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India - a Country Of a High Infant Mortality Rate

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India is probably the only country in the world which can boast of being a Global Superpower but still has an exceptionally high Infant Mortality Rate. It has declined over past two decades or so but the change has been relatively slow as compared to other nations This is primarily due to exceptionally poor health indicators of 9 states: Assam, Bihar, Chattisgarh, Jharkhand, Madhya Pradesh, Odhisa, Rajasthan, UP & Uttarakhand. These states have been labelled as ‘High Focus States’ and as a result they have received special attention from policy makers. This state-level variation however masks the further district level variation in the IMR.

I am interested in analyzing this district level variation and seeing whether there is spatial correlation amongst IMR and the factors that explain it. The main objective of my paper is to see whether drinking water and sanitation facilities have any impact on the IMR after controlling for relevant factors at district level. This is because majority of India still lives in rural areas where these facilities are still not commonplace. If a significant relationship is found then it would be interesting to see in future the impact of schemes like Swachh Bharat Mission by Ministry of Drinking Water and Sanitation on IMR and other relevant child health indicators.

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Infant Mortality Rate is widely considered to be the most important indicator of health and well-being of the society. Govt. of India knows this and as a result has taken a number of initiatives to tackle this problem. This ranges from setting up of National Rural Health Mission in 2005, setting up a goal of reducing IMR to 30 by 2010 to the setting up of National Diarrhoeal Disease Control Programme all the way back in 1978. Dreze and Sen (2002) showed that the decline in IMR has slowed down after 1990s and this happened right along the time when Indian economy was liberalized. This slowdown has also been shown in Claeson M, Bos ER, Mawji T, Pathmanathan I (2000) and NIMS et al., (2012) which also showed the significant variation in the decline of IMR across states in India.

A lot of research has been done over the years to determine the factors which affect IMR and the consensus among researchers points to Demographic, Socioeconomic and Environmental factors among others. A lot of these studies have shown how important government intervention can be to tackle the problem of Infant Mortality Rate. Barenberg, Basu and Soyle use panel data on Indian states show in their working paper that a one percent increase in public expenditure on health care can reduce the IMR by 8 deaths per 1000 live births.

Some studies point to need for policies aimed at socio-economically disadvantaged communities to improve child health measures (Gwatkins (2008), NFHS-3, Murthi M, Guio A, Dreze J (1995)) as children belonging to such communities are at high risk of facing premature death. This is because Poverty and Malnutrition prevalent in these communities increase the risk of infants and children to various infectious diseases like ARI. Pathak PK, Singh A (2011) show that the burden of malnutrition was disproportionately concentrated among poor children while Raj A, Saggurti N, Winter M, Labonte A, Decker MR, et al. (2010) show that the risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age.

Various demographic and epidemiological studies have shown that female literacy, nutritional status of mother, large family size, immunization and poor access to health care services among others as important determinants of child health. Singh A, Mahapatra B, Datta S (2008) show that despite controlling for socio economic and demographic variables there is 9 to 12 per cent higher risk of death of children during infancy and childhood if the mothers have been exposed to physical violence. A study by Pathak PK, Singh A, Subramanian SV (2010) showed that the use of Pre-natal care and Skilled Birth Attendance remained disproportionately low among the poor mothers in India which could be another reason why IMR is so high. This is because Pre-natal care and SBA can reduce chances of asphyxia, infections other complications during birthing process. (Tucker and McGuire, 2004) UNICEF, 2008 b; WHO/UNICEF, 2009).

However, despite such overwhelming work done to study IMR most of the studies in the past have failed to take into account the geographical space and the spatial correlation amongst the relevant variables. Ignoring such correlation can lead to questionable results. This is because if there is spatial correlation in the errors then statistical inference using Ordinary Least Squares method become unreliable. This problem can be solved using Exploratory Spatial Data Analysis which uses geospatial data along with all the other relevant variables to take into account the spatial correlation.

There have been very few studies which have used such geo spatial analysis to study infant mortality rate in India and most of them have been conducted in the past decade or so. Singh et. all (2011) were the one of the first ones to do this. They classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) and used geo-spatial techniques like Moran’s-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression.

They main result was that the areas which lacked in child nutrition, wealth or female literacy were more likely to have low infant and child survival irrespective of the state they belong to. Kumar et all (2012) controlled for geographical and biophysical variables along with all the other relevant factors to analyze the Under Five Mortality Rate in a district level geospatial analysis of 284 districts across 9 high focus states. It revealed that despite controlling for biophysical (like rainfall, temperature, topography etc.) and geographical factors, health program initiatives play an important role in reducing U5MR.

Gupta et al. Genus (2016) studied spatial clustering and risk factors of IMR in a district level analysis across India and found that the absence of drinking water from a treated source an unavailability of toilet facilities were negatively affected the Infant Mortality Rate. This paper is the most relevant one to my study as it uses data from the same sources as mine but the big difference is that it uses Annual Health Survey 2010-11 data while I use the data from 2011-12.

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