CHAPTER IV

ESTIMATION OF INFANT MORTALITY AT THE DISTRICT LEVEL

4.1 Introduction

The Infant Mortality Rate (the probability of not surviving by age one) is one of the
sensitive indicators of development. It is one of the key indicators from the
programme point of view. Reduction of IMR has been accorded high priority in
improving the health situation of the population. The National Population Policy,
2000 aims at a reduction of IMR to less than 30 by 2010. The Millennium Declaration
aims to reduce infant mortality by two thirds from its current level. A reduction in the
IMR depends on both exogenous and endogenous factors such as medical assistance
at delivery, nutritional level, and health of mother as well as care during and after
delivery.

The estimates on infant and child mortality at the national level and for major states of
India are provided by the SRS annually. The NFHS also provides the estimates by
mothers educational level, standard of living of the households as well as the other
socio economic characteristics of the households. Thus, at the state level we have
good information on these estimates. However, very little is known about the levels
and differentials of IMR at the district level. In India, there is large inter district
variation in the level of socio economic development among districts within a state.
Also, the Rapid Household Survey under the Reproductive and Child Health suggests
that there is large variation in health care indicators at the district level. With
decentralized planning it has become inevitable to plan at the district level. Hence, the
need of critical indicators like IMR is manifold. There are some indirect estimates of
IMR and CMR by registrar government of India for the districts of India for the
period 1981 and 1991 using data of Children Ever Born and Children Surviving.
However, in such an exercise the prerequisite is the quality of data. If the quality of

37

data is good, the estimates will be reliable. In this chapter it is attempted to review a
few of the methods used in the estimation of IMR and provide the estimates of IMR
using the Reproductive and Child Health Survey data (RCH, Round II). Unlike the
CEB-CS data, the estimates are derived based on the birth history of women.
However due to some problems with respect to incompleteness of survey, small
sample size, the estimates we provide are not for all districts of India. It is attempted
to provide the estimates for as many as districts of India as possible after considering
the quality of data, and sample size.

4.2 Review of Methods

Estimates of IMR can be derived directly as well as indirectly. The direct estimates
are usually based on the number of infant deaths reported during the last one year per
1000 live births. The civil registration system as well as the SRS adopts this technique
for providing the estimates. However, for some cases, the reference period is also
taken as three years. Besides, the following indirect methods are used in providing the
estimates of IMR.
1) Estimation of Infant Mortality from information on Children Ever
Born and Children Surviving
2) Estimation of IMR based on Regression Methods
3) Estimation of IMR from the Birth History of women

A brief description of each method is given below.

4.2.1 Method 1: Estimation of Infant Mortality from Information on Children

ever Born and Children surviving
Most of the indirect estimates of IMR and child mortality are based on this method.
Brass was the first to develop the procedure to convert proportion dead of children
ever born by women in age groups 15-19, 20-24, etc. into estimation of the
probability of dying before attaining certain exact childhood ages. The basic data
required for this method are:
a. The number of children ever born, classified by sex and by five year age group
of women

38

b. The number of children surviving (or the number of children dead) , classified
by sex and by five year age groups of women
c. The total number of women (irrespective of marital status), classified by five
year age groups
As a first step, average parity per woman is computed as

P(i) = CEB(i)/FP (i)

Where CEB (i) is the children ever borne by women in age group i and FP (i) is the
total number of women in age group i. In the second step the proportion of dead
children for each age group of mother is defined as

D (i) = CD (i)/CEB (i)

or

D(i) = 1-CS (i)/CEB(i)

Where CD (i) is the number of children dead reported to women in age group i. The
multiplier k (i) is calculated for non mortality factors determining the value of D(i)

The equation of
k (i)= a(i)+ b(i) (P(1)/P(2))+c(i)(P(2)/P(3))

The probability of dying is calculated as

q(x)= k(i)* D(i).

The data required are mean CEB and mean CS by five year age groups, mean age at
child bearing and month and year of survey. The demographic package MORTPAK,
developed by the United Nation is used for such an exercise.
The main data source of such estimates is the national census as well as the large scale
household surveys. Though, it is easy to estimate, one needs to check the data quality
before undertaking such an exercise. The reporting of age is largely inaccurate in the
Indian context and underreporting of deaths is more likely from illiterate and older
women. Moreover, the census takes place once in 10 years and so it is not possible to
derive these estimates for the inter-censal period.

39

There are some estimates by Irudaya Rajan and Mohanchandran (1998) as well as the
estimates by RGI (1998) on the levels and differentials in IMR in districts of India.
The estimates of Irudaya Rajan vary from the RGI estimates of 1998 (Census District
profile 1991). Both the estimates used the 1991 census data of CEB-CS and the
Trussell variant, but there is a variation in the estimates. For example, the estimated
IMR by RGI for Madhya Pradesh in 1991 was 133 as compared to 74 by Irudaya
Rajan. There is large variation in these two estimates in the IMR for districts as well.
However, we have shown the estimates of RGI based on this method for the periods
1981 and 1991, and the estimates are given in the Appendix B. We have used these
estimates to derive the life expectancy at birth for the year 1991. We could not
provide the estimates using the CEB-CS data of 2001 as the data on CS is yet to be
released by Census of India.
4.2.2 Method 2: Regression Methods

It is stated that the some of the estimates obtained from the CEB-CS data may not be
reliable (Irudayarajan 1998, RGI 1998). We have attempted to estimate the infant
mortality rate and under five mortality rate by using the regression method. It is
hypothesized that the IMR is closely related to mortality at broad ages. If data on
deaths of children of age five and above to total deaths are available, then it is
possible to derive the regression equation. The regression equation we have proposed
is
IMR=a+b* D5+/TD

Under this a regression equation is fitted with IMR as a dependent variable and deaths
of aged 5 and above to total deaths as an independent variable. This exercise has been
done for major states for India using the SRS data of the year 2000. We have obtained
the Age Specific Death Rate for the country and states. Then we estimate the deaths in
each age group as well as the total deaths for the period 2000. The ratio of deaths of
five and above to total deaths is estimated. We regress the level of IMR with the ratio
of deaths of five and above to total deaths. The resulting coefficients are given in the
table below. The regression equation under model 1 explains about 71 percent
variability. Hence the coefficients can be used to provide the estimates at the district

40

level if we have data on deaths of children aged 5 and above and total deaths of the
district. If we could obtain the data from civil registration on deaths to population
aged five and above and total deaths, it is possible to derive the estimates of IMR.
Table 4.1: Results of Regression Coefficients (OLS) of Infant Mortality Rate and Life
Expectancy at Birth in India and Major States, 2000.

Method

Total
Intercept (a)
Regression Coefficient (b)
R2
F
N
Year
Unit
Rural
Intercept (a)
Regression Coefficient (b)
R2
F
N
Year
Unit
Urban
Intercept (a)
Regression Coefficient (b)
R2
F
N
Year
Unit

Model.1
IMR=a+ b*D5+/TD

196.941
-1.7630
0.710
34.29
16
2000
State/India
192.323
-1.6703
0.631
23.97
16
2000
State/India
199.114
-1.8831
0.872
95.69
16
2000
State/India

4.2.3 Method 3: Estimation of Infant Mortality Rate from Birth History

Demographic surveys ask questions directly to the mother about the number of
children ever borne and children surviving by sex. A birth history used to be collected
which asked about the sex, date of birth, whether the birth was multiple, and age at
death of each of her children. Mortality can be calculated directly from the
information in the birth history. The methodology for estimation was outlined by
Rutstein (1984). The approach uses the synthetic cohort and calculates the
41

probabilities of death. The use of synthetic cohort permits the calculation of

probabilities of death for the period of time closest to the date of survey. Not all
children born recently have been exposed during entire age range covered by the
mortality measures, as the real cohort probabilities cannot be calculated for recent
births. The mathematical formulation of the model is

n qx = 1

i = x+n

(1 q(i))
i= X

Where (n) q(x) is the conventional probability of dying between ages x and x+n and
q(i) are the sub interval probability of dying. The reliability of this estimate is largely
affected by
1. Omission of births and deaths
2. Misreporting of dates of births and age at death
3. Misreporting of mothers age
However, the reporting of births in recent years is less likely to suffer from such a
limitation. The similar procedure is used to provide the estimates in almost all the
demographic survey.

4.3 RCH Data at District Level:

In the present exercise we have used the Reproductive and Child Health Data (District
Level Household Survey) for estimation of IMR at the district level. For the first time
the RCH, Round II collected the data on birth history of women at the district level.
About 1100 households were covered in each district using systematic random
sampling. The present exercise uses direct calculation of mortality measures based on
the birth history. Keeping the limitations in mind we are careful in providing the
estimates. The estimates are not given for those districts where the sample size is
small or the data quality is believed not to be good. Moreover, we have taken the
estimates in last 0-4 years preceding the survey. As a result the chance of error will be
minimized. It may further be mentioned that the RCH, Round II covered two phases.
The first phase covered half the districts of India during 2003 and the remaining half
were covered in 2004-05. In some of the districts, the survey is continuing and so it
was not possible to provide the estimates for these districts. In some other districts the

42

sample size was not adequate to provide the estimates. Keeping all these in mind, we
have provided the estimates wherever deemed possible and reliable. It may be
mentioned that the first estimates of IMR for half the districts under Round II were
carried out by the RCH team (Ram et al.). We have utilized these estimates. The state
level estimates and estimates of India are based on half of the districts selected under
RCH. However for Phase II we have provided the estimates using the same technique.

4.4 Estimates of Infant Mortality Rate for Districts of India

As we are utilizing the birth history data to provide the estimates at the district level, a
comparative estimate with SRS is provided for India and states (Graph 4.1). The
estimates of IMR are based on information in 0-4 years preceding the survey. The
estimates are also based on half the districts selected in Round II. It is observed that
the estimates derived from the above method are close to that of SRS for the country
and the major states of India. For example, the IMR derived from DLHS-RCH for the
period 2001 is 11 by SRS compared to13 by DLHS-RCH. In general, the estimates
derived by RCH are close to that of SRS for other states.
Graph 4.4.1:

A Comparison of Infant Mortality Rate Estimates of DLHS-RCH and

SRS, 2001

100
SRS

90

91

RCH

86

83

80

76

80

72
66

70
60

50

52

51

49

45

49

48

66
59

58

60

52

62 62

66

68

55

40

40

32

30
20

11 13

10

U
P

ri s
sa
O

M
P

aj
as
th
an

Bi
ha
r

H
ar
ya
na

AP

Pu
nj
ab

Ka
rn
at
ak
a

uj
ar
at
G

M
H

W
B

TN

0
Ke
ra
la

IMR

79

43

Graph 4.4.2: Infant Mortality Rate in Districts of Punjab-2001.

80

75

70

65
60

60

IMR

50

45

40

46

47

48

49

52

53

54

60

55

35

30
21

23

23

20

10

Pa
t ia
N
aw
la
an
Fa
sh
te
ah
hg
r
ar
h
S
ah
ib
G
ur
da
sp
ur
Sa
ng
ru
r
M
og
a
Ba
th
in
da
Ka
pu
rth
al
a
Lu
dh
ia
na
R
up
na
ga
H
r
os
hi
ar
pu
r
Fi
ro
zp
ur
M
uk
ts
a
Am r
ri t
sa
r
Fa
rid
ko
t

Ja
la
nd
ha
r
M
an
sa

Accordingly, we have utilized the above data to provide the estimates at district level.
The IMR estimates for the districts of India are given in Appendix 4. For comparison
purposes the estimates of RGI for the year 1981 and 1991 are also given. We
emphasize understanding the range rather than the value itself. Because the IMR are
quite sensitive to many factors discussed before.

Appendix B gives the estimated value of IMR for the periods 1981 and 1991 as
estimated by RGI, the RCH estimates of IMR based on birth history of women, the
life expectancy at birth for the years 1991 and 2001 and the female literacy of 2001. It
may be mentioned that the estimates of 1981 and 1991 is given to understand the
trends. The estimates derived from RCH may refer to the period 2001 as it is the mid
period of 1999-2003. The data of Warangal district is not available and so the
estimates are not provided for the district. The other districts are arranged in
ascending order of IMR as estimated using RCH data for the year 2001. To
understand the estimates, female literacy, the most preferred indicator of development
is given in the Appendix 4. For the state of Andhra Pradesh, the estimate of IMR
derived from RCH is 59 during this period compared to 66 by SRS. The estimates are
close at the state level. The estimates of IMR vary from 22 to 86 per 1000 live births
44

in the districts of Andhra Pradesh. The districts having lower IMR than the state level
are Cuddapah, Medak, Rangareddi, Anantapur, Karimnagar, Guntur, Chittor,
Mahbubnagar and Khammam. All other districts have higher IMR than the state
average.
In the case of Bihar, the data is yet to be received for 14 districts. The estimates of
IMR in other districts vary from 41 to 86 per 1000 live births. The districts having
higher IMR than the state average are Madhepura, Kathiar, Araria, Khagaria, Paschim
Champaran, Darbhanga, Buxar, Jehanabad, Kisanganj, Purba Champaran and
Madhubani. Similarly, the estimates for other major states of India are given in the
Appendix B. We can classify those districts having IMR of less than 30 as low (as the
target of National Population policy, 2000 to be achieved by 2010), 30-66 as medium
(less than national estimates) and above 66 as high. The implications are that high
priority should be given to the districts with a level of IMR higher than the
national/state average.
4.5 Classification of Districts on Infant Mortality Rate, 2001 (Within the State):

On the basis of estimates of IMR, we have classified the districts of India into three
broad categories, namely, low with IMR of less than 30, medium with IMR between
33 and 66 and high with IMR 67 or more. The names of such districts for each of the
major states are shown below. The rational of this classification is the target of the
National Population Policy (2000) and the national average. The implication is that
the districts with higher level of IMR may be prioritised.

Classification of Districts by Infant Mortality Rate (IMR) levels in India, 2001.

State
Andhra
Pradesh

Bihar

Low
Cuddapah,
Medak

Medium
Rangareddi, Anantapur,
Karimnagar, Nizamabad,
Hyderabad , Guntur, Chittoor,
Mahbubnagar, Khammam,
Vizianangram,
West Godavari,
Warangal,Kurnool.
Siwan, Rohtas, Sitamarhi,
Nawada, Gaya, Patna, Bhojpur,
Aurangabad, Vaishali,
Bhagalpur, Begusarai,
Gopalganj, Muzaffarpur.

High
Prakasam, Nalgonda Nellore, East
Godavari ,Krishna, Adilabad,
Visakhapatnam

Madhepura, Katihar, Araria,

Khagaria ,Pashchim Champaran,
Darbhanga, Buxar, Jehanabad
,Kisanganj, Purba
Champaran,Samastipur, Madhubani.

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State

Low

Chhattisgarh

Medium
Raipur,Kanker, Raigarh,
Dantewara, Rajnandgaon,
Bilaspur, Janjgir-Champa,
Koriya, Durg
Mahesana,Navsari, Junagarh,
Amreli, Kheda, Anand,
Jamnagar, Narmada, Bharuch,
Valsad , Porbandar, Rajkot,
Ahmadabad ,The Dangs,
Gandhinagar, Bhavnagar,
Surendranagar, Kachcha.
Rewari,Bhiwani,Sirsa,Yamuna
nagar,Panchkula,Jind,Jhajjar,
Karnal,Rohtak,Panipat,Kuruks
hetra,
Fatehabad,Mahendragarh,
Gurgaon.
Giridih, Gumla, Purbi
Singhbhum, Dumka, Garhwa,
Deoghar, Kodarma,
Hazaribag, Bokaro.
Uttara Kannada, Dharwad,
Chikmagalur, Bijapur, Bidar,
Chitradurga, Chamaraj nagar,
Belgaum, Haveri, Gadag,
Gulbarga,Bhagalkot,
Kolar,
Tumkur, Mandya.
Wayanad

Gujarat

Surat

Haryana

Sonipat

Jharkhand

Dhanbad.

Karnataka

Banglore,Dakshina
Kannada, Udupi,
Banglore Rural,
Hassan, Kodagu,
Shimoga.

Kerala

Kannur,
Malappuram,
Alappuzha, Idukki,
Palakkad, Kottayam,
Kollam, Earnakulam
,Thrissur,
Pathanamitta,
Kozhikode,
Kasargarh,
Triruvananthapuram.

Madhya
Pradesh

Indore,
Hoshangabad.

Rajgarh, Bhopal, Gwalior,

Mandsaur, Jabalpur, Shajapur,
Betul, Ujjain, Ratlam, Sehore,
West Nimar, Narsimhapur,
Dewas,Neemach, Harda.

Maharashtra

Ratnagiri,Solapur,
Mumbai(Suburba,),
Satara, Sindhudurg

Hingoli, Kolhapur, Mumbai,

Ahmadnagar, Sangli, Thane,
Pune, Jalna, Wardha, Gondia,
Nashik, Amaravati, Parbhani,
Jalgaon Buldhana, Bid,
Nagpur, Osmanabad, Nanded,
Gadchiroli ,Yamatmal, Akola,
Washim, Lature.

High

Kawardha,Surguja,
Jashpur, Mahasamund,
Bastar, Dhamtari, Korba.
Sabar Kantha, Banas
Kantha, Panch Mahals,
Patan.

Kaithal,Faridabad,
Ambala.

Hisar,

Pashchimi Singhbhum,
Lohardaga, Ranchi ,Godda,
Sahibganj.
Raichur, Davanagere,
Mysore, Koppal, Bellary.

Raisen, Dhar, Chhindwara,

East Nimar, Bhind, Katni,
Barwani, Chhattarpur,
Vidisha, Sidhi, Datia,
Jhabua, Damoh, Rewa,
Sagar, Dindori, Umaria,
Sheoni ,Shahdol, Morena,
Satna, Guna, Balaghat,
Mandla,Shivpuri,
Tikamgarh,Panna,Sheopur.
Chandrapur, Aurangabad.

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State

Low

Puri, Cuttack, Dhenkanal,

Jharsuguda, Debagarh,
Sambalpur, Bhadrak, Nayagarh,
Baleshwar, Bargarh, Mayurbhanj,
Sonapur ,Nabrangpur ,Khordh.

Orissa

Punjab

Jalandhar, Mansa,
Patiala.

Rajasthan

Tamil Nadu

Thanjavur,
Kanniyakumari,
Madurai, DindigulAnna, The Nilgiri,
Vellore,
Virudhunagar,
Kancheepuram
Coimbatore, Salem,
Chennai

Almora

West Bengal Kolkatta,

Barddhaman,
Dakshina Dinajpur

High
Anugul, Nuapada, Jajapur,
Koraput, Baudh, Kalahandi,
Ganjam, Sundergarh,

Jagatsinghpur,
Kandhamal, Kendujhar,

Kendrapada, Rayagada,
Balangir, Malkangiri, Gajapati.
Nawanshahr, Fatehgarh Sahib, Faridkot.
Gurdaspur,
Sangrur,
Moga,
Bathinda, Kapurthala, Ludhiana,
Rupnagar, Hoshiarpur, Firozpur,
Muktsar, Amritsar.
Ganganagar, Alwar, Jhunjhunun, Pali, Churu, Hanumangarh,
Dausa,
Jalor
,Dungarpur, Jaipur, Sirohi, Baran, Udaipur,
Jhalawar, Bikaner, Banswara, Bundi, Jaisalmer, Bharatpur,
Sikar,
Dhaulpur,
Barmer, Jodhpur, Ajmer, Tonk,
Bhilwara, Nagaur, Kota.
Karauli,Chhittaurgarh,
Rajsamand, Sawai Madhopur.
Thiruvallur, Sivaganga,
Ariyalur, Viluppuram, Theni.
Ramanathpuram, Pudukkottai,
Thoothukkudi, Thiruvarur, Erode,
Dharmapuri, Tiruchirappalli,
Cuddalore, Nagapattinam,
Tiruvannamalai, Karur (kapur),
Namakkal, Tirunelveli
,Kottabomman, Perambalur.
Deoria, Gautam Buddha Nagar,
Ambedkar Nagar, Bulandshahr,
Auraiya, Sultanpur, Manipuri,
Santkabir Nagar, Firozabad,
Muzaffarnagar, Agra, Mau
,Ballia, Jyotiba Phule Nagar,
Etawah, Chandauli, Sonbhadra,
Kanpur (Nagar), Saharanpur,
Azamgarh, Gorakhpur, Hamirpur,
Mahoba, Kushinagar.

Uttar
Pradesh

Uttaranchal

Medium

Basti, Sharwasti, Meerut,

Ghazipur, Pilibhit, Rampur,
Siddharthnagar , Allahabad,
Ghaziabad, Banda, Varanasi,
Rae Bareli, Maharajganj,
Hathras, Mirzapur, Sant ravidas
nagar, Fatehpur, Jaunpur ,
Ferrukhabad, Kannauj, Bijnor,
Pratapgarh, Jalaun, Hardoi,
Barabanki, Lalitpur, Chitrakoot,
Shahjahanpur, Bahraich,
Sitapur, Kaushambi ,Unnao,
Baghpat, Moradabad, Bareilly
,Faizabad, Jhansi, Budaun,
Kheri, Balrampur ,Gonda
Etah,Aligarh,Mathura.
Rudraprayag, Champawat.

Nainital, Dehradun, Tehri

Garhwal, Garhwal (Pourigarwal),
Udham Singh Nagar, Pithoragarh,
Uttarkashi, Bageshwar,
Hardwar,Chamoli
Uttar Dinajpur, Murshidabad,
North 24 Parganas, Birbhum,
Jalpaiguri Maldah.
Medinipur, Haora, Nadia,
Puruliya, Bankura, Darjiling,
Koach Bihar,
South 24
Parganas, Hugli.

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