Explaining the rural-urban gap in infant mortality in India

Background: Prior studies suggest that infant mortality in rural areas of India is substantially higher than in urban areas. However, little is known about the determinants explaining such excess of rural mortality. Objective: This study systematically assesses the role of socioeconomic and maternal and child health (MCH) care-related programme factors in explaining the rural-urban gap in infant mortality during the past two decades. Methods: Long-term changes in rural and urban infant mortality were assessed using Sample Registration System (SRS) data. Binary logistic regression was used to analyse the association between socioeconomic and MCH care-related programme factors and infant mortality using data from the three rounds of the National Family Health Survey (NFHS). Fairlie's decomposition technique was applied to understand the relative contribution of different co-variates to the rural-urban gap in infant mortality. Results: Relative inequality between rural and urban India has increased over time. The rural-urban gap in infant mortality can be largely explained by the distributions of the co-variates in rural and urban area. The largest part of the rural disadvantage in infant mortality is attributable to the underlying disadvantage in household wealth and maternal education, whereas breastfeeding and knowledge of Oral Rehydration Solution has contributed to narrowing the gap. The share of women using modern contraceptive methods and the percentage of fully vaccinated children in the community have also contributed to widening the rural-urban gap in infant mortality. Conclusions: In addition to strengthening MCH programmes in rural areas, substantial efforts must also be made to improve household wealth and female education levels.