Abstract
IntroductionThe Millennium Development Goals prompted renewed international efforts to reduce under-five mortality and measure national progress. However, scant evidence exists about the distribution of child mortality at low sub-national levels, which in diverse and decentralized countries like India are required to inform policy-making. This study estimates changes in child mortality across a range of markers of inequalities in Orissa and Madhya Pradesh, two of India’s largest, poorest, and most disadvantaged states.MethodsEstimates of under-five and neonatal mortality rates were computed using seven datasets from three available sources – sample registration system, summary birth histories in surveys, and complete birth histories. Inequalities were gauged by comparison of mortality rates within four sub-state populations defined by the following characteristics: rural–urban location, ethnicity, wealth, and district.ResultsTrend estimates suggest that progress has been made in mortality rates at the state levels. However, reduction rates have been modest, particularly for neonatal mortality. Different mortality rates are observed across all the equity markers, although there is a pattern of convergence between rural and urban areas, largely due to inadequate progress in urban settings. Inter-district disparities and differences between socioeconomic groups are also evident.ConclusionsAlthough child mortality rates continue to decline at the national level, our evidence shows that considerable disparities persist. While progress in reducing under-five and neonatal mortality rates in urban areas appears to be levelling off, polices targeting rural populations and scheduled caste and tribe groups appear to have achieved some success in reducing mortality differentials. The results of this study thus add weight to recent government initiatives targeting these groups. Equitable progress, particularly for neonatal mortality, requires continuing efforts to strengthen health systems and overcome barriers to identify and reach vulnerable groups.
Highlights
The Millennium Development Goals prompted renewed international efforts to reduce under-five mortality and measure national progress
The state-level results, reported in Figure 1, demonstrate that there has been a reduction in the U5MR in both Madhya Pradesh (MP) and Orissa from 156 deaths per 1,000 live births in 1990 to 95
In Orissa, the impact of current programs aimed at reducing high under-five mortality amongst scheduled castes and tribes is obvious, but the analysis shows that other groups are being left behind
Summary
The Millennium Development Goals prompted renewed international efforts to reduce under-five mortality and measure national progress. Amongst India’s twenty-eight states, Orissa and Madhya Pradesh (MP) rank within the top three highest states in terms of under-five mortality rates [13], with levels similar to Zimbabwe and Kenya [14] These rates have remained persistently high over the last decade [15]. Both states have weak infrastructure compared to other states, low socio-economic status, and high levels of fertility They have been included along with six other states – Bihar, Chhattisgarh, Jharkhand, Rajasthan, Uttarakhand, and Uttar Pradesh – in the Empowered Action Group (EAG) requiring high focus by the Government of India, and are two of eighteen states targeted under the Indian Government’s flagship program for health sector reform, the National Rural Health Mission (NRHM). With a collective population of over 114 million, the two states provide fertile ground to assess the degree of health disparities across sub-populations defined by wealth and non-wealth equity markers
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