India’s Infant Mortality Rate Hits Historic Low of 25, but Neonatal Deaths Persist

India’s infant mortality rate (IMR) has reached a historic low of 25 deaths per 1,000 live births, according to the 2023 Sample Registration System (SRS) data from the Registrar General of India. This marks a steep fall from 40 in 2013 and represents an 80% decline since 1971, when IMR stood at 129.

Causes Behind Infant Mortality

Despite the progress, experts warn that neonatal deaths—those occurring in the first 28 days of life—still account for nearly 70% of infant deaths in India. A study in The Lancet Global Health found that prematurity, low birth weight, neonatal infections, and birth asphyxia together were responsible for nearly 78% of neonatal deaths. ¹

Another paper in the Indian Journal of Pediatrics emphasised that interventions such as Kangaroo Mother Care (KMC), neonatal resuscitation training, and exclusive breastfeeding can substantially improve survival rates. ²

Regional Disparities

The national average conceals wide differences between states. Manipur and Mizoram recorded IMRs as low as 3, while Kerala reported an IMR of 5, supported by strong primary health systems and near-universal institutional deliveries. In contrast, Madhya Pradesh, Uttar Pradesh, and Chhattisgarh continue to report IMRs above 35, among the highest in the country. Research in BMC Public Health noted that such disparities are linked to maternal education, access to skilled healthcare, and nutrition levels. ³

Health System Improvements

The fall in IMR is partly credited to public health programs under the National Health Mission, which expanded maternal and child health coverage. Initiatives such as Janani Suraksha Yojana encouraged institutional deliveries, while Poshan Abhiyaan targeted malnutrition in women and children. Studies in BMJ Global Health have shown that scaling up antenatal care and skilled birth attendance directly correlates with reductions in neonatal mortality. ⁴

Progress Ahead

India has committed to achieving the Sustainable Development Goal (SDG) 3.2, which calls for an under-five mortality rate of 25 or fewer deaths per 1,000 live births by 2030.

While India has already achieved this target at the national level, the persistence of high neonatal deaths and state-level inequalities means further investment in NICU access, maternal nutrition, and early neonatal care will be critical.

UNICEF, in a statement on child survival in India, emphasised its continuing role. “At UNICEF, we are a proud and long-standing partner in this important journey. Together, we remain steadfast in our shared commitment: to support every child’s chance to survive and thrive, every mother’s access to quality care, and leaving no community behind,” the organisation said. ⁶

References:

1.Liu, Li, et al. “Global, Regional, and National Causes of Under-5 Mortality in 2000–15: An Updated Systematic Analysis with Implications for the Sustainable Development Goals.” The Lancet Global Health 4, no. 9 (2016) https://pubmed.ncbi.nlm.nih.gov/27839855/

2. Sankar, M. J., et al. “State of Newborn Health in India.” Indian Journal of Pediatrics 87 (2020): 619–628. https://pubmed.ncbi.nlm.nih.gov/27924104/.

3. Singh, P. K., et al. “Regional Inequalities in Neonatal and Child Mortality in India: A Decomposition Analysis.” BMC Public Health 21 (2021): 1282. journals.plos.org/plosone/article?id=10.1371/journal.pone.0026856

4. Bhutta, Zulfiqar A., et al. “Interventions to Improve Maternal, Newborn, and Child Health in South Asia: Evidence, Program Experience, and Research Priorities."Pubmed:National library of medicine, https://pubmed.ncbi.nlm.nih.gov/27839855/

5. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & Trends in Child Mortality: Report 2023. New York: UNICEF, 2023. https://childmortality.org.

6. UNICEF. “UN Report Highlights Great Strides in India on Under-Five Child Survival.” UNICEF India, September 19, 2022. https://www.unicef.org/india/press-releases/un-report-highlights-great-strides-india-under-five-child-survival.

(Rh/Eth/ARC/MSM)