Abstract
The study analyzes the spatial clustering and risk factors of infant mortality across high-focus states of India, using the Annual Health Survey (2010–2011), Census of India (2011), and District Level Household and Facility Survey-3 (2007–2008). Research has found substantial spatial autocorrelation across the districts and identified the “hot spots” characterized by higher infant mortality rate (IMR) in the districts of the central region (Uttar Pradesh and Madhya Pradesh) of India. This study has considered several theoretical perspectives and implements a series of spatial regression models that allows accounting for household amenities and mother/child and health facility variables to determine the key risk factors of infant mortality. Our empirical analysis underscores the importance of the infrastructure of the health facility in improving the infant mortality scenario of the districts. The regression results show that the districts with a higher proportion of 24-h functioning primary healthcare centers have overall less infant mortality. In addition, the absence of drinking water from a treated source, unavailability of toilet facilities, and higher proportion of people in the bottom wealth quintile in the household were adversely associated with the IMR. In conclusion, reduction of infant mortality would be possible only if area-specific measures would be adopted on those clusters of districts where infant mortality is high irrespective of the state they belong to.
Highlights
Infant and child survival depend on a host of socioeconomic, environmental, and contextual factors
In the context of intra-district variation in infant mortality, the main questions that emerge are as follows: Where are the “hot spots” of infant mortality in the highfocus states? Whether maternal- and child-level factors at the aggregated level are enough to explain regional disparity in infant mortality rate (IMR)? Would district-level contextual factors be more appropriate for programmatic intervention? Could emphasis on health infrastructure in primary healthcare centers further improve infant survival? The objective of this paper is to address some of these questions by investigating the determinants of IMR in the high-focus states of India
Our analysis indicated that the district with a higher proportion of kachha houses and unavailability of toilet facilities has a higher IMR level, while the availability of treated water in the household was found to be negatively associated with the IMR
Summary
Infant and child survival depend on a host of socioeconomic, environmental, and contextual factors. Determining the contribution of each of these factors provides useful feedback to the programs related to maternal and child health. The distribution of infant and child mortality and their determinants vary across genders, socioeconomic groups, and geographical regions. Mapping of the variation in infant mortality can help in improving programs in terms of the allocation of limited resources to those regions with high unmet needs of healthcare. It is widely accepted that infant mortality is an indicator of both economic and social wellbeing and represents multiple social determinants of health (Rodwin and Neuberg, 2005). Infant mortality is declining worldwide, the pace of decline has been rather slow in India. Reduction in infant mortality is the major focus of India’s maternal and child
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