Association of parental death and separation with child mortality in India.

Parental death and separation in early life can have profound effects on child health, increasing the risk of mortality. Using data from the fifth round of the National Family Health Survey (2019-21), this study examined the association of parental death and separation on mortality among children aged 0-59 months in India. A total of 232,577 children were included in the analysis, with infant and under-five mortality rates estimated using the life table technique. Cox proportional hazards models with 95% confidence intervals were applied to assess the effect of parental death and separation on all-cause mortality. Results showed that child mortality was significantly associated with both parental death and parental separation. Male children experienced higher mortality rates than female children when either parent had died (IMR/U5MR: 39 and 65 vs. 26 and 29 per thousand, respectively). Children whose parents had died showed higher hazards of infant and under-five mortality, although these associations were not statistically significant after adjustment (HR = 1.45, 95% CI: 0.96-2.19, p = 0.08; HR = 1.63, 95% CI: 1.01-2.63, p = 0.04). In contrast, children residing in rural areas had significantly higher hazards of infant mortality (HR = 1.37, 95% CI: 1.22-1.53, p < 0.01) and under-five mortality (HR = 1.38, 95% CI: 1.25-1.52, p < 0.01). Among children of higher educated parents, those from wealthier households showed significantly lower mortality risks compared with children of separated parents. The findings indicate that parental death and separation have substantial adverse effects on child survival, underscoring the need for strengthened healthcare access, targeted public health interventions, and policies that support vulnerable families to reduce child mortality in India.