Trends and Determinants of Infant Mortality in Empowered Action Group States, India (1990-2006)

Background: Infant Mortality Rate (IMR) is one of the most sensitive indicators to assess the health status of any country. In India there has been a continuous decline in infant mortality rate however for the Empowered Action Group (EAG) states which constitute 45% of the total population of India, still shows very high infant mortality rates. The Ministry of Health and Family Welfare, India, established Empowered Action Group (EAG) namely Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttaranchal and Uttar Pradesh in 2001 to have special focus by monitoring and facilitating the attainment of national health goals on some of these states which are demographically lagging behind. Objective: This study aimed to explore the trends and determinants of infant mortality in EAG states, India during last one and half decade, (1990-2006). Methods:: Data from three rounds of the National Family Health Survey (NFHS), the Indian version of the Demographic and Health Survey (DHS) which were canvassed during 1992–93 (NFHS-1), 1998–99 (NFHS-2), and 2005–06 (NFHS-3) in India were analyzed. To identify the disparities and nature of the association between Infant mortality and selected socioeconomic background characteristics, bivariate and multivariate Cox proportional hazard model (both separate and pooled) analysis were performed. Key findings: In India, there has been a decline in overall infant mortality but still differentials in infant mortality by mother's age at birth, the composite variable of birth order and birth interval, economic status, sanitation facility and region were evident.Controlling for a set of socioeconomic and demographic factors, the hazard of infant mortality was less (CHR=0.77 95% CI=0.75-0.79) (AHR=0.83 95% CI=0.80-0.86) and (CHR=0.87 95% CI=0.85-0.90) (AHR=0.89 95% CI=0.87-0.92) during the period 2005-06 and 1998-1999 respectively as compared to period 1992-1993. Conclusion: Infant mortality is reducing over the one and half decade but disparities across different socioeconomic and geographical setting remain.Investments that focusing on educating women on increasing age at marriage, age at first birth, and increasing the birth interval between two births. In addition, investments in the quality of care offered by the both the private and public health systems throughout the EAG states may be required in order to ensure continued progress in child health also strengthening health facilities at the district level to save newborns.