Infant Mortality and Low Birth Weight in the Kolhan Region of Jharkhand

What is Infant Mortality?

Infant Mortality is the probability that a child born in a specific year will die within the first year of life, subject to age-specific mortality rates of that period. It serves as a key indicator of both child survival and the overall health of the population, as the factors influencing infant mortality, such as access to clean and safe drinking water, access to proper sanitation, food security, and access to healthcare, also shape the well-being of a society. Therefore, IMR (Infant Mortality Rate) reflects a society’s social, economic, and environmental conditions and is often used to identify vulnerable populations of a country.

There are two types of Infant Mortality:

Neonatal Mortality: This refers to the death of a newborn within 28 days of their birth. Primary causes of neonatal mortality are jaundice, respiratory distress, birth asphyxia and low birth weight(LBW).
Post Neonatal Mortality: This refers to the death of a newborn between 28 days and one year of age. Primary causes of post neonatal mortality are untreated infections, environmental factors, and sheer neglect of an infant.

Infant Mortality and Low Birth Weight:

An infant is considered to have low birth weight if it weighed less than 2.5kg at the time of their birth. Globally approximately 20% of all births are low birth weight. A newborn’s weight is a strong indicator of its health and nutrition. A newborn with a low birth weight implies that the fetus was severely undernourished in the womb, stunting a newborn’s physical and mental growth, which in turn often leads to premature death. Low birth weight is one of the strongest predictors of infant mortality. In India, 83% of all births with low-birth-weight result in death within the first 28 days of their birth.¹ Additionally, newborns with a low birth weight are 11 to 12 times more likely to die before they turn one year old. Furthermore, infants with low birth weight, have a 200% higher risk of death compared to infants with a normal birth weight and this risk worsens by 37% in case the infant with low birth weight is also a premature infant.²

Why does low birth weight lead to Infant Mortality?

Infants with low birth weight are more susceptible to several risk factors such as intrauterine growth retardation, fetal anomalies and placenta conditions that increases the likelihood of their death. A study by (Prabbati et al, 2019) highlighted that out of 344 newborns with LBW, for 170 of them were diagnosed with Jaundice, 77 had Respiratory Distress, 37 had Sepsis, 19 had Apnea, 9 had Asphyxia, 8 had Hypoglycemia, 2 had Hyperglycemia, 4 had NEC, 1 had Early HDN, 1 had Polycythemia, 14 had Congenital Abnormalities and 2 had PDA.³ Another study by (Sweet et al, 2017) reveals that newborns with diseases such as Respiratory Distress are 2 times more likely to die as compared to its counterparts that are free of these diseases.⁴ Therefore, being born with low birth weight predisposes newborns with diseases that significantly increases their likelihood of death.

Trends of Infant Mortality in India:

Globally, infant mortality rate (IMR) averages at 25 deaths per 1000 live births. Developed nations usually maintain an IMR below 5 deaths per 1000 live births. On the other hand, developing nations stand at an IMR greater than 25 deaths per 1000 live births, while underdeveloped countries face even higher rates, surpassing 50 deaths per 1000 live births.

IMR Trends In India from 2014 - 2020 — [Source – SRS]

According to the graph above, India has decreased its Infant Mortality Rate by 28% over a period of six years (2014-2020). From 2014 to 2016, the decline was quite steep, averaging a reduction of 2.5 deaths per 1000 live births each year. However, between 2016 to 2018, the rate of decline slowed, with a decrease of only 7 percentage points. After 2018, the decline accelerated again, reaching a 13% reduction

In 2014, the disparity between urban and rural IMR was quite unsettling. Rural India was experiencing 17 more deaths per 1000 live births than its urban counterparts. While this gap reduced over the years, it highlighted that the decline in urban India was not as significant as rural India over the years. One plausible reason of India failing to keep up with its existing pace of decline between the period of 2016 to 2018 could be the stagnation of IMR in urban India. As a result, while the overall IMR for the country decreased, the stagnation in urban areas slowed the progress.

Under the Millenium Development Goal, India aimed to reduce its Infant Mortality Rate to 28 deaths per 1000 live births by 2015. Although India did not meet this goal by 2015, it achieved it within the next five years. By 2020, India reduced its IMR to 28, marking a significant milestone with a 20% decrease over the five-year period.

In 2007, 9 out of 28 states in India contributed to the 70% of all neonatal deaths in India and 1 in 5 neonatal deaths globally⁵. These nine states were: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttarakhand, and Uttar Pradesh. Out of all these states, Jharkhand was the only state out of the nine, to achieve the MDG target by 2020.

Low Birth Weight and Infant Mortality in the Kolhan Region of Jharkhand:

While India has made progress in reducing infant mortality, the impact varies across regions. Economically weaker and tribal-dominated areas often experience higher IMR due to limited healthcare access. However, the Kolhan region of Jharkhand defies this trend. Despite its economic challenges, targeted interventions like Project MANSI, launched by the Tata Steel Foundation and the American India Foundation in 2019, have significantly improved infant survival rates. As a result, Kolhan’s IMR is not only better than Jharkhand’s state average but also lower than the national average.

That said, low birth weight (LBW) remains a key concern in the region – accounting for 33% of all births, contributing significantly to infant mortality. To further reduce IMR, it is crucial to mitigate the influence of LBW on IMR. The following section provides a district-wise breakdown of infant mortality due to LBW in Kolhan, highlighting variations in mortality rates across West Singbhum, East Singbhum, and Seraikella Kharaswan, identifying the areas that require targeted interventions to drive further improvements in IMR.

Data Source:

Data used for the analysis below has been extracted from “Operations Sunshine” – “it is an innovative digital platform for real time tracking system of high-risk newborns or mothers through mobile android-based application software with an integrated approach for reducing neonatal child mortality under Project Maternal and Newborn Survival Initiative (MANSI) – PPP initiative under Jharkhand NHM”⁵. The dataset includes information on various factors such as the infant’s birthweight, residence (by district, block, panchayat, and village), religion, caste, gender, preterm status, child type and the infant’s status. The data covers the period of 2023- 2024.

Analysis:

By Region:

The total number of infant deaths in Kolhan Region of Jharkhand between 2023-2024 is 979. Out of these, 649 deaths were attributed to low-birth-weight, which accounts for 67% of all infant deaths. Additionally, infant mortality rate for those with low birth weight is 17 deaths per 1000 live births.

The Kolhan Region consists of three districts: West Singbhum, East Singbhum and Seraikella Kharaswan. West Singbhum records the highest number of deaths, and the percentage of deaths attributed to low birth weight is also the highest in this district. This is followed by Seraikella Kharaswan and East Singbhum.

However, given that the total number of births is highest in West Singbhum, the ratio of low birth weight (LBW) deaths to LBW births, is the highest in Seraikhella Kharaswan. This indicates that the burden of deaths due to lbw is greater in this region compared to West Singbhum.

This difference is reflected in the infant mortality rate due low-birth-weight in each of these regions. According to the table below, Seraikella-Kharaswan has the highest infant mortality rate due to low-birth-weight, followed by West Singbhum and East Singbhum, with an IMR (due to LBW) of 10 deaths per 1000 live births with LBW.

By infant type and region:

Infants can be categorised into two groups: neonates (newborns under 28 days old) and post-neonates (newborns between 28 days and one year old). It can be seen percentage of neonatal death is 1.54 percentage points higher than post-neonatal death.

Moreover, contribution of LBW to neonatal deaths is highest in West Singbhum, followed by Seraikella Kharaswan and East Singbhum. However, the contribution of low birth weight to post neonatal deaths is unexpectedly higher in Seaikella Kharaswan and East Singbhum.

When accounting for the number of births in each of these category, we observe that West Singbhum has the highest NMR (due to low birth weight) with 21 deaths per 1000 live births with LBW. In contrast, Seraikella Kharaswan has the highest IMR (due to low birth weight) with 14 deaths per 1000 live births with LBW.

Conclusion:

In conclusion, Kolhan region of Jharkhand reported a comparatively lower infant mortality rate (IMR); however, the region suffers from a relatively higher prevalence of low birth weight (LBW) outcomes than the national average. This gap underscores the need for enhanced prenatal counselling, particularly on aspects that can help prevent LBW such as – Iron-folic acid supplementation, nutrition, antenatal care attendance and greater reliance on doctors than traditional healers.

Seraikella Kharaswan has the greatest post-neonatal mortality due to LBW, while West Singbhum has relatively higher neonatal mortality because of LBW. This could be due to lower acceptance of institutional deliveries and SNCU admission of newborns with LBW in West Singbhum. Hence, strengthening institutional support and mandating Special Newborn Care Unit (SNCU) admission for newborns with low birth weight can help reduce NMR (due to LBW) in West Singhbhum. On the other hand, provision of triad of intensive post discharge counselling to address post-neonatal mortality and reduce the likelihood of infections among post-neonates could be an effective strategy for Seraikella Kheraswan.

Bibliography:

Dandona R, Kumar GA, Henry NJ, Joshua V, Ramji S, Gupta SS, et al. Sub national mapping of under-5 and neonatal mortality trends in India: the global burden of disease study 2000–17. Lancet. 2020;395:1640–58.
Jana, A., Saha, U. R., Reshmi, R. S., & Muhammad, T. (2023). Relationship between low birth weight and infant mortality: Evidence from National Family Health Survey 2019-21, India. Archives of Public Health, 81(1). https://doi.org/10.1186/s13690-023-01037-y
Pabbati, J., Subramanian, P., & Renikuntla, M. (2019). Morbidity and mortality of low-birth-weight babies in early neonatal period in a rural area teaching hospital, Telangana, India. International Journal of Contemporary Pediatrics, 6(4), 1582. https://doi.org/10.18203/2349-3291.ijcp20192759
Sweet, L. R., Keech, C., Klein, N. P., Marshall, H. S., Tagbo, B. N., Quine, D., Kaur, P., Tikhonov, I., Nisar, M. I., Kochhar, S., Muñoz, F. M., & Brighton Collaboration Respiratory Distress in the Neonate Working Group (2017). Respiratory distress in the neonate: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine, 35(48 Pt A), 6506–6517.
Coffey, D., Franz, N., Arenberg, S., Xu, M., & Vyas, S. (2022, April 13). Annual health survey (AHS), India, 2007-2012. Annual Health Survey (AHS), India, 2007-2012. https://doi.org/10.3886/ICPSR38097.v2

Author

Sampriti Bhattacharjee

"Sampriti Bhattacharjee is currently serving as a Banyan Impact Fellow with AIF's MANSI program in Jamshedpur, Jharkhand. She holds a Master’s degree in Population Studies and Health Economics from the Gokhale Institute of Politics and Economics and a Bachelor’s degree from Ashoka University. Her academic journey has been deeply anchored in Development Economics, with a particular focus on Maternal and Child Health—a passion that was ignited during her undergraduate studies through various elective courses exploring the intersection of health and economics. Sampriti's research interests have driven her to examine the determinants of child health, particularly within the Indian context. Her thesis, titled “The Role of Birth Order, Birth Spacing, and Son Preference on Stunting: Evidence from India,” allowed her to delve into the complex relationship between health and its broader economic implications. Recognizing the critical influence of maternal health on child outcomes, Sampriti was committed to further exploring the determinants of maternal health. To pursue this goal, she undertook an internship at the Institute for Social and Economic Change (ISEC), where she conducted research and authored a paper on the “Impact of Socioeconomic Factors on the Uptake of Maternal Health Services in Karnataka.” The intention behind this research was to uncover the reasons preventing women in Karnataka from accessing maternal healthcare and to improve policy interventions that target these barriers. With the same enthusiasm and determination, Sampriti is eager to work towards improving the maternal and infant health conditions of the Santhal community living in Jamshedpur."

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