of age per 1,000 live births, from 47 in 2010 to 28 in 2020 as per National Family Health Survey (NFHS) data, it still compares unfavourably with not just OECD (4.1) but also Bangladesh (25.6). At the country-level, India seems to be on track to achieve the Sustainable Development Goal of 25 or below, but it needs to be seen if the pandemic and the resultant worsening of vulnerabilities has dented the record, more so as the progress in lowering IMR slowed in the five years before the pandemic hit. After stellar improvement between 2009 and 2014—falling from 50 to 39—it slowed down, with sharp deceleration in some of India’s poorest states, including Madhya Pradesh, Uttar Pradesh, and Chhattisgarh. There is also a sharp rural-urban divide.

    India’s IMR showing has benefited a raft of government programmes aimed at strengthening health and nutrition support for pregnant and lactating women, as well as more effective implementation of programmes to bolster women and child health outcomes. However, there remain critical barriers in terms of availability of affordable healthcare infrastructure, logistics, and adequate insurance coverage; these would explain most of the urban-rural and inter-state variations in IMR performance. The deficit of trained healthcare personnel drastically limits access to interventions that can prevent neonatal death due to complications.

    A 2020 study, published in BMJ, showed using NFHS Round IV data that life expectancy of vulnerable groups such as SCs and STs tended to be relatively lower. Both the state governments and the Centre need to investigate this further. Immediate efforts must be made to improve healthcare access, especially for children and women of reproductive age. Against a requirement of 202 community health centres in tribal areas in Madhya Pradesh, there were less than half, and just five ob-gyns against the required 96. Anaemia among Indian women continues to be an outsized factor too. Per NFHS data, more than half the women in the 15-49 age group suffer from this and thus their pregnancies carry serious complications for their children, at birth and later. Without a multi-pronged approach to address early-year mortality, efforts to increase life expectancy at birth will remain Sisyphean.

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