Urban-rural differential in neonatal and post-neonatal mortality clustering among Indian siblings: Evidence from National Family Health Survey 2015–16

It is universally accepted that the first 365 days after birth is a critical period for child survival. The present study explored the phenomenon of neonatal and post-neonatal mortality clustering among Indian siblings and the existing urban–rural differential in the same using birth history data of National Family Health Survey (NFHS) 2015–16. We estimated random-intercept logit models for 1,296,196 and 1,248,535 children born to 474,786 and 456,662 mothers for analysing neonatal and post-neonatal mortality clustering respectively. The effect of scaring and unobserved heterogeneity among mother along with an urban–rural variation on neonatal and post-neonatal mortality of child was examined. Children, whose previous siblings were dead during their conception, had 2.42 [CI: 2.32–2.52] and 2.36 [CI: 2.16–2.58] times higher risk of neonatal mortality in the rural–urban regions respectively. Further, the risk of post-neonatal mortality was 1.60 [CI: 1.51–1.71] and 1.45 [CI: 1.25–1.67] times higher among rural and urban children respectively who had lost their preceding siblings. Moreover, we found a higher clustering of neonatal deaths among urban mothers compared to their rural counterparts. Comparatively, the clustering of post-neonatal deaths was common among rural mothers of India. Even after controlling for relevant covariates, we find the risk of neonatal and post-neonatal mortality varies greatly with the risk variation being slightly higher among urban mothers. The findings point toward targeting high-risk mothers with crucial programme benefits. Additionally, higher mortality clustering within mothers from urban regions means that region-wise interventions are required to tackle neonatal and post-neonatal mortality existing in urban–rural region separately.