Demonetisation may have reversed gains made to check the infant mortality rate (IMR), according to a new study that cites government data to show that the decline in the IMR stagnated in some States and slowed down in others in 2017 and 2018 for the first time since 2005.
The IMR, or the probability of dying between birth and age 1 per 1,000 live births, is considered to be the “litmus test” for assessing availability, accessibility and affordability of public health services, explains Dr. Amir Maroof Khan, Associate Professor at the University College of Medical Sciences and Guru Teg Bahadur Hospital.
“Children, unlike adults, don’t have the capability to endure health problems or various socio-economic factors that influence their health. Therefore, WHO and governments around the world accept the IMR as the most important indicator. This also explains why the biggest chunk of India’s health expenditure is dedicated to child and maternal health whether it is through Anaemia Mukt Bharat, Poshan Abhiyaan, Angwandwadi services or immunisation programmes,” he says.
The study titled “Pauses and reversals of infant mortality decline in India in 2017 and 2018,” is authored by Jean Dreze, Ashish Gupta, et al, and is a working paper that is yet to be published. It shows that according to the Sample Registration System (SRS) data, the decline in the IMR stagnated in 2017 and 2018 in some States, slowed down or reversed in some others.
Annual estimates of the infant mortality from the SRS are representative at the national level and for the larger States.
“Infant mortality faltered in eight of 20 States in 2017 for which data is recorded under SRS. In 2018, it faltered in six States, including four [Chhattisgarh, Jharkhand, Madhya Pradesh and Uttar Pradesh] where the IMR increased. In Chhattisgarh, Jharkhand and Madhya Pradesh, the IMR was higher in 2018 than two years earlier, and in Uttar Pradesh it was the same,” the research paper highlights.
The stagnation of the decline of the infant mortality in either 2017 or 2018 was more common in urban areas (15 of 20 States) than rural areas (9 of 20 States). The former account for 78.5% of India’s urban population and the later account for 49.5% of rural population, respectively. The States where the overall IMR faltered in 2017 or 2018 constitute 56.4% of the population, the study adds.
The authors say demonetisation is “one plausible hypothesis” for the blow to the infant mortality rate. Demonetisation or the nationwide ban on all currency notes of ₹500 and ₹1,000 was announced on November 8, 2016.
Co-author Aashish Gupta explains why rural areas took longer to feel the impact on the IMR. “The rural economy is less dependent on cash, and programmes to improve access to clean fuels and toilets were primarily directed at rural areas. It is likely that without these programmes, the IMR increases would have been higher.”
As many as 129 of every 1,000 infants died before reaching their first birthday in 1971, when the Sample Registration System (SRS) started monitoring mortality. By 2011, it had declined to a fourth and reached 44 deaths per 1,000 live births though there were periods of stagnation and pauses in between. But, since 2005, the IMR has seen a uniform decline in rural and urban areas, “year after year, until 2016,” says the study.
According to the National Family Health Survey-4, 2015-2016, the rate was 41 deaths for every 1,000 infants born. The Union Health Minister told Parliament that India aims to reduce this further to 23 per 1,000 live births by 2025. However, COVID-19 and its impact on hunger, poverty and delivery of health services is likely to delay these plans. UNICEF forecasts that COVID-19 will lead to additional 6.7 million wasted children. As wasting is a predictor of child mortality, UNICEF estimates that there will be additional 10,000 child deaths per month globally.