An analysis of levels and trends in

  An Analysis of Levels and Trends in Infant and Child Mortality Rates in India 2014 National Institute of Public Cooperation and Child Development New Delhi Study Team Overall Guidance and Support Dr Dinesh Paul Director Shri S K Shrivastav Additional Director Shri S C Shrivastava Joint Director Project In Charge Shri H P Joshi Assistant Director Project Assistants Ms Bhavisha Ms Kadambari Singh Layout and Design Shri A J Kaul CONTENTS Page No List of Tables i List of Figures viii Introduction Levels and Trends of Infant and Child Mortality Rates Maternal Determinants of Infant and Child Mortality 42 Child Determinants of Infant and Child Mortality 67 Socio-economic Determinants of Infant and Child Mortality 86 Environmental Determinants of Infant and Child Mortality 128 Summary and Conclusion 135 Annexure-I Detailed tables 146 Annexure-II Data sources 217 References 223 Glossary & Abbreviations 224 LIST OF TABLES Table Table Table : : : Table : Table : Table : Table Infant Mortality Rate in India, SRS, 1991-2013 Percentage of Infants Deaths to Total Deaths, SRS, 1991-2013 Neo-natal and Post Neo-natal Mortality Rates in India, SRS, 19912013 Under-Five Mortality Rate in India, SRS, 1990-2013 Page No 11 15 Trends in Infant and Child Mortality as per NFHS-1, NFHS-2 and NFHS-3 Rural-Urban Differentials in Infant Mortality Rate in India, SRS, 1991-2013 16 : Rural –Urban Differentials in the Percentage of Neo-Natal Deaths and Early Neo-Natal Deaths to Infant Deaths in India, SRS, 1991-2013 21 Table : 22 Table : Table 10 Table 11 Table 12 : : : Rural –Urban Differentials in Peri-Natal Mortality Rate in India, SRS, 1991-2013 Rural –Urban Differentials in Childhood Mortality Rate in India, NFHS-1, NFHS-2 and NFHS-3 Sex Differentials in Infant Mortality Rate in India, SRS, 1991-2013 Inter -State Differentials in IMR in India, SRS, 1991-2013 Inter-State Differentials in Percentage decline in IMR between 1991 and 2013 Table 13 : Inter-State Differentials in Neo-Natal Mortality Rates in India, SRS, 1991-2013 : Inter-State Differentials in Early Neo-Natal Mortality Rates in India, SRS, 1996-2013 : Inter-State Differentials in Peri-Natal Mortality Rates in India, SRS, 1991-2013 30 Table 16 : 34 Table 17 Table 18 Table 19 Table 20 Table 21 : : : : : Inter-State Differentials in Under-Five Mortality, SRS, 20082013 Infant Mortality Rate , AHS Neo-Natal Mortality Rate, AHS Post Neo-Natal Mortality Rate, AHS Under- Five Mortality Rate, AHS Rural-Urban Differentials in IMR , AHS Table 22 : Rural-Urban Differentials in Neo-natal Mortality Rate, AHS 39 Table 23 : Rural-Urban Differentials in Post Neonatal Mortality Rate, AHS 40 Table 24 Table 25 Table 26 Table 27 : : : : Rural-Urban Differentials in U5MR, AHS Sex Differentials in Infant Mortality Rate, AHS Sex Differentials in Under Five Mortality Rate (U5MR), AHS Percentage of Female by Age at Effective Marriage, 1993-2013 40 41 41 44 Table 14 Table 15 18 23 24 27 28 31 32 36 37 38 38 39 i Table 28 : Neonatal, Postnatal, Infant, Child and Under-Five Mortality Rates by Mother’s Age at Childbirth, NFHS Antenatal Care by Age of Mother, NFHS-3, 2005-06 Antenatal Care, TT Injections and IFA Tablets by Age of Mother, CES 2009 Antenatal Care (ANC) by Mother's Age at Birth, NFHS-3 2005-06 Percentage of Live Births Delivered in a Health Facility by Age of Mother, NFHS Place of Delivery and Assistance at Delivery by Age of Mother, CES 2006 & 2009 Early Initiation of Breastfeeding by Age of Mother, CES 2006 & 2009 Immunisation Status by Age of Mother, CES 2006 and 2009 Vitamin A Status by Age of Mother, CES 2006 & 2009 Percentage Distribution of Current Live Births by Birth Order SRS, 1991-2013 Percentage Distribution of Births among Ever Married Women 1549 Years, DLHS-3, 2007-08 Antenatal Care (ANC) Provider by Birth Order, NFHS-3 2005-06 Assistance at Delivery by Birth Order, NFHS Percentage of children who received all basic vaccines by birth order of the child, NFHS Neonatal, Postnatal, Infant, Child and Under-five Mortality Rates by Birth Interval, NFHS Percentage Distribution of Second and Higher Order Live Births by Birth Interval, SRS, 1991-2013 Category of Elevated Risk of Mortality, the Risk Ratio and Per Cent Distribution of Currently Married Women by Category of Risk NFHS, 2005-06 Effect of Assistance at Childbirth on Neonatal and Post-Neonatal Mortality, NFHS Percentage of Women Age 15-49 Below 145 cm, Mean Body Mass Index (BMI), and Percentage with Specific BMI Levels by State, NFHS-3, 2005-06 Percentage of Women Age 15-49 with Anaemia by States, NFHS-3, 2005-06 Neonatal, Post Neonatal, Infant, Child and Under-Five Mortality Rates by Child's Sex, NFHS 45 Table 29 Table 30 : : Table 31 Table 32 : : Table 33 : Table 34 Table 35 Table 36 Table 37 : : : : Table 38 : Table 39 Table 40 Table 41 : : : Table 42 : Table 43 : Table 44 : Table 45 : Table 46 : Table 47 : Table 48 : Table 49 Table 50 Table 51 : : : Immunisation Status by Child’ Sex, NFHS Immunisation Status by Child’ Sex, CES 2006 and 2009 Percentage of Children Consumed Vitamin A rich food and Vitamin A Supplements by states, India, NFHS-3, 2005-06 69 70 71 Table 52 : Percentage of Children Under Age Five Years Classified as Malnourished According to Three Anthropometric Indices of Nutritional Status: Height-for-Age, Weight-for-Height, and Weightfor-Age, by Background Characteristics, NFHS-3, 2005-06 75 46 47 47 48 48 49 50 51 53 54 55 56 56 58 60 62 63 65 66 69 ii Table 53 : Table 54 : Table 55 : Table 56 : Table 57 : Table 58 : Table 59 : Table 60 : Table 61 Table 62 : : Table 63 : Table 64 : Table 65 : Table 66 : Table 67 : Table 68 : Table 69 : Table 70 : Table 71 : Table 72 Table 73 Table 74 : : : Percentage of Children Aged 6-59 Months Classified as Having Anaemia, by Background Characteristics, NFHS-3, 2005-06 Percentage of Children Consuming Food Rich in Iron, Iron Supplementation, Deworming Tablets and Iodised Salt by states, NFHS-3, 2005-06 Among Children Under Age Five, Percentage who had Symptoms of Acute Respiratory Infection (ARI) in the Two Weeks Preceding the Survey who Received Specific Treatment, According to State , NFHS-3, 2005-06 Percentage of Children below Five Years who had Diarrhoea in the Two Weeks Preceding the Survey, by Age in Months, NFHS-3, 200506 Among Children Under Age Five who had Diarrhoea in the Two Weeks Preceeding the survey, Percentage who Received Advice or Treatment from a Health Provider, Received Oral Rehydration Therapy (ORT), and Other Treatments, by State, NFHS-3, 2005-06 Rural-Urban Distribution in Antenatal Care by Provider , NFHS-3, 2005-06 Rural-Urban Distribution in Antenatal Care (ANC), TT Injections and IFA Tablets Consumption, CES, 2009 Rural-Urban Distribution of Women by Stage of Pregnancy at the time of first ANC, CES, 2009 Assistance Received during Delivery by Residence, CES, 2009 Rural-Urban Distribution of Status of Initiation of Breastfeeding, CES 2006 and 2009 Timing of First Post Natal Check-up by Rural/Urban Residence, NFHS-3, 2005-06 Rural-Urban Distribution of Status of Vitamin A Supplementation, CES 2006 and 2009 Early Childhood Mortality Rates By Mother's Education, NFHS-3, 2005-06 Rural-Urban Distribution of Early Childhood Mortality Rates by Education of Mother, NFHS-3, 2005-06 Antenatal Care (ANC) Provider by Mothers’ Education, NFHS 3, 2005-06 Percentage of Mothers Received Antenatal Checkup, TT Injections and Consumed IFA Tablets by Education, CES, 2009 Assistance Received during Delivery by Education of Mother, NFHS 3, 2005-06 Assistance Received according to Place of Delivery by Education of Mother, CES, 2009 Timing of First Post Natal Check-up by Mother's Education, NFHS Early Childhood Mortality Rates by Religion, NFHS-3, 2005-06 Antenatal Care (ANC) by Provider and Religion, NFHS 3, 2005-06 Percentage of Mothers Received Antenatal Checkup, TT Injections and Consumed IFA Tablets by Religion, CES, 2009 77 80 82 83 84 86 87 88 89 90 90 93 94 95 96 96 97 98 99 102 103 104 iii Table 75 : Table 76 Table 77 Table 78 : : : Table 79 Table 80 : : Table 81 : Table 82 : Table 83 : Table 84 Table 85 Table 86 Table 87 : : : : Table 88 Table 89 : : Table 90 Table 91 : : Table 92 : Table 93 Table 94 : : Table 95 : Table 96 Table 97 Table 98 : : : Place of Delivery and Assistance Received during Delivery by Religion, CES, 2009 Status of Initiation of Breastfeeding by Religion, NFHS 3, 2005-06 Vaccination Status of Children by Religion, CES 2006 and 2009 Status of Vitamin A Supplementation by Religion, CES 2006 and 2009 Early Childhood Mortality Rates by Caste, NFHS (2005-06) Percentage Decline in Infant and Under-Five Mortality Rates by Social Groups and Rural Urban Residence between Three Rounds of NFHS Percentage of Mothers Received Antenatal Care (ANC), TT Injections and Consumed IFA Tablets by Social Groups, CES, 2009 Antenatal Care (ANC) by Provider and Social Groups, NFHS-3, 200506 Status of Initiation of Breastfeeding by Social Groups, CES 2006 and 2009 Timing of First Post Natal Check-up by Social Groups, NFHS Vaccination Status of Children by Social Groups, NFHS Vaccination Status of Children by Social Groups, CES 2006 and 2009 Status of Vitamin A Supplementation by Social Groups, CES 2006 and 2009 Early Chilhood Mortality Rates By Wealth Index, NFHS-3 Percentage of Mothers Received Antenatal Care (ANC), TT Injections and Consumed IFA Tablets by Wealth Index, CES, 2009 Antenatal Care (ANC) Provider by Wealth Index, NFHS 3, 2005-06 Timing of First Post Natal Check-up by Wealth Index, NFHS 3, 200506 Status of Initiation of Breastfeeding by Wealth Index, CES 2006 and 2009 Vaccination Status by Wealth Index, CES 2006 and 2009 Status of Vitamin A Supplementation by Wealth Index, CES 2006 and 2009 Percentage Distribution of Households by Source of Drinking Water, Census, 2011 Distance of the Water Source from the House, Census, 2011 Distribution of Households by Type of Toilet Facility, Census, 2011 Distribution of Households by Type of Fuel used for Cooking, Census, 2011 105 106 107 108 109 110 111 111 114 115 115 116 117 119 120 121 123 124 125 127 128 130 131 133 iv LIST OF Detailed TABLES (Annexure – I) Table A1 Table A2 Table A3 Table Table Table Table A4 A5 A6 A7 : Percentage of 0-4 Years Population to Total Population and Percentage of Deaths in the Age Group to Total Deaths, India, 19912013 : Infant Mortality Rates in States and UTs, 1991-2013 : Infant Mortality Rates (Male) in States and UTs, 1991-2013 Table A8 Table A9 Table A10 Table A11 Table A12 : Infant Mortality Rates (Female) in States and UTs, 1991-2013 : Infant Mortality Rates (Rural) in States and UTs, 1991-2013 : Infant Mortality Rates (Urban) in States and UTs, 1991-2013 : Percentage of Infant Deaths to Total Deaths India and Major States, 1992-2013 Neo-Natal Mortality Rate in Major States, 1991-2013 Neo-Natal Mortality Rate (Rural) in Major States, 1991-2013 : Neo-Natal Mortality Rate (Urban) in Major States, 1991-2013 : Early Neo-Natal Mortality rate in Major States, 1996-2013 : Early Neo-Natal Mortality Rates (Rural) in Major States, 1996- Table A13 : Early Neo-Natal Mortality rate (Urban) in Major States, 1996- Page No 147 148 150 152 154 156 158 159 160 161 162 163 2013 164 2013 Table A14 Table A15 Table A16 Table A17 Table A18 : : : : : Table A19 : Table A20 : Table A21 : Table A22 : Table A23 Table A24 : : Table A25 : Table A26 : Table A27 Table A28 Table A29 Table A30 Peri-Natal Mortality Rate in Major States, 1991-2013 Peri-Natal Mortality Rate (Rural) in Major States, 1991-2013 Peri-Natal Mortality Rate (Urban) in Major States, 1991-2013 Still Birth Rate in Major States, 1991-2013 Estimated Death Rates for Children Aged 0-4 Years in Major States, 1991-2013 Estimated Death Rates for Children (Male) Aged 0-4 Years in Major States, 1991-2013 Estimated Death Rates for Children (Female) Aged 0-4 Years in Major States, 1991-2013 Estimated Death Rates for Children (Rural) Aged 0-4 Years in Major States , 1991-2013 Estimated Death Rates for Children (Urban) Aged 0-4 Years in Major States, 1991-2013 Under mortality rate by Sex in Major States, 2008-2013 Under mortality rate by Rural/Urban residence in Major States, 2008-2013 Under-Five Mortality Rates for the Five Years Period Preceding the Surveys, by States, NFHS-1, NFHS-2 and NFHS-3 Crude Death Rate in Major States, 1991-2013 165 166 167 168 169 Early Childhood Mortality Rate by State, NFHS-1, NFHS-2 and NFHS-3 Mean age at effective marriage in India and Major States, 1992-2013 Total Fertility Rate in Major States, 1991-2013 General Fertility Rate in India and Major States, 1991-2013 178 179 182 183 170 171 172 173 174 175 176 177 v Table A51 : Percentage of children age 12-23 months who received Vitamin A according to States/Uts, CES 2006 and 2009 States Andra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerela Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland orrissa Punjab Rajastahan Sikkim Tamilnadu Tripura Uttar Pradesh Uttarakhand West Bengal Uts Combined Total CES-2006 First dose Received at Received one First dose of Vitamin least one dose of vitamin of Vitamin dose of A during past six A A vitamin A months - 65 45.6 37.6 46.9 57.6 30.9 80 46 60.6 81.7 56.5 59.2 62.5 72 66.3 68 23.8 44 67.2 23.3 79 58.5 70.5 78.3 61 46 36.5 62.6 79.9 68.5 57.9 40 26 11.3 34.9 26.6 18.1 11.6 18.3 44.1 60.3 47 37.9 42 25.1 30.5 52.9 6.9 8.9 42.3 10.9 43.5 43.7 65.5 55.5 36.7 17.7 23.1 32.4 50.9 32.5 36.8 84.4 40 69.3 49 62.1 65.2 87.8 66.9 55.9 87.8 59 63.3 58.5 66.8 45.1 82.6 47.9 58.1 74.4 28.2 69.7 73.1 59.9 90.1 52.6 68 48.9 60.8 73.4 67.8 64 CES-2009 Received at Received one least one dose of vitamin A dose of during past six vitamin A months 84.7 43.1 71.1 49.4 67.3 67.7 87.8 69.3 58.1 92.7 61.6 63.3 87.1 68.2 48.8 84.5 48 58.8 74.6 29.9 71 73.4 60.5 82.6 56.6 68 49.1 60.8 74.1 71.4 65.4 78.4 38.4 65.5 45.1 56.2 63.3 70.6 57.5 50.8 79 54.9 58.7 80.6 65.9 44.7 68.9 46.7 53.2 73.9 25.4 65.3 71.7 57.2 88.7 53.9 65.8 44.4 59.6 71.9 65.8 59.4 Source : Coverage Evaluation Surveys, 2006 and 2009 212 Table A52 : Percentage of children age 6-59 months classified as having anaemia, according to states, India, 2005-06 State Anaemia status by Haemoglobin level Mild (10.0-10.9 g/dl) India1 Delhi Haryana Himachal Pradesh Jammu & Kashmir Punjab Rajasthan Uttaranchal Chattisgarh Madhya Pradesh Uttar Pradesh Bihar Jharkhand Orissa West Bengal Arunachal Pradesh Assam Manipur Meghalaya Mizoram Sikkim Tripura Goa Gujarat Maharashtra Andhra Pradesh Karnataka Kerala Tamil Nadu 2.6 26.3 25.8 25.7 25.8 21.7 22.8 28.5 24 27.1 25.4 29.6 29.3 28.9 30 27.1 28.7 25.6 31.7 23.5 28.9 27.5 19.5 25 21.9 23.7 28.6 23.5 27.1 Moderate Severe (7.0-9.9 g/dl) (