Reducing infant (0–11 months) and child (0–4 years) mortality in India: a disposition from the Sample Registration System



Despite major advances in maternal and child health care initiatives in India, the Millennium Development Goal (MDG)-4 targeting a two-third reduction in under-five mortality appears to be unattainable by 2015. This paper assesses India’s feasibility towards averting infant (0–11 months) and child (0–4 years) mortality by 2015 across regions and major states.

Subjects and methods

Using statewise estimates on infant mortality rate (IMR) during 1990–2009 and child mortality rate (CMR) during 1990–2008 from the Sample Registration System of India, this paper estimates average annual rate of reduction (AARR) in IMR and CMR across regions and major states. The estimates are also provided for the shortfall in IMR and CMR from the projected estimates of 2015 and the required AARR for the successive years up to 2015.


Estimated figures suggest that India has experienced a substantial decline in the IMR and CMR since 1990. However, an AARR of around 10 and 8 % is required for reducing infant (during 2010–2015) and child mortality (during 2009–2015), respectively, in order to achieve a two-third reduction in the IMR and CMR from the level of 1990.


Although the MDG-4 target is based on U5MR in totality, this study draws attention towards the progress in major components of the U5MR separately, and advocates for disaggregation of MDG target at national level in terms of focus (region-specific) towards achieving required reduction in separate components of under-five mortality.

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  1. Basu AM, Stephenson R (2005) Low levels of maternal education and the proximate determinants of childhood mortality: a little learning is not a dangerous thing. Soc Sci Med 60:2011–2023

    PubMed  Article  Google Scholar 

  2. Bhat PNM, Preston SH, Dyson T (1984) Vital rates in India 1961–1981. National Academy Press, Washington DC

    Google Scholar 

  3. Cates W Jr, Abdool Karim Q, El-Sadr W, Haffner DW, Kalema-Zikusoka G, Rogo K, Petruney T, Averill EM (2010) Family planning and the millennium development goals. Science 329:1603

    PubMed  Article  CAS  Google Scholar 

  4. Government of India (2011) High level expert group report on universal health coverage for India. Planning Commission, New Delhi, India

  5. Registrar General Census Commissioner (1993) Sample registration system: fertility and mortality indicators 1991. Registrar General of India, New Delhi

    Google Scholar 

  6. IIPS, ORC Macro, (2007) National Family Health Survey, 2005–06 (NFHS – 3), India, vol I. International Institute for Population Sciences, Mumbai

    Google Scholar 

  7. Kumar C, Singh PK, Rai RK (2012) Under-five mortality in high focus states in India: a district level geospatial analysis. PLoS One 7:e37515

    PubMed  Article  CAS  Google Scholar 

  8. Kumar C, Singh PK, Rai RK, Singh L (2013a) Early neonatal mortality in India, 1990–2006. J Community Health 38:120–130

    PubMed  Article  Google Scholar 

  9. Kumar C, Singh PK, Rai RK (2013b) Coverage gap in maternal and child health services in India: assessing trends and regional deprivation during 1992–2006. J Public Health (Oxford). doi:10.1093/pubmed/fds108

    Google Scholar 

  10. Mahapatra P (2010) An overview of the SRS in India. Prince Mahidol Award Conference and Global Health Information Forum 2010. Accessed 4 June 2013

  11. Measham AR, Heaver AR (1996) India’s Family Welfare Programme: moving to a reproductive and child health approach. The World Bank, Washington, DC

    Google Scholar 

  12. Measure DHS India (2012) URL: Accessed 4 June 2013

  13. Ministry of Health and Family Welfare (2012) Annual report, 2011–12. Government of India, New Delhi

    Google Scholar 

  14. Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Sankar MJ, Bhandari N, Sreenivas V, Sundararaman T, Govil D, Orsin D, Kirkwood B (2011) Reproductive health, and child health and nutrition in India: meeting the challenge. Lancet 377:332–349

    PubMed  Article  Google Scholar 

  15. Paxton A, Wardlaw T (2011) Are we making progress in maternal mortality? N Engl J Med 364:1990–1993

    PubMed  Article  CAS  Google Scholar 

  16. Raj A, Saggurti N, Balaiah D, Silverman JG (2009) Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study. Lancet 373:1883–1889

    PubMed  Article  Google Scholar 

  17. Registrar General of India (1971) Sample registration of births and deaths in India 1969–1970. Registrar General of India, Vital Statistics Division, New Delhi

    Google Scholar 

  18. Registrar General of India (1972) Sampling variability in vital rates. Registrar General of India, SRS Analytical Series, New Delhi

    Google Scholar 

  19. Registrar General of India (1982) Sample registration system, 1970–1975, chap 4. Registrar General of India, New Delhi, 62 pp

    Google Scholar 

  20. Registrar General of India (2012) Compiled report. Sample Registration System (SRS) Statistical report, 1999–2011. Registrar General of India, New Delhi

  21. Sachs JD (2012) Primary health care in low-income countries: building on recent achievements. JAMA 307:2031–2032

    PubMed  Article  CAS  Google Scholar 

  22. Singh L, Rai RK, Singh PK (2012) Assessing the utilization of maternal and child health care among married adolescent women: evidence from India. J Biosoc Sci 44(1):1–26

    PubMed  Article  Google Scholar 

  23. Singh PK, Kumar C, Rai RK, Singh L (2013) Factors associated with maternal healthcare service utilization in nine high focus states in India: a multilevel analysis based on 14,385 communities in 292 districts. Health Policy Plan. doi:10.1093/heapol/czt039

    Google Scholar 

  24. Swamy VS, Saxena AK, Palmore JA, Mishra V, Rele JR, Luther NY (1992) Evaluating the sample registration system using indirect estimates of fertility and mortality. Occasional paper, Registrar General of India, New Delhi

    Google Scholar 

  25. The Million Death Study Collaborators (2010) Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet 376:1853–1860

    Article  Google Scholar 

  26. The Partnership for Maternal, Newborn and Child Health (2011) Analyzing commitments to advance the global strategy for women’s and children’s health. The PMNCH 2011 Report, Geneva, Switzerland

  27. UNICEF (2007) Technical note: how to calculate average annual rate of reduction (AARR) of underweight prevalence; 2007. Accessed 4 June 2013

  28. UNICEF (2011) Levels and trends in child mortality: report 2011. Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation, New York

  29. Ved RR, Dua AS (2005) Review of women and children’s health in India: focus on safe motherhood. NCMH background papers, Burden of disease in India, NCMH, New Delhi

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Authors are grateful to Dr. Sulabha Parasuraman, Former Professor and Head, Department of Population Policies and Programme, International Institute for Population Sciences (IIPS), Mumbai, India for her thoughtful insight, discussions, and suggestions, which helped immensely in formulating this paper. Authors also extend their sincere thanks to the editor and anonymous reviewers for their constructive suggestions.

Conflict of interest

The authors declare that they have no conflict of interest.


No funding was obtained to perform this study.

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Correspondence to Chandan Kumar.

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Kumar, C., Rai, R.K. & Singh, P.K. Reducing infant (0–11 months) and child (0–4 years) mortality in India: a disposition from the Sample Registration System. J Public Health 21, 575–582 (2013).

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  • Infant mortality
  • Child mortality
  • Millennium development goal
  • India