Infant mortality rose after DeMo, Covid may cause another setback: Study

India’s efforts at reducing infant mortality rate (IMR) faltered after demonetisation in 2016, according to a study by economists Jean Drèze, Aashish Gupta, Sai Ankit Parashar and Kanika Sharma. They found that the annual rate of decline in IMR, which was 4.8 per cent per year between 2005 and 2016, fell to 2.9 per cent in 2017 and 3.1 per cent in 2018. 

The study warns that another setback is likely this year due to the Covid-19 pandemic and the nationwide lockdown, which caused a major disruption in health services such as antenatal care and child immunisation.

Between 2005 and 2016, the annual rate of decline in overall infant mortality rate was 4.8 per cent per year, compared with 2.1 per cent per year in the 1990-2005 period and 2.6 per cent per year between 1971 and 1990.

The study (“Pauses and Reversals of Infant Mortality Decline in India in 2017 and 2018”) says: “One plausible hypothesis is that these setbacks are at least partly attributable to India’s startling experiment with wholesale demonetisation in November 2016, when 86 per cent of the currency became worthless overnight.” 

The data used in the study is based on summary reports from the Sample Registration System (SRS). According to the paper, overall infant mortality increased in Chhattisgarh, Jharkhand, Madhya Pradesh and Uttar Pradesh, and stagnated for at least a year in seven other states. 

“This sort of faltering of IMR (infant mortality rate) decline has not been observed in the SRS for many years. It is all the more alarming as it occurred at a time of rapid improvement in environmental determinants of health such as sanitation and LPG access,” the report states.

From 2005 to 2016, India experienced a long spell of rapid decline in infant mortality rates. The period was marked by fast economic growth combined with major initiatives in the social sector, including the launch of the National Rural Health Mission in 2005 and the gradual universalisation of Integrated Child Development Services from 2006 onwards, the study says.

While noting that there is no precedent for this kind of setback in the last 15 years, the study says the reversals of infant mortality decline in 2017 at the state level were largely confined to urban areas. In 2018, however, similar reversals also occurred in rural areas in several states. 

Experts, however, do not agree with this interpretation of the data. This, they say, is a long-term trend and there is a decline historically after five or six years as infant mortality stagnates. “It is not a linear trend. Last time the curve became flat was 7-8 years ago. There could be many explanations such as a bad crop year, GDP change. Correlation with demonetisation is just a hypothesis,” says Dileep Mavalankar, director, Indian Institute of Public Health, Gandhinagar. 

“The trend is never smooth. There are times of sharp rises and falls. Demonetisation had to affect all geographic areas almost equally... Moreover, most of the population gets medical care in the government sector, which is free of cost,” says Ketan Bharadva, president, Infant Young Child Feeding Chapter, Indian Academy of Pediatrics.