By Dr. Gyan Pathak
Death of children below the age of five in India is still a serious problem. The national average of percentage of deaths in the age-group 0-4 years to total deaths in India was 8.2% in 2023. Worst scenario was observed in Uttar Pradesh, where it was as high as 14.7 per cent, followed by Madhya Pradesh 14.3 per cent, Rajasthan 12.8 per cent, Bihar 11.3 per cent, Chhattisgarh 10.9 per cent, Assam 10.4 per cent, and Jharkhand 10.4 per cent. Barring Jharkhand, all the BJP or NDA ruled states are worst contributors in child deaths. Among the states with lowest death rates among children as share of total deaths are Kerala 1.3 per cent, Himachal Pradesh 2.3 per cent, and Tamil Nadu 2.3 per cent, all are opposition ruled states. The highest child death sharing states has therefore something to learn from the lowest child death sharing states.
It has been revealed in the Census of India’s latest Sample Registration Survey Statistical Report of 2023. The share of child deaths in all deaths has also a pattern. Higher proportions of child deaths occurred in rural areas of the country (9.5%) compared to urban areas (5.3%), with only some exceptions like Delhi, Himachal Pradesh, Kerala and Tamil Nadu where the proportion is higher in urban areas. It also shows that the opposition ruled states performed better in healthcare in even rural areas.
While the total death rate for India was 6.7 in 2023, the male death rate was 6.7 and the female death rate was 6.6. The death rate in rural areas was however much higher at 7.5 than that of urban areas at 4.5. Among the bigger States/UTs, Uttar Pradesh and Madhya Pradesh had the highest total death rate for children below 5 years of age at 10.5, with the highest male death rate at 10.9 in U.P. and the highest female death rate at10.8 in M.P. Kerala had the lowest total death rate at 1.6, with the male death rate at 2.1 and the female death rate at 1.0.
The Under-Five Mortality Rates (U5MR) indicates the probability of a child dying before their fifth birthday, expressed as the number of deaths per 1,000 live births. For India as a whole, the U5MR was 29 in 2023, which means that out of every 1,000 live births, 29 children died before reaching the age of five. The U5MR is higher in rural areas (33) compared to urban areas (20). Among the bigger States/UTs, the U5MR ranges from 8 in Kerala to 44 in Madhya Pradesh for the year 2023. Kerala (8) had the lowest U5MR, followed by Tamil Nadu (13) and Jammu & Kashmir (15). Madhya Pradesh (44) had the highest U5MR, followed by Uttar Pradesh (42) and Chhattisgarh (41). The U5MR is generally higher in rural areas than in urban areas across most States/UTs, except in Delhi and Kerala, where it is observed to be lower in rural areas.
The overall crude death rate (CDR) for India in 2023 was 6.4, with a higher CDR of 6.8 in rural areas and a lower CDR of 5.7 in urban areas. Among the bigger States/UTs, Chhattisgarh had the highest CDR of 8.3, while Delhi had the lowest CDR of 4.5. Among the smaller States, Manipur had the lowest CDR of 4.5 and Goa had the highest CDR of 6.8. Among the smaller UTs, Puducherry had the highest CDR of 6.4, while Chandigarh had the lowest CDR of 4.0.
Overall, there was a decrease in the Crude Death Rate in India from 7.0% in 2011-13 to 6.9% in 2021-23, representing a decline by 1.4%. The rural Crude Death Rate also decreased from 7.6% to 7.3%, a percentage change of -3.9%, while the urban Crude Death Rate increased from 5.6% to 6.1%, a percentage change of 8.9%. Among the bigger States and Union Territories, there was a significant decrease in the Crude Death Rate for Assam (-19.0%), Uttar Pradesh (-13.0%) and Jharkhand (-10.1%), while the highest increase in the Crude Death Rate was for Punjab (20.9%) followed by Haryana (17.2%), Chhattisgarh (15.2%) and Delhi (14.3%). Other States and Union Territories showed more modest changes in the Crude Death Rate over the period.
It is observed that female death rate is lower than male death rate both in rural and urban areas. While the total CDR in India in 2023was 6.4 per 1,000 population. The CDR for males (7.2 per 1,000 population) was higher than that for females (5.7 per 1,000 population). The CDR was also higher for rural areas compared to urban areas. Chart 80 represents the Crude Death Rate by sex and residence for India.
Among the bigger States/UTs in India, the highest CDR was recorded in Chhattisgarh (8.3) and the lowest rate in Delhi (4.5). The Crude Death Rate for males is generally higher than that for females across all States and Union Territories presented. For Males, the highest death rate was recorded in Chhattisgarh (9.5) and the lowest in Delhi (5.0).For females, the death rate was highest in Odisha and Chhattisgarh (7.1) and lowest in Delhi (4.0) in 2023. Chart 81 shows Crude Death Rate by sex for India and bigger States/UTs.
The data reveals that a significant proportion of deaths in India and most of the bigger States/UTs occurred among people aged 60years and above, with the highest proportion recorded in Kerala (78.5%) followed by Himachal Pradesh (76.2), Maharashtra (68.8%), and Delhi (67.5%). In the other age groups, the ‘<1 year’ age-group had the highest proportion of deaths in Uttar Pradesh (13.3%) and Madhya Pradesh (12.3%). The 5-14 year age-group had the highest proportion of deaths in Chhattisgarh (2.4%).
The data shows that in India, 7.3% of deaths were in the ‘less than 1 year’ age-group while 8.4% of rural deaths and 4.6% urban deaths are of Infants. The percentage vary across different States/UTs, with higher percentage of infant deaths in rural areas compared to urban areas in most cases except Delhi and Himachal Pradesh. The percentage of infant deaths varies across different States/UTs, with some States having much higher rates of Infant Mortality than others. For example, Uttar Pradesh has the highest percentage of infant deaths (13.3%) while Kerala has the lowest (0.9%). The higher percentage of infant deaths in rural areas compared to urban areas is consistent across most States/UTs.
Infant Mortality Rate (IMR) varies across different States/UTs in India, ranging from 3 in Manipur to 37 in Chhattisgarh, Madhya Pradesh and Uttar Pradesh. In most cases, the IMR is higher in rural areas compared to urban areas. Assam had the highest difference in IMR between rural (32) and urban areas (15). There was also the discernible difference in the IMR between Males and Females in some of the States/UTs. Kerala had the highest difference in IMR between males and females, with a rate of 09 for males and 02 for females. A & N Islands, DNH and D&D and Lakshadweep had the highest IMR among the smaller UTs with a rate of 09, and Meghalaya had the highest IMR among the smaller States with a rate of 34.
Overall Infant Mortality Rate in India has decreased by 37.8% from 42.3 in 2011-13 to 26.3 in 2021-23. The rural Infant Mortality Rate has decreased by 36.3%, while the urban Infant Mortality Rate has decreased by 36.0%. Among the bigger States/UTs, the highest decline in percentage change for Infant Mortality Rate was observed in Jammu & Kashmir, which is 63.0%. Chhattisgarh had the lowest decline in the percentage for Infant Mortality Rate which is 19.8%. Madhya Pradesh had the highest Infant Mortality Rate in both periods and has shown a decrease of 30.3%.
India’s overall Neo-Natal Mortality Rate was 19 deaths per 1,000 live births in 2023, with a higher rate in rural areas (21 deaths per 1,000 live births) than in urban areas (13 deaths per 1,000 live births). The percentage of Neo-Natal deaths to infant deaths was 73.2%indicating that a significant proportion of infant deaths occurred within the first 28 days of life. Among the bigger States/UTs, Kerala had the lowest Neo-Natal Mortality Rate of 4 deaths per 1,000 live births, while Madhya Pradesh had the highest rate of 27 deaths per 1,000 live births. Andhra Pradesh had the highest percentage of Neo-Natal deaths to infant deaths at 83.7%.Delhihad the lowest percentage of Neo-Natal Deaths to Infant Deaths at 63.1%.
The Total Peri-Natal Mortality Rate in India was 21 in 2023, with a Still Birth Rate of 7. In terms of residence, the rural Peri-Natal Mortality Rate was higher than the urban rate, with a difference of 8. The state of Odisha had the highest Peri-Natal Mortality Rate of 32, and the highest Still-Birth Rate of 16. On the other hand, Andhra Pradesh had the lowest still birth rate of 2 and Kerala had the lowest Peri-Natal Mortality Rate of 9.
The probability of survival to Age 5 in the year 2023 was estimated at 0.971 for the country as a whole, 0.970 for males, and 0.971 for females. The Probability of Survival to Age 5 was estimated as 0.967 for rural areas and 0.980 for Urban Areas during 2023. The probability of Survival to Age-5 varies from 0.956 in Madhya Pradesh to 0.992 in Kerala. (IPA Service)
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