District-Level Estimates of Child Mortality in Uttar Pradesh, India.

The study examines district-wise variations in child mortality across Uttar Pradesh using the National Family Health Survey (NFHS)-5 dataset for Uttar Pradesh, by estimating the neonatal mortality rate (NMR), post-neonatal mortality rate (PNMR), child mortality rate (CMR), and under-five mortality rate (U5MR). Findings suggest that Uttar Pradesh continues to exhibit one of India's highest child mortality burdens, as the estimates are above the national average. Neonatal mortality, averaging about 36 deaths per 1,000 live births, remains the largest contributor to child deaths. Several central and western districts, such as Amethi, Mainpuri, and Shahjahanpur, record NMRs above 60, while some eastern districts like Ballia and Deoria have achieved rates below 12, nearing the 2030 Sustainable Development Goals (SDG). Post-neonatal mortality averages around 15 per 1,000, with high levels in Agra, Hardoi, and Kheri, indicating gaps in infant care and immunization coverage. In contrast, districts such as Kushinagar and Muzaffarnagar have PNMRs under 3, reflecting effective community-level health programs. Child mortality (ages 1-4) has declined significantly, with a state average near 10 per 1,000. Most districts report single-digit CMRs, but outliers like Fatehpur and Allahabad remain high, suggesting persistent issues related to nutrition and healthcare quality. The composite U5MR stands at nearly 60 deaths per 1,000 live births, still more than twice the SDG target. Extremes range from 111 in Amethi and 101 in Shahjahanpur to below 25 in Jaunpur, Muzaffarnagar, and Deoria. This divergence highlights both successful interventions and critical shortfalls within the state. The eight aspirational districts Bahraich, Balrampur, Chandauli, Chitrakoot, Fatehpur, Shravasti, Siddharthnagar, and Sonbhadra perform marginally better than the state average (U5MR 56.5 vs. 59.9), suggesting positive effects of targeted development initiatives. However, internal variation persists, with Siddharthnagar performing exceptionally well and Fatehpur lagging behind. Overall, Uttar Pradesh's child mortality has declined but remains uneven. Sustained improvements in neonatal care, maternal health, nutrition, and equitable healthcare delivery, especially in high-mortality districts, are crucial for meeting national and SDG by 2030.