Disparities in child mortality trends: what is the evidence from disadvantaged states in India? the case of Orissa and Madhya Pradesh

Abstract

IntroductionThe Millennium Development Goals prompted renewed international efforts to reduce under-five mortality and measure national progress. However, scant evidence exists about the distribution of child mortality at low sub-national levels, which in diverse and decentralized countries like India are required to inform policy-making. This study estimates changes in child mortality across a range of markers of inequalities in Orissa and Madhya Pradesh, two of India’s largest, poorest, and most disadvantaged states.MethodsEstimates of under-five and neonatal mortality rates were computed using seven datasets from three available sources – sample registration system, summary birth histories in surveys, and complete birth histories. Inequalities were gauged by comparison of mortality rates within four sub-state populations defined by the following characteristics: rural–urban location, ethnicity, wealth, and district.ResultsTrend estimates suggest that progress has been made in mortality rates at the state levels. However, reduction rates have been modest, particularly for neonatal mortality. Different mortality rates are observed across all the equity markers, although there is a pattern of convergence between rural and urban areas, largely due to inadequate progress in urban settings. Inter-district disparities and differences between socioeconomic groups are also evident.ConclusionsAlthough child mortality rates continue to decline at the national level, our evidence shows that considerable disparities persist. While progress in reducing under-five and neonatal mortality rates in urban areas appears to be levelling off, polices targeting rural populations and scheduled caste and tribe groups appear to have achieved some success in reducing mortality differentials. The results of this study thus add weight to recent government initiatives targeting these groups. Equitable progress, particularly for neonatal mortality, requires continuing efforts to strengthen health systems and overcome barriers to identify and reach vulnerable groups.

The persistent caste divide in India’s infant mortality: A study of Dalits (ex-untouchables), Adivasis (indigenous peoples), Other Backward Classes, and forward castes

“…Consistent with previous research (Dommaraju et al 2008;June et al 2011;Mohindra et al 2006;Nguyen et al 2013;Singh et al 2013;Singh-Manoux et al 2008;Subramanian et al 2006aSubramanian et al , 2006b, we find that despite large improvements in health conditions and reductions in mortality in India in recent years, children from lower castes continue to experience higher mortality than those from forward castes. Estimates obtained from the Cox Proportional Hazards Model show that in NFHS-2, with mother's age and child's sex controlled, OBC, Dalit, and Adivasi children are 23, 32, and 27 per cent more likely, respectively, than forward-caste children to die in the first year of life.…”

“…These surveys have also allowed researchers to carry out micro-level multivariate analyses, with the aim of disentangling the effects of caste and socioeconomic background on mortality (Das et al 2010;Dommaraju et al 2008;June et al 2011;Mohindra et al 2006;Nguyen et al 2013;Singh-Manoux et al 2008;Subramanian et al 2006aSubramanian et al , 2006b). These studies typically use logit models, with infant and child mortality as the outcome variable, caste as the primary independent variable, and various parental characteristics as control variables.…”

“…By analyzing rural mortality, Das et al (2010) reinforce the findings of earlier studies and show that Adivasi children are less likely than Dalit children to die during infancy, but more likely to die during early childhood, particularly by the time they are five years old. Nguyen et al (2013) focus on just two states, Odisha and Madhya Pradesh. By using a number of data sets, they find that in Madhya Pradesh the under-age 5 mortality among Dalits and Adivasis has fallen at a faster pace compared with that among the other caste groups, whereas in Odisha the converse is true.…”

Trends and factors associated with dengue mortality and fatality in Brazil

“…Better socioeconomic and health conditions have been recognized as protective factors against death, particularly from infectious diseases (18) (19) (20) . Only the number of primary health care units was associated with lower case fatality rates, which suggests that access to primary care health professionals may reduce the DHF case fatality rate.…”

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

“…A growing literature has emerged to study the trends of child mortality, and its determinants, in a wide range of countries (see for instance: Dallolio et al, 2012;Feng, et al, 2012;Amouzou et al, 2012;Nattey et al, 2013;Nguyen et al, 2013). For example, Nguyen et al (2013) estimated the change in child mortality rates in two of India's largest and poorest states over the period 1990-2007 found that although there was a decline in child mortality rates at the national level, there were considerable disparities across socio-economic groups, ethnicities, districts, and wealth. In a cross sectional study, Nattey et al (2013) investigated the relationship between household socio-economic status and under-5 mortality, and examined the risk factors associated with under-five mortality in Tanzania.…”