INFANT AND CHILD MORTALITY 7 This chapter provides information on levels, trends, and differentials in neonatal, postneonatal, infant, child, and under-five mortality, as well as levels and differentials in perinatal mortality. These mortality rates are relevant to a demographic assessment of the population and are an important measure of a country’s level of socioeconomic development and quality of life. They can also be used for monitoring and evaluating population and health programmes. 7.1 INFANT AND CHILD MORTALITY NFHS-3 asked all women age 15-49 to provide a complete history of their births including for each live birth, the sex, month and year of birth, survival status, and age at the time of the survey or age at death. Age at death was recorded in days for children dying in the first month of life, in months for other children dying before their second birthday, and in years for children dying at later ages. This information was used to calculate the following direct estimates of infant and child mortality: Neonatal mortality: The probability of dying in the first month of life Postneonatal mortality: The probability of dying after the first month of life but before the first birthday Infant mortality (1q0): The probability of dying before the first birthday Child mortality (4q1): The probability of dying between the first and fifth birthdays Under-five mortality (5q0): The probability of dying before the fifth birthday 7.2 LEVELS AND TRENDS Table 7.1 and Figure 7.1 present various measures of infant and child mortality by residence for the three five-year periods preceding the survey. According to these estimates, infant mortality in India has declined from 77 deaths per 1,000 live births in 1991-95 (10-14 years before the survey) to 57 deaths per 1,000 live births in 2001-05 (0-4 years before the survey), thus implying an average rate of decline of 2 infant deaths per 1,000 live births per year. All other measures of infant and child mortality presented in Table 7.1 also show declining trends during the years before the survey. By comparing the estimates for the period 10-14 years before the survey with the estimates for the period 0-4 years before the survey, it is seen that the neonatal mortality rate has decreased by 12 deaths per 1,000 live births (from 51 to 39), the postneonatal mortality rate has decreased by 7 deaths per 1,000 live births (from 25 to 18), and the child mortality rate (at age 1-4 years) has decreased by 14 deaths per 1,000 children age 1 (from 32 to 18). In spite of these impressive declines, one out of every 14 children born during the five years before NFHS-3 will die before reaching age five. Infant and Child Mortality | 179 Table 7.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey by residence, India, 2005-06 Neonatal Postneonatal Infant Child Under-five 1 Years preceding mortality mortality mortality mortality mortality the survey (NN) (PNN) (1q0) (4q1) (5q0) URBAN 0-4 28.5 13.0 41.5 10.6 51.7 5-9 35.9 18.8 54.7 14.8 68.7 10-14 34.6 18.1 52.7 17.7 69.5 RURAL 0-4 42.5 19.7 62.2 21.0 82.0 5-9 53.9 24.2 78.1 28.7 104.5 10-14 57.5 28.1 85.5 38.4 120.6 TOTAL 0-4 39.0 18.0 57.0 18.4 74.3 5-9 49.3 22.8 72.2 25.0 95.4 10-14 51.3 25.3 76.6 32.3 106.5 1 Computed as the difference between the infant and neonatal mortality rates. Figure 7.1 Early Childhood Mortality Rates for the Five-Year Period preceding the Survey, NFHS-1, NFHS-2, and NFHS-3 Deaths per 1,000 120 109 100 95 79 80 74 68 60 57 49 43 39 40 33 30 29 24 18 18 20 0 Neonatal mortality Postneonatal Infant mortality Child mortality Under-five mortality mortality NFHS-1 NFHS-2 NFHS-3 Infant and child mortality rates are considerably higher in rural areas than in urban areas. In 2001-05, the infant mortality rate was 50 percent higher in rural areas (62) than in urban areas (42). The rural-urban difference in mortality is especially large for children in the age interval 1- 4 years, for whom the rate in rural areas is twice as high as the rate in urban areas. In both the neonatal and postneonatal periods, mortality in rural areas is about 50 percent higher than mortality in urban areas. Infant and child mortality rates have declined slightly faster in rural areas than in urban areas. Between 1991-95 and 2001-05, infant mortality declined by 27 percent in rural areas, compared with 21 percent in urban areas. During the same period, the child mortality rate 180 | Infant and Child Mortality declined by 45 percent in rural areas, compared with 40 percent in urban areas. Even in the neonatal period, the decline in mortality was slightly faster in rural areas (26 percent) than in urban areas (18 percent). Rather than relying only on NFHS-3 data for the trend analysis, one can also use the estimates from NFHS-1 and NFHS-2 to discern the trends in infant and child mortality. For the period 0-4 years before the survey, NFHS-1 and NFHS-2 recorded infant mortality rates of 79 and 68, respectively (see Table 7.2). Comparison of these estimates with the NFHS-3 estimate of 57 indicates that the infant mortality rate declined by 22 deaths per 1,000 live births in approximately 13 years (with similar declines in the two periods). This implies an average reduction of 1.7 infant deaths per year, which is slightly slower than the reduction of 2 infant deaths per annum implied by the birth history data from NFHS-3. It should also be noted that the estimated infant mortality rate of 57 for 2001-05 from NFHS-3 is very close to the average Sample Registration System (SRS) estimate of 60 for the period 2002-05. Table 7.2 Early childhood mortality rates by background characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the five-year period preceding the survey, by background characteristics and residence, India, 2005-06, and for NFHS-2 and NFHS-1 Neonatal Postneonatal Infant Child Under-five 1 mortality mortality mortality mortality mortality Background characteristic (NN) (PNN) (1q0) (4q1) (5q0) URBAN Education No education 38.2 23.1 61.3 21.4 81.4 <5 years complete 39.9 13.4 53.3 6.5 59.4 5-7 years complete 31.4 16.7 48.1 7.5 55.2 8-9 years complete 25.8 5.4 31.2 4.7 35.7 10-11 years complete 16.2 8.3 24.5 4.3 28.7 12 or more years complete 19.4 4.2 23.6 4.7 28.2 Religion Hindu 30.9 13.3 44.3 10.9 54.7 Muslim 21.6 13.9 35.5 9.6 44.8 Christian 11.3 5.0 16.3 9.4 25.5 Sikh * * * * * Buddhist/Neo-Buddhist * * * * * Other * * * * * Caste/tribe Scheduled caste 35.0 15.7 50.7 15.5 65.4 Scheduled tribe 29.0 14.8 43.8 10.4 53.8 Other backward class 26.4 15.8 42.2 12.9 54.5 Other 27.5 8.6 36.1 6.2 42.1 Wealth index Lowest 39.4 25.4 64.8 29.2 92.1 Second 40.8 21.6 62.4 21.5 82.5 Middle 32.0 17.8 49.8 16.4 65.3 Fourth 31.3 14.9 46.2 8.0 53.9 Highest 21.1 6.3 27.4 5.6 32.8 Total 28.5 13.0 41.5 10.6 51.7 NFHS-2 31.7 15.4 47.0 16.9 63.1 NFHS-1 34.1 22.0 56.1 19.6 74.6 RURAL Education No education 47.0 24.1 71.1 27.8 97.0 <5 years complete 50.5 18.6 69.2 15.8 83.8 5-7 years complete 35.8 14.4 50.1 13.3 62.8 8-9 years complete 35.1 11.6 46.7 6.1 52.5 10-11 years complete 35.0 10.5 45.5 3.0 48.3 12 or more years complete 20.0 9.6 29.6 2.3 31.8 Continued… Infant and Child Mortality | 181 Table 7.2 Early childhood mortality rates by background characteristics—Continued Neonatal Postneonatal Infant Child Under-five 1 mortality mortality mortality mortality mortality Background characteristic (NN) (PNN) (1q0) (4q1) (5q0) Religion Hindu 43.3 19.7 63.0 20.9 82.5 Muslim 40.1 20.3 60.4 23.1 82.2 Christian 42.0 12.8 54.8 12.9 67.0 Sikh 34.3 11.7 46.0 8.7 54.3 Buddhist/Neo-Buddhist (36.7) (10.0) (46.6) (17.3) (63.2) Other 44.7 42.0 86.7 49.2 131.7 Caste/tribe Scheduled caste 49.6 21.4 71.0 25.6 94.7 Scheduled tribe 40.9 23.0 63.9 38.3 99.8 Other backward class 42.1 19.1 61.1 18.7 78.7 Other 38.1 17.5 55.7 13.3 68.2 Wealth index Lowest 48.8 21.9 70.7 32.5 100.9 Second 44.9 24.2 69.2 22.8 90.4 Middle 41.2 19.4 60.6 13.8 73.6 Fourth 32.4 9.9 42.3 7.1 49.1 Highest 24.3 9.2 33.6 2.7 36.2 Total 42.5 19.7 62.2 21.0 82.0 NFHS-2 46.7 26.6 73.3 32.8 103.7 NFHS-1 52.9 32.2 85.0 37.6 119.4 TOTAL Education No education 45.7 24.0 69.7 26.9 94.7 <5 years complete 48.4 17.6 66.0 13.8 78.8 5-7 years complete 34.5 15.1 49.5 11.5 60.5 8-9 years complete 32.0 9.5 41.5 5.6 46.9 10-11 years complete 26.9 9.6 36.5 3.6 40.0 12 or more years complete 19.6 6.3 25.9 3.9 29.7 Religion Hindu 40.3 18.2 58.5 18.5 76.0 Muslim 34.1 18.2 52.4 18.6 70.0 Christian 31.5 10.1 41.7 11.6 52.8 Sikh 35.9 9.7 45.6 6.8 52.1 Buddhist/Neo-Buddhist 43.0 9.8 52.8 17.1 69.0 Other 43.3 41.4 84.6 50.4 130.7 Caste/tribe Scheduled caste 46.3 20.1 66.4 23.2 88.1 Scheduled tribe 39.9 22.3 62.1 35.8 95.7 Other backward class 38.3 18.3 56.6 17.3 72.8 Other 34.5 14.5 48.9 10.8 59.2 Wealth index Lowest 48.4 22.0 70.4 32.3 100.5 Second 44.6 24.0 68.5 22.6 89.6 Middle 39.3 19.1 58.3 14.4 71.9 Fourth 31.9 12.1 44.0 7.5 51.2 Highest 22.0 7.2 29.2 4.8 33.8 Total 39.0 18.0 57.0 18.4 74.3 NFHS-2 43.4 24.2 67.6 29.3 94.9 NFHS-1 48.6 29.9 78.5 33.4 109.3 Note: All estimates are for the five years preceding the survey (approximately 1988-1992 for NFHS-1, 1994-1998 for NFHS-2, and 2001-2005 for NFHS-3).