Healthy outcomes: Address key gaps to make infant survival universal

India's infant mortality rate hits a record low, but stark regional gaps in nutrition, immunisation, and newborn care threaten to slow public health gains

India has reached an important milestone in public health. The latest Sample Registration System (2023) data reveals that the country’s infant mortality rate (IMR) has dropped to 25 per 1,000 live births — the lowest ever and a steep fall from 129 in 1971. This reflects decades of steady progress in immunisation, maternal- and child-health programmes, and overall improvement in sanitation and nutrition. States like Kerala (5) and Manipur (3) showcase how strong primary health care and decentralised planning can deliver outcomes comparable with advanced economies. Yet, progress remains patchy. Larger states such as Uttar Pradesh, Madhya Pradesh, and Chhattisgarh still report an IMR as high as 37, pointing to sharp regional and rural-urban gaps. 

The World Health Organization-United Nations Children’s Fund immunisation report (2025) underscores a worrying vulnerability: More than 900,000 Indian infants missed all vaccines in 2024. Despite broad coverage, these gaps risk reversing gains by leaving communities exposed to preventable outbreaks. Alongside immunisation, maternal and child nutrition remains a critical weakness. The National Family Health Survey-5 (2019-21) shows that anaemia affects 52 per cent of pregnant women and 67 per cent of children under five — figures that directly undermine birth outcomes, cognitive development, and infant survival. The persistence of such high levels of anaemia reflects not just dietary insufficiency but also poor access to iron supplements, and inadequate antenatal care. Equally troubling is the fragile state of maternal and newborn care infrastructure. The availability of quality care during pregnancy, delivery, and the neonatal period often determines survival. Yet, many primary health centres in poorer states lack obstetric facilities or essential equipment, leaving mothers dependent on informal or unsafe options. Madhya Pradesh, one of the states with the highest IMR, reportedly faces a staggering 70 per cent vacancy in child specialists, crippling its newborn-care capacity. 

Bridging these gaps requires a multidimensional response. Kerala’s success highlights the value of investing in primary health care, community participation, and local governance. Replicating these principles in high-burden states is essential. Nutrition intervention must go beyond Integrated Child Development Services (ICDS) and the Poshan Abhiyaan to ensure universal access to fortified foods, iron supplementation, and dietary diversification. Innovation like Telangana’s Aarogya Lakshmi programme, which provides one hot cooked meal daily to pregnant and lactating women, could be adopted by other states. Equally, behaviour-change campaigns are vital to improve maternal diets, breastfeeding practices, and vaccine uptake. 

On health care, expanding special newborn care units, upgrading community-health centres with round-the-clock obstetric services, and filling vacant specialist posts should be prioritised. Greater investment in the training of Accredited Social Health Activists and incentives could strengthen service delivery and create awareness to counter vaccine hesitancy. India’s decline in the IMR is a milestone worth celebrating, but it must not obscure the persistent inequities in maternal and infant care. Only by simultaneously resolving gaps in infrastructure, workforce, nutrition, immunisation, sanitation, and social equity can India ensure its infant survival gains become truly universal and sustainable.