Introduction:
The under-five mortality rate (U5MR) has been widely used as one of the important indicators of socio-economic development and the effectiveness of health and welfare programmes. It is generally defined as the probability of dying between birth and exactly five years of age, expressed per thousand live births. As per 2010 data, about 7.6 million children under the age of five years die in the world, with a substantial concentration of death in the developing countries of sub-Saharan Africa and Southern Asia. [1] According to the latest round of the National Family Health Survey (NFHS 4), the Indian version of worldwide Demographic Health Survey (DHS), the U5MR in India was 50 deaths per 1000 live births in 2015-16. [2] This indicates that the U5MR figure for India was closer to the Millennium Development Goals (MDGs) target of 41 deaths per thousand live births. While this gives a positive message, the real concern lies in the unequal survival chances by regions and socioeconomic groups. The post-2015 sustainable development agenda aims to reduce under-5 mortality to at least as low as 25 deaths per 1,000 live births. [3] India may achieve this goal at the aggregate level, but what will be the level of U5MR in different states and socioeconomic groups? This paper focuses on Odisha, one of the socioeconomically poor states of India. As aggregate figures mask the intra-state differences, this paper attempts to understand and analyse trends, regional patterns and social differences in the U5MR in the state of Odisha.
Data and Methods
Primarily, three sources of data were utilised for the analysis; the Sample Registration System (SRS), the National Family Health Survey (NFHS) and the Census of India. The Sample Registration System (SRS) provides estimates of births and deaths at the state/national level. SRS based U5MR estimates were not available in reports till 2010. However, U5MR or 5q0 can be computed from age-specific death rates in the age groups 0, and 1-4 and the values can be read from the life tables as 5q0 = (I-I5/I0)1000. Besides, data from all four rounds of the National Family Health Survey (NFHS) were used to show the trend in U5MR in Odisha. The present paper also utilizes the district level estimates of U5MR from the office of Registrar General of India for 2001 and the first round of Annual Health Survey conducted during 2010-11.
Analysis and Findings
Trends in Under-five Mortality Rate
The calculated estimates (Table 1) show a declining trend of U5MR both for Odisha and national average during 1990 and 2009. However, the national figures have been lower than that of Odisha. According to the latest SRS report, U5MR in Odisha was 47 against the national average of 37 in 2017. [4]
| Table 1: Trends in Under-Five Mortality Rate in Odisha and India |
| Year |
Odisha |
India |
|
Total |
Rural |
Urban |
Rural-Urban Gap |
Total |
Rural |
Urban |
Rural-Urban Gap |
1990-94* |
148 |
154 |
89 |
65 |
114 |
124 |
72 |
52 |
1995-99** |
127 |
131 |
86 |
45 |
102 |
112 |
63 |
49 |
2000-04** |
107 |
110 |
72 |
38 |
86 |
95 |
52 |
43 |
2005-09** |
91 |
96 |
56 |
40 |
71 |
79 |
45 |
34 |
Sources: Author’s calculation based on SRS Abridged Life Tables- * India, Registrar General (1998). [5] ** India, Registrar General (2012). [6]
Notes: Estimates for 1995-99, 2000-04 are based on reconstructed Life Tables |
| Table 2: A Comparative View of Trends of Under-five Mortality Rates for five year period preceding the survey in Odisha and India |
| Period |
Odisha |
India |
Survey |
Total |
Rural |
Urban |
Total |
Rural |
Urban |
NFHS-1(1993) |
131.0 |
135.1 |
107.2 |
109.3 |
119.4 |
74.6 |
NFHS-2(1998-99) |
104.4 |
104.8 |
(102.0) |
94.9 |
103.7 |
63.1 |
NFHS-3(2005-06) |
90.6 |
97.1 |
50.1 |
74.3 |
82.0 |
51.7 |
NFHS 4 (2015-16) |
48.6 |
52.6 |
25.2 |
49.7 |
55.8 |
34.4 |
Source: IIPS and ICF (2017). [7]
Notes:
Under-five mortality rates for five-year periods preceding NFHS 4 and for 0-4 years before NFHS-3, NFHS-2 and NFHS-1
Figures in ( ) Based on 250-499 unweighted person-years of exposure to the risk of death |
 |
 |
| |
All the rounds of the National Family Health Survey also provide an overview of the trend of U5MR in Odisha over the last two decades (Table 2). The under-five mortality rate has declined from 131 deaths per 1000 live births in 1992-93 to 104.4 in 1998-99 and 90.6 in 2005-06. It further reduced to 48.6 in 2015-16. Over the last two and half a decade (from NFHS-1 to NFHS 4), the U5MR has declined to the tune of around 82.4 points (Figure 1). The survival chance of children below five years in Odisha has improved over time. As a result, Odisha’s U5MR figure fell below the national average. Though the rural-urban gap in U5MR has been narrowing down in Odisha, it remains substantially high (Figure 2).
Differentials by Socioeconomic Groups
Unequal chance to survive across groups has been an issue of great importance. Rights-based perspective to development emphasizes on right to survive. This section tries to see if there are differences in the mortality rate during the early years of childhood across social groups. NFHS 4 estimates for the under-five mortality rate by socioeconomic background characteristics are given in Table 3. As per NFHS-4 estimates, the under-five mortality rate was the highest for Scheduled Tribes (STs) followed by the Scheduled Castes (SCs and Other Backward Classes (OBC) and ‘others’ (Non-SC/ST/OBC). ST-‘Others’ gap in UFMR is remarkably high. Differentials in U5MR by the educational levels of mothers are also clear; the level of U5MR falls with increasing levels of maternal education. The male-female difference is found to be very low. The age of mother and U5MR have an inverse relationship. A clear gradient is observed in U5MR by birth order of children; level increases with increasing birth order.
| Table 3: Under-five mortality rates for the five years preceding the survey, by background characteristics, Odisha, 2015-16 |
| Background Characteristics |
U5MR |
Social Group |
Scheduled Caste |
45.7 |
Scheduled Tribe |
65.6 |
Other Backward Class |
42.9 |
Others |
35.2 |
Residence |
Urban |
25.2 |
Rural |
52.6 |
Education |
No Education |
71.7 |
< 10 years complete |
45.7 |
10 or more years complete |
19.5 |
Child’s Sex |
Male |
49.4 |
Female |
47.8 |
Birth Order |
1 |
46.1 |
2-3 |
45.5 |
4+ |
70.5 |
Mother’s Age |
<20 |
48.4 |
20-29 |
43.6 |
30-39 |
65.2 |
Previous Birth Interval* |
< 2 years |
84.8 |
2-3 years |
41.8 |
4 years or more |
49.8 |
Total |
48.6 |
| Source: IIPS and ICF (2017). [7] |
District Level Variations
The level of under-five mortality varies substantially across districts. There have been very large inter-district variations observed in the state of Odisha. According to 2010-11 data, U5MR was as high as 145 deaths per 1000 live births in Kandhamal, whereas the figure for Jharsuguda was 58 deaths per 1000 live births. This indicates a range of 87 points between the lowest and the highest. Among 30 districts of Odisha, about five districts (Khordha, Rayagada, Puri, Balangir, and Kandhamal) have reported an under-five mortality rate above 100 or more per thousand live births. Nine districts (Sonapur, Kendujhar, Gajapati, Nayagarh, Nabarangapur, Baudh, Dhenkanal, Cuttack, and Ganjam) which reported the U5MR between 81-100 deaths per thousand live births. Overall, more than 14 districts have a higher under-five mortality rate as compared to the state average (82 deaths per 1000 live births).
| Table 4: Under-Five Mortality Rate in Odisha by Districts, AHS, 2010-11 and the Census 2001 |
| Districts |
Census 2001# |
Annual Health Survey, 2010-11* |
Kandhamal |
174 |
145 |
Balangir |
110 |
115 |
Puri |
126 |
108 |
Rayagada |
150 |
105 |
Khordha |
105 |
102 |
Ganjam |
119 |
93 |
Cuttack |
119 |
91 |
Dhenkanal |
122 |
90 |
Baudh |
134 |
89 |
Nabarangpur |
144 |
87 |
Nayagarh |
124 |
86 |
Kendujhar |
119 |
85 |
Gajapati |
158 |
85 |
Sonapur |
102 |
84 |
Malkanagiri |
143 |
79 |
Kalahandi |
147 |
77 |
Nuapada |
127 |
75 |
Bargarh |
97 |
74 |
Sambalpur |
112 |
73 |
Debagarh |
140 |
72 |
Mayurbhanj |
85 |
72 |
Koraput |
142 |
72 |
Kendrapara |
125 |
70 |
Jagatsinghapur |
110 |
67 |
Bhadrak |
112 |
66 |
Sundargarh |
105 |
65 |
Jajapur |
112 |
63 |
Anugul |
109 |
60 |
Jharsuguda |
84 |
58 |
Baleshwar |
84 |
58 |
ORISSA |
119 |
82 |
Coefficient Variation value |
18.03 |
23.12 |
Source: # India, General India (2009). [8]
*India, Registrar General (2012). [9] |
A Comparison between the district-specific estimates of the 2001 Census and Annual Health Survey, 2010-11 reveals that all the districts have recorded a decline in U5MR besides Kandhamal and Balangir. The average figure for Odisha has declined by 37 points. District level patterns in U5MR have not changed much as the correlation coefficient value between the census 2001 estimates and AHS 2010-11 estimates is statistically significant (p< 0.01). However, the increasing coefficient of Variations (CV) values between 2001 and 2010-11 indicate a slight increase in the degree of district-level variations in U5MR.
Conclusion
The examination of data reveals a declining trend of U5MR in Odisha, yet the current level is substantially high. Geographic (spatial) variation in U5MR is notable and the magnitude of inter-district variation had slightly increased between 2001 and 2010-11. However, 28 districts out of 30 districts of the state have registered a decline with varying rates. The rate is remarkably high in some of the southern districts of the state with a substantial presence of tribal population. Disaggregated data reveal that U5MR is exceptionally high among scheduled tribes, rural residents and illiterate mothers. U5MR decreases with an increasing level of education too. Similarly, higher birth order and higher mother’s age are associated with higher U5MR. There is a need to improve general socioeconomic conditions as well as the efficiency of the schemes related to maternal and child health services. Moreover, policymakers and programme managers need to focus on deprived groups and disadvantaged regions to achieve the U5MR targets for 2030 as proposed by the United Nations sustainable development agenda.
References
- United Nations. The Millennium Development Goals Report 2012. New York: United Nations. 2012.
- IIPS and ICF. National Family Health Survey (NFHS-4), 2015-16, India. Mumbai: IIPS; 2017.
- United Nations. Transforming our World: The 2030 Agenda for Sustainable Development, A/RES/70/1. New York: UN General Assembly; 2015.
- Registrar General of India. ‘Sample Registration System Statistical Report 2017’. New Delhi: Government of India; 2017.
- Registrar General of India. ‘SRS based Abridged Life Tables, 1990-94 and 1991-95’ SRS Analytical Studies, Report No.1 of 1998. New Delhi: Government of India; 1998.
- Registrar General of India. SRS based Abridged Life Tables, 2003-07 to 2006-10. New Delhi: Government of India; 2012.
- IIPS and ICF. National Family Health Survey (NFHS-4), 2015-16: Odisha. Mumbai: IIPS. 2017.
- Registrar General of India. District Level Estimates of Child Mortality in India based on 2001 census data. New Delhi: Government of India; 2009.
- Registrar General of India. Annual Health Survey Bulletin 2010-11 of Odisha. New Delhi; Government of India; 2012.
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