Infant Mortality Rate (IMR): Key Indicator of Child Health

When a country wants to know how healthy its people really are, one of the first numbers it looks at is how many of its babies survive their first year of life. This single statistic, the Infant Mortality Rate (IMR), quietly reveals a great deal about a nation’s healthcare system, nutrition standards, sanitation, and even the status of women. It is one of the most widely used indicators in population studies, and for good reason: a society that keeps its youngest members alive is usually doing many other things right too.

What is the Infant Mortality Rate? 🔗

The Infant Mortality Rate is defined as the number of deaths of children under one year of age per 1,000 live births in a given year. The World Health Organization explains it as the probability of a child born in a specific year dying before reaching the age of one, assuming the age-specific mortality rates of that period. Although it is called a “rate,” it is technically a probability, which is why demographers use it cautiously when making comparisons.

The formula is straightforward:

IMR = (Number of infant deaths under 1 year in a given year ÷ Number of live births in the same year) × 1,000

For example, if a state recorded 50,000 live births in a year and 1,250 of those babies died before turning one, the IMR would be 25 per 1,000 live births. This is roughly the situation India faces today.

Why this number matters so much 🔗

IMR is more than a count of deaths. It is what public health experts call a “sentinel indicator”, meaning it signals the condition of an entire system. A high IMR usually points to problems with maternal nutrition, antenatal care, hygiene during delivery, immunization coverage, access to clean water, and household income. A low IMR suggests these systems are functioning well. Research published in epidemiology journals confirms that IMR remains an important indicator of health for whole populations, reflecting how structural factors affecting entire societies impact infant survival.

Because babies are biologically the most vulnerable group, they are the first to suffer when public health falters and the first to benefit when it improves. That is why IMR is treated as a barometer of healthcare quality and overall development.

The current picture in India 🔗

India has made remarkable progress on this front. According to the Sample Registration System (SRS) by the Registrar General of India, India’s IMR in 2023 stood at 25 deaths per 1,000 live births, down from 110 in 1981. To put that in perspective, the IMR has fallen to roughly a quarter of what it was four decades ago. Yet the rural-urban gap remains significant, with rural areas reporting an IMR of 28 compared to 18 in urban areas.

The variation across states is even more striking. Kerala records an IMR of just 5, comparable to several high-income countries, while Uttar Pradesh, Madhya Pradesh, and Chhattisgarh report rates as high as 37. Uttar Pradesh, Bihar, and Madhya Pradesh together account for over half of all infant deaths in the country, with Uttar Pradesh alone responsible for nearly one in three. This regional disparity is one of the biggest challenges in population and family health studies today.

Neonatal and post-neonatal mortality 🔗

Not all infant deaths happen the same way or for the same reasons. To understand IMR better, demographers split it into two components based on age at death.

Neonatal mortality 🔗

The Neonatal Mortality Rate (NMR) covers deaths within the first 28 days of life. This is the most dangerous period for any human being. The daily risk of dying in the first four weeks of life is roughly 30 times higher than in the period from one month to 59 months of age. The causes are mostly biological and obstetric: premature birth, low birth weight, birth asphyxia, birth trauma, and infections like neonatal sepsis or pneumonia.

India’s NMR currently stands at around 19 per 1,000 live births. According to data shared by the Ministry of Health and Family Welfare, the Neonatal Mortality Rate declined from 26 per 1,000 live births in 2014 to 20 per 1,000 in 2020. The Sustainable Development Goal target is to bring this down to 12 per 1,000 by 2030.

A worrying trend is that even as overall infant deaths have fallen, the share of deaths happening in the neonatal period has grown. The earliest days of life have become disproportionately deadly relative to the rest of infancy, which means future progress on IMR depends almost entirely on improving newborn care.

Post-neonatal mortality 🔗

The Post-Neonatal Mortality Rate (PNMR) covers deaths between 28 days and one year of age. The causes here look very different. Instead of being driven mainly by birth complications, post-neonatal deaths are linked to environmental and nutritional factors: diarrhoeal diseases, pneumonia, malnutrition, and vaccine-preventable infections. Pneumonia and diarrhoeal diseases remain major causes of post-neonatal mortality, reflecting persistent gaps in water, sanitation, and hygiene.

This distinction matters because the interventions needed are different. Saving a newborn requires skilled birth attendants and well-equipped facilities. Saving a six-month-old usually requires clean water, breastfeeding support, immunization, and timely treatment of common illnesses. Programmes that lump these together often miss the mark on one side or the other.

Why some babies are at greater risk 🔗

Infant mortality is never spread evenly across a population. Several factors push the risk up:

Socio-economic conditions 🔗

Poverty is the single biggest predictor. Within urban areas, infant deaths are over three times more frequent in the poorest households than in the richest. Poor families often cannot afford nutritious food during pregnancy, transport to a hospital during labour, or follow-up care for a sick baby.

Maternal health and education 🔗

A mother’s age, nutrition, education, and access to antenatal care strongly shape her baby’s chances. Teenage pregnancies, anaemia, and undernutrition raise the odds of preterm birth and low birth weight. Educated mothers are more likely to seek institutional delivery, complete immunization schedules, and recognize danger signs early.

Sanitation and environment 🔗

Open defecation, contaminated water, indoor air pollution from biomass fuels, and crowded housing all elevate the risk of fatal infections in infants.

Gender 🔗

In several Indian states, female infants face higher mortality than males in the post-neonatal period, partly because of unequal feeding, delayed healthcare-seeking, and son preference. This is one of the few places in the world where the biological survival advantage of girls is reversed by social factors.

Strategies for reducing IMR 🔗

Bringing IMR down is not the work of a single policy. It requires a network of interventions that touch every stage from before pregnancy to early childhood.

Strengthening maternal healthcare 🔗

Healthy babies start with healthy mothers. India’s Janani Suraksha Yojana, a conditional cash transfer scheme launched in 2005, promotes institutional delivery, while Janani Shishu Suraksha Karyakram eliminates out-of-pocket expenses for pregnant women and sick infants. Regular antenatal check-ups, iron and folic acid supplementation, and tetanus immunization for mothers are all proven to reduce neonatal deaths.

Facility-based newborn care 🔗

Many neonatal deaths can be prevented with timely medical attention. The government has set up Sick Newborn Care Units at district hospitals and Newborn Stabilization Units at community health centres. Trained personnel, oxygen support, warmers, and basic resuscitation equipment can turn around outcomes for premature and asphyxiated babies.

Immunization 🔗

Vaccines are among the most cost-effective health interventions ever invented. India’s Universal Immunization Programme, supported by the newer U-WIN digital vaccination platform launched in October 2024, aims to ensure every child receives protection against diseases like measles, diphtheria, polio, and pneumonia. Coverage of pneumococcal and rotavirus vaccines has been particularly important for reducing post-neonatal deaths.

Breastfeeding and nutrition 🔗

Exclusive breastfeeding for the first six months protects babies from infections and provides the nutrition they need. The Mothers’ Absolute Affection (MAA) programme promotes early initiation and exclusive breastfeeding. Complementary feeding practices and micronutrient supplementation matter just as much in the second half of infancy.

Sanitation, water, and hygiene 🔗

The Swachh Bharat Mission, by accelerating toilet construction and reducing open defecation, has indirect but powerful effects on infant survival. Clean water under the Jal Jeevan Mission similarly cuts down diarrhoeal diseases. UNICEF emphasizes that newborn and child health depends on a continuum of interventions spanning pregnancy, delivery, and the early years.

Community-based care 🔗

Accredited Social Health Activists (ASHAs) play a critical role by visiting homes, identifying sick newborns, and counselling mothers. Home Based Newborn Care and Home Based Care of Young Children programmes extend this reach into rural areas where facility access is limited.

Limitations of IMR as a measure 🔗

Despite its usefulness, IMR is not a perfect indicator. The way countries define a “live birth” varies, which affects international comparisons. Very premature babies who survive briefly may be recorded as live births in one country and as stillbirths in another. Vital registration systems in many parts of India are still incomplete, so estimates depend heavily on sample surveys like the SRS and the National Family Health Survey. IMR also tells us nothing about deaths after the first year or about morbidity, which is why public health experts use it alongside indicators like Under-5 Mortality Rate, Maternal Mortality Ratio, and life expectancy.

What do you think? If India has cut its IMR by nearly 75% in four decades, what should be the next priority, closing the gap between states like Kerala and Uttar Pradesh, or pushing the national average closer to the levels seen in high-income countries? And do you think interventions targeting the first 28 days of life deserve more attention than the rest of infancy?

References

1. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/1
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC1732453/
3. https://www.dataforindia.com/infant-mortality/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC5144119/
5. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2112476&reg=3&lang=2
6. https://www.drishtiias.com/daily-updates/daily-news-analysis/un-igme-2025-report-on-child-mortality
7. https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=1796436
8. https://www.unicef.org/india/what-we-do/newborn-and-child-health