(P07-038-25) Regional Disparities in Child Mortality: Insights From NFHS-4 and NFHS-5 Data

Objectives: The Infant Mortality Rate (IMR) and Under-Five Mortality Rate (U5MR) are critical indicators of population health and development. While India has achieved a notable reduction in child mortality rates; considerable progress remains to be made and regional variations addressed. We analyses the spatial patterns of child mortality by 88 geophysical regions to get a more nuanced understanding of child mortality patterns and drivers. The analysis reveals striking patterns of regional contiguities that cut across the politico-administrative boundaries of the states, and sharp differences among the regions within, highlighting the need for a more decentralized approach.

Methods: The study examines the spatio-temporal effects of development indicators on U5MR and IMR across 88 NSSO-defined natural regions of India using NFHS-4 and NFHS-5 dataset and uses geo-spatial techniques such as Moran’s-I, univariate and bivariate LISA, Ordinary Least Squares, Spatial Lag Model, and Spatial Error Model (SEM).

Results: The SEM performed the best for U5MR and IMR across NFHS-4 and NFHS-5 data having higher R-squared values and lower AIC value. It shows a strong association of maternal education and antenatal care in reducing child mortality and the growing challenge of undernutrition. The persistence of significant spatial error coefficients across both rounds highlights the importance of addressing regional disparities. 12 regions had already achieved the SDG target of U5MR of 25 or less in NFHS-4, this number has gone up to 22 in NFHS-5. This calls for a closer look at the lagging regions in the leading states and the leading regions in lagging states for more nuanced planning. The hotspots and cold spots have remained largely unchanged for both IMR and U5MR across NFHS-4 and NFHS-5 indicating the slow nature of change of behavior in community health practices.

Conclusions: Policies should prioritize geographically tailored interventions, such as enhancing healthcare infrastructure, implementing nutritional support programs, and promoting community-level initiatives in high-mortality clusters. Spatially informed policymaking is crucial for addressing spatial heterogeneity and achieving sustained improvements in child survival across India.

Funding Sources: None