Trends and sub-national disparities in neonatal mortality in India from 1981 to 2011

Nandita Saikia, Jawaharlal Nehru University
Vladimir M. Shkolnikov, Max-Planck Institute for Demographic Research and New Economic School, Russia

Despite progress made in recent decades, infant and neonatal mortality rates (NMRs) in India have remained high compared with neighboring developing countries. The tempo and quantum of reductions in neonatal mortality have been inconsistent across time, states, and urban and rural subpopulations. Decompositions have shown that the total NMR decrease in India since the early 1980s has been largely driven by mortality changes in poorer states and rural areas, whereas compositional changes had negligible impact. The amount of disparity in NMRs across the sub-populations, which had been declining beforehand, had stabilized in the 2000s when many states and especially their urban areas experienced difficulties. These disparities produce a heavy burden of avoidable death. While the mortality excess in poorer states and rural areas constitutes the core of the overall death toll, some richer states, and urban areas, show unexpectedly slow mortality decreases. Contrary to this, the experience of the two Vanguard states of Kerala and Tamil Nadu highlights a great potential for progress in low-income settings with sensible health and social policies. Key Words: Neonatal, Mortality, India, Disparity, Sample Registration System