Reducing infant and child mortality: assessing the social inclusiveness of child health care policies and programmes in three states of India.

backgroundEven though the overall infant mortality rate and child mortality rate have considerably declined in India, the marginalised groups-Scheduled Caste, and Scheduled Tribe, continue to have higher mortality rates. This study looks at the changes in IMR and CMR amongst disadvantaged and advanced social groups at the national level and in three states of India. DATA AND

methodsData from five rounds of National Family Health Survey spanning nearly three decades have been used to measure IMR and CMR according to the social groups for India and for selected states-Bihar, West Bengal, and Tamil Nadu. The relative hazard curves were drawn to understand which social group's children face a higher risk of dying in the first year of birth and between first year and age four in those three states. Further, a log-rank test was applied to examine whether the differences between the survival curves or distributions of the three social groups are statistically significant. Finally, the binary logit regression model was applied to investigate the effect of ethnicity, and other socio-economic and demographic covariates on the risk of infant and child deaths (1-4 years) in the country and in selected states.

resultsHazard curve shows the probability of death within one year of birth was highest among the children belonging to the ST families, followed by SCs in India. And, the CMR was found to be higher amongst the STs compared to all other social groups as well at the national level. While Bihar had a remarkably high infant and child mortality rates, Tamil Nadu possessed the lowest child death rates irrespective of class, caste, and religion. The regression model revealed that most of the caste/tribe gaps in infant and child deaths might be attributed to the place of residence, mother's level of education, economic status, and the number of children in a family. Notably, the multivariate analysis showed that ethnicity was an independent risk factor, when controlled for socioeconomic status.

conclusionThe study detects the persistence of significant caste/tribe differentials in infant and child mortality in India. Poverty, education and health care access issues could be the possible reasons for the premature deaths of the children from deprived castes and tribes. There is a need to critically analyse the current health programmes aimed at reducing IMR and CMR to make them attuned to the needs of the marginalised communities.