Infant Mortality Rate (IMR) and Causes of Infant Mortality
Definition
- IMR: Number of deaths of infants (<1 year of age) per 1,000 live births in a given year
- Formula: (Infant deaths / Live births) Γ 1000
- Key indicator of socio-economic development, maternal & child health status, and quality of healthcare
Current Status in India (2026 Context)
- As per Sample Registration System (SRS) 2023: National IMR = 25 per 1,000 live births (down from 39 in 2014 and 26 in 2022)
- Rural IMR = 28; Urban IMR = 18
- Neonatal Mortality Rate (NMR, 0β28 days) constitutes ~70% of IMR (β17β18 per 1,000 live births)
- Under-5 Mortality Rate (U5MR) = 29 per 1,000 live births
- SDG target: IMR β€12 by 2030; India on track with accelerated decline under RMNCH+A
Classification of Infant Mortality
- Neonatal Mortality (0β28 days): 70β75% of total IMR
- Early neonatal (0β7 days): 60β65%
- Late neonatal (8β28 days): 10β15%
- Post-neonatal Mortality (29 daysβ1 year): 25β30% of total IMR
Major Causes of Infant Mortality (SRS Cause-of-Death Report 2020β22)
Neonatal Causes (β70% of IMR)
- Prematurity & Low Birth Weight (LBW): 31.6%
- Birth asphyxia & birth trauma: 10.2%
- Neonatal sepsis/infections: 4.1%
- Congenital anomalies: 5.3%
- Others: Respiratory distress, hypothermia, jaundice
Post-neonatal Causes (β30% of IMR)
- Pneumonia / Acute Respiratory Infections (ARI): 16.2%
- Diarrhoeal diseases: 8β10%
- Malnutrition / Severe Acute Malnutrition (SAM): 6β8%
- Vaccine-preventable diseases (measles, pertussis)
- Injuries, congenital heart disease, meningitis
Determinants & Risk Factors
- Biological: LBW/prematurity, male sex, multiple births
- Maternal: Young age (<20 years), short birth interval, anemia, hypertension, inadequate ANC
- Social: Poverty, low female literacy, rural residence, poor sanitation, gender bias
- Healthcare access: Three-delays model (decision, reach, care)
- Environmental: Indoor air pollution, climate change-related heat stress & vector-borne diseases
National Interventions Addressing IMR
- RMNCH+A strategy & LaQshya
- Facility-Based Newborn Care (FBNC): NBCC, NBSU, SNCU/MNCU
- SAANS Campaign (pneumonia management)
- Anemia Mukt Bharat & POSHAN Abhiyaan
- Mission Indradhanush & U-WIN (immunization)
- Home-Based Newborn Care (HBNC) by ASHA
- Janani Shishu Suraksha Karyakram (JSSK) β free transport, drugs, diagnostics
- MusQan quality certification for paediatric services
Prevention Strategies (Pediatricianβs Perspective)
- Antenatal: 4+ ANC visits, IFA, tetanus toxoid, detection of high-risk pregnancies
- Intranatal: Skilled birth attendance, partograph use, delayed cord clamping
- Postnatal: Essential Newborn Care (warm chain, breastfeeding within 1 hour, vitamin K, eye care)
- Community: ASHA home visits, KMC for LBW, danger-sign recognition
- Surveillance: ABDM-linked tracking of high-risk infants
- Convergence: RBSK for birth defects, NTEP for TB exposure