The remedy for India’s high Infant Mortality Rate is to increase investment in primary health care

India's Infant Mortality Rate (IMR) and Under-five mortality rate (U5MR) are not showing any significant decline, and hence, India's rank for IMR/U5MR performance globally continues to remain in the bottom quarter of all countries despite our robust economic growth rates. The only way this can be remedied is to invest much more in primary healthcare, ICDS, mid-day meals and MGNREGA to secure the health and nutrition of its citizens, and especially children.

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What trend has been observed in India's infant mortality and under-five mortality rates in the latest Sample Registration System report?

THERE seems to be some euphoria in the country, with the Sample Registration System 2020 statistical report ('SRS') results showing a declining infant mortality rate ('IMR') and Under-five mortality rate ('U5MR'). A number of media reports have praised the decline, especially in states like Uttar Pradesh and Bihar. Over the last decade or so, one sees a secular decline of two to three points each year, so in that sense the 2020 results are not spectacular in any way (see Table 1).

Do these trends actually denote significant gains?

The SRS sampling frame is revised every 10 years based on the results of the latest census, with the last revision in 2014. Therefore, the SRS sample within that decennial period is not independent, and hence any overlapping confidence interval for an SRS estimate indicates that the trend or changes observed are statistically insignificant. The 95 per cent confidence intervals for India's IMR are overlapping between succeeding years, including 2019 and 2020, and hence, there is basically no significant decline in IMR to celebrate. More importantly, there is no significant decline in IMR in both Madhya Pradesh and Kerala between 2015 and 2020. Such decline is expected as India has still a long way to go if we view India's performance globally.