Trends in socioeconomic inequality in mortality during childhood between 1993 and 2021 in India

Abstract

Introduction: In India, most child deaths now occur within the first 28 days of birth. Trends in socioeconomic disparities in death during these early and late neonatal stages over the past few decades have been understudied. This paper elucidates these trends in early neonatal and late neonatal mortality by household wealth and maternal education. We also examined these trends for post neonatal and child mortality, thereby examining the risk of death by socioeconomic status from birth until 59 months.

Methods: Using data from five rounds of India's National Family Health Survey, we examined how the early neonatal, late neonatal, post neonatal and child mortality rates changed between 1993 and 2021 by household wealth and maternal education. We also examined how the absolute (difference in rates) and relative (ratio of rates) inequality between the highest and lowest socioeconomic groups changed for each outcome, and which children are on track to meet the Sustainable Development Goal targets.

Results: Despite large absolute reductions in early neonatal, late neonatal, post neonatal and child mortality, India's most vulnerable children remain at the highest risk of death as of 2021. Between 1993 and 2021, the absolute and relative socioeconomic inequality for early neonatal deaths increased. Now, most child deaths are among India's most vulnerable children in terms of household wealth and maternal education, and these children are not on track to meet the Sustainable Development Goal targets for early neonatal and post neonatal mortality.

Conclusions: Our study highlights persistent socioeconomic inequalities in child death, and that these inequalities exist regardless of mortality stage. More pro poor policies and interventions are required to close these gaps. Doing so is essential for India to meet global targets.

Keywords: Child health; Cross-sectional survey; Epidemiology; Health policy; India.

Figure 1. Deaths per 1000 live births by highest and lowest household wealth quintile in 1993 and 2021. (A) Early neonatal (0–7 days), (B) late neonatal (8–28 days), (C) post neonatal (1–11 months) and (D) child (12–59 months).

Figure 2. Deaths per 1000 live births by maternal education in 1993 and 2021. (A) Early neonatal (0–7 days), (B) late neonatal (8–28 days), (C) post neonatal (1–11 months) and (D) child (12–59 months).

Figure 3. Share of deaths by household wealth quintile and maternal education for the early neonatal, late neonatal, post neonatal and child mortality periods in 1993 and 2021. Note: Lowest, low, middle, high and highest refer to wealth quintiles. For education, these refer to (a) no schooling, (b) 1st–5th grade, (c) 6th–8th grade, (d) 9th–12th grade and (e) above 12th grade. CMR, child mortality rate; ENMR, early neonatal mortality rate; LNMR, late neonatal mortality rate; PNMR, post neonatal mortality rate.