Abstract
National Rural Health Mission (NRHM) - India was launched in 2005 to tackle urban-rural health inequalities, especially in maternal and child health. We examined national and state level trends in Infant Mortality Rates (IMR) from 2000 through 2009 to: 1) assess whether the NRHM had increased the average annual reduction rate (AARR) of IMR 2) evaluate state-wise progress towards Millennium Development Goals (MDG4) and estimate required AARRs for 'off track' states. Log-linear regression models were applied to national and state IMR data collated from the Sample Registration System (SRS)-India to estimate average annual reduction rates and compare AAARs before and after introduction of NRHM. The log-linear trend of infant mortality rates was also projected forward to 2015. The infant mortality rate in rural India declined from 74 to 55/1000 live births between 2000 and 2009, with AARR of 3.0% (95% CI=2.6%-3.4%) and the urban-rural gap in infant mortality narrowed (p =0.036). However there was no evidence (p=0.49) that AARR in rural India increased post NRHM (3.4%, 95% CI 2.0-4.7%) compared to pre NRHM (2.8%, 95% CI 2.1%-3.5%). States varied widely in rates of infant mortality reduction. Projections of infant mortality rates suggested that only eight states might be on track to help India achieve MDG4 by 2015. Despite a narrowing urban-rural gap and high AARRs in some states, there was no evidence that the rate of reduction in infant mortality has increased in rural India post NRHM introduction. India appears unlikely to achieve child survival-related NRHM and millennium development goals. Government should revisit the child survival related NRHM strategies and ensure equitable access to health services. More robust monitoring and evaluation mechanisms must be inbuilt for following years.
Highlights
India’s under-five mortality rate (U5MR) has declined by 32%; from 116 in 1990 to 66 per 1000 live births in 2009, placing it 48th globally[1]
The total infant mortality rate (IMR) in India decreased from 68 to 50 per 1000 live births between 2000 and 2009, with an annual reduction rates (AARRs) of 3.1%
The IMR declined with an AARR of 3.0% during pre-National Rural Health Mission (NRHM) era and 3.3% in the post-NRHM era
Summary
India’s under-five mortality rate (U5MR) has declined by 32%; from 116 in 1990 to 66 per 1000 live births in 2009, placing it 48th globally[1]. India’s progress has huge strategic importance in the global quest for Millennium Development Goals (MDG4). This largely depends on tackling infant mortality (forming >70% of all under five deaths[5,6,7]) in rural areas where >70% population lives and where the infant mortality rate (IMR) historically has stayed twice as high as urban areas (Figure 1). Rural areas, after the launch of NRHM and 3) to assess whether India and its states are likely to achieve the NRHM goal (national IMR of 30/1000 live births by 2012) or MDG4 (2/3rd reduction in baseline U5MR of 1990, by 2015). Since there is insufficient state-level U5MR information, we used IMR as an indicator
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