[Answered]Infant mortality rates in India are still one of the highest in the world with significant regional variations. Elaborate.

Infant mortality rate means the number of deaths of infants under one year old in a given year per 1,000 live births in the same year.This rate is often used as an indicator of the level of health in a country and of the quality of life in a community.High infant mortality has been a long term issue in India due to various reasons like poor maternal health and inter-generational poverty in families.

Infant mortality in India:

1. According to the United Nations Inter-agency Group for Child Mortality Estimation (UNIGME) about 8,00,000 infant deaths were reported in India in 2017, the lowest in five years. However, the infant death numbers still remained the highest in the world.
2. India accounts for 18% of global child deaths following a steady decline from 22% in 2012.Most children under five die due to preventable or treatable causes such as complications during birth, pneumonia, diarrhoea, neonatal sepsis and malaria.
3. Infant deaths were reported highest in the world in India, followed by Nigeria, Pakistan and Democratic Republic of Congo.
4. India’s under five mortality rate has been estimated at 39 deaths per 1,000 live births, the same as the global average. But the gender gap in child survival remains far below the global average which means that girl children, after they are born, face discrimination in India.
5. The number of Indian children who died before their fifth birthday went below one million for the first time. Initiatives like Mission Indradhanush, Mother and Child Tracking System and neonatal ICUs in every district, have helped India to achieve remarkable progress over the last five years.

Regional variations in Infant mortality rate:

1. In India there is a high Intra-State and Inter-State variations in IMR, such variations receives less attention from policymakers.
2. According to India’s Sample Registration System, Goa (8), Pondicherry (10), Kerala (6) and Manipur (9) saw the lowest infant-mortality rates in 2016.While Madhya Pradesh, Assam, Odisha and Uttar Pradesh saw the highest, in that order.

3. Southern States like Kerala have an extremely lower IMR because of widespread literacy and urbanisation.The settlements intra state have higher IMR is due to lack of healthcare infrastructure facilities.

Way forward:

1. Low birth weight can be prevented if the mother is well-nourished, diarrhoea can be avoided by exclusively breast-feeding the child in the first six months.
2. Merely ensuring that women go to hospitals to deliver their children can prevent asphyxia and trauma.
3. A majority of these deaths are preventable. Financial resources were not the biggest constraint in improving this health indicator.It is the political will that is essential now to ensure better newborn survival.
4. Addressing gaps in quality of health care is the need of the hour in India.Hospitals should ensure that the critical products to save the newborns are available.
5. The biggest cause of death is premature birth.The second is complications like asphyxia during delivery.Preventing these would mean paying attention to the mother’s health during pregnancy.
6. Education campaign should be taken up to aware the mother of the merits of antenatal care, institutional delivery, importance of exclusive breast feeding, immunisation, home care for diarrhoea; all these are meant to create awareness among family members to provide support to women during pregnancies and deliveries.
7. India continues to show impressive decline in child deaths. The investment on ensuring holistic nutrition under the POSHAN campaign and national commitment to make India open defecation-free by 2019 are steps that will help in accelerating progress further.

SDG goal 3 calls for an end to preventable deaths of newborns and children under 5 years of age and specifies that all countries should aim to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-five mortality to at least as low as 25 deaths per 1,000 live births by 2030.The uptake of the Janani Suraksha Yojana and NRHM needs to be ensured across the states it could address some of the variations in IMR across India.