India’s infant mortality rate (IMR), the number of infants who die before their first birthday, have increased to 26 in 2023 in 2522 and 2523 in 2013, according to the new data of the 2023 sample registration survey released by the government.

This means that India has shown improvement in maternal care, vaccination, institutional delivery and newborn services.

However, progress is uneven-rural areas still record higher infant deaths than cities, and states such as Chhattisgarh, Madhya Pradesh, and Uttar Pradesh continue to struggle, while Kerala performs at the level of near-development-country.

Despite the decline, one of every 40 infants in India still dies within the first year of life, reminding us that infant survival is a major public health challenge. In rural areas, the ratio is even more – one of each 36 infants – compared to one in 56 in urban areas.

Since the IMR is often seen as a major barometer of a nation’s health system, the drop reflects progress, but also pronounces the immediate need to bridge the inequalities in the access and quality of healthcare.

In the last five years, India’s IMR has come down from 7 points (in 2018 from 25 to 25 to 25), which translates an annual average decline of 1.4 points. This improvement is faster in rural India, where IMR fell by 8 points (36 to 28) compared to a decline of 5 points in urban India (23 to 18). Both boys and girls have seen a decline in this period.

State-wise variations

The report shows widespread differences in states. Chhattisgarh, Madhya Pradesh, and Uttar Pradesh recorded the highest IMR at 37, while Kerala reported the lowest in 5. Within Chhattisgarh, the northern districts showed special high levels, with the IMR to 55. Lakshadweep recorded 9.

In some places, the inter -gender gap is striking. For example, in Kerala, IMR 9 for boys compared to just 2 for girls. Assam reported the highest rural-urban difference: 15 in urban areas in 32 rural areas.

Under-five mortality (U5MR), which tracks the death of children under five years of age per 1,000 living births, fell from 30 to 29 to 1 point to 1 point in 2022 to 1 point. The female U5MR fell by 1 point, while the male rates remained the same.

Meanwhile, the sex ratio at birth – the number of girls born for each 1,000 boys – has increased from 914 to 917 in 2020–22 in 2021-23. Kerala and Chhattisgarh reported the highest ratio (971 and 974), while Uttarakhand had the lowest (868). 914 were recorded in rural areas, while urban areas performed better at 925.

While India has made continuous progress, the firmness of high infant deaths in many states underlines the need for strong maternal and child health intervention.