Who is more likely to die — an infant less than one year old or someone in their late seventies? This may seem like a no-brainer, but in Uttar Pradesh or rural Gujarat, the infant is more likely to die than a 75-79-year-old.
This shocking reality emerges from data in the recently released SRS 2018 report. The data also shows that in most of India’s big states, the death rate among those less than a year old is higher than those aged 65-69. This is correlated to high infant mortality rate (IMR), which India has been struggling to bring down. Thus, in Kerala and nine other states, the death rate of infants is lower than for any age group above 65 years. Most of these states are also those with the lowest IMR.
The death rate for infants aged less than a year in UP is 68.3, higher than the 64.2 for the 75-79 age group. In rural Gujarat, the death rate for infants at 52 was significantly higher than 45.9 for the 75-79 age group.
Age-specific crude death rate in a year is the total number of deaths in a particular age group in that year for every thousand of the population in that age group. IMR is the ratio of the number of deaths of children under one year to the total number of live births in that year. While the values of crude death rate of children under one year and IMR are close, they do not correspond exactly.
Kerala, Delhi, Tamil Nadu, Maharashtra, Himachal Pradesh, Punjab and West Bengal, in that order, have the lowest IMR and also have the lowest crude death rate of infants under one year. But Jammu & Kashmir, which has a low IMR of 22, is among the states where crude death rate of those under one year (29.4) is more than the death rate in the 65-69 age group (22.3). Madhya Pradesh has the highest IMR of 48, but is below UP when it comes to crude death rate in the below-one-year age group though UP’s IMR is lower at 42.
“High IMR is due to a mix of medical and socioeconomic reasons. So many states continue to have a relatively high IMR even after their health services improve because the socioeconomic reasons continue to contribute to the death of infants. But a lot of preventable mortality in this age group is definitely due to inadequate health services,” explained Dr N Devadasan, former director of the Institute of Public Health.
There is an obvious gender skew too, with two factors contributing to it — higher IMR among girls than boys and lower death rates among older women than men. As a result, there are states besides UP and Gujarat where an infant girl is more likely to die than a 75-79-year-old woman, particularly in rural areas.
For instance, in rural Madhya Pradesh, girls in the below-one-year age group have a crude death rate of 57.6 compared to 29.7 and 44.8 for women in the 65-69 or 70-74-year age groups. Similarly, in Rajasthan, the death rate for girls below one year is 57.9 compared to 21.4 and 27.7 for women in the 65-69 and 70-74 age groups, respectively.
Obviously, in many states, the first year of life is more dangerous than its twilight. And this is particularly true for females and for rural populations.