India has made remarkable strides in reducing infant mortality over the past two decades. Yet, with an Infant Mortality Rate (IMR) of approximately 27 per 1,000 live births (SRS 2020), the nation still faces a formidable challenge. Understanding the root causes is the first step towards meaningful action.
Live births — India's Infant Mortality Rate (IMR) as of the Sample Registration System 2020 report. While down from 68 in 2000, the journey to the SDG target of 12 per 1,000 continues.
Every child deserves a healthy start. At Uttar Pradesh Health & Welfare Promotion Trust, we have worked since 2004 to address the underlying determinants of infant and child survival across India's most vulnerable communities. This article outlines the ten most critical causes of infant mortality in India and what must be done to address each one.
Top 10 Causes of Infant Mortality in India
Preterm Birth & Low Birth Weight
India accounts for the largest share of preterm births globally. Babies born before 37 weeks or weighing less than 2.5 kg face dramatically higher risks of respiratory distress, infections, and developmental complications. Inadequate antenatal care, poor maternal nutrition, and early marriage are primary contributors in India's rural heartland.
Neonatal Infections & Sepsis
Infections during the first 28 days of life — including pneumonia, tetanus, and blood infections (sepsis) — remain a leading killer of newborns in India. Unhygienic delivery practices, lack of skilled birth attendants, and delayed care-seeking contribute directly to neonatal deaths from infections, especially in states like Uttar Pradesh, Rajasthan, and Bihar.
Birth Asphyxia
Birth asphyxia — when a baby does not receive enough oxygen during labour or shortly after birth — is responsible for a significant proportion of neonatal deaths and permanent disabilities. The absence of trained healthcare workers and essential resuscitation equipment at the time of birth remains a key challenge in peripheral health facilities.
Pneumonia & Acute Respiratory Infections
Pneumonia is the single largest infectious cause of child mortality globally and remains a critical threat in India. Indoor air pollution from biomass fuels, low immunisation coverage, and lack of exclusive breastfeeding during the first six months significantly increase a child's vulnerability to severe respiratory infections.
Diarrhoeal Diseases & Dehydration
Poor water, sanitation, and hygiene (WASH) conditions expose infants to repeated diarrhoeal episodes that rapidly lead to dangerous dehydration and malnutrition. India's NFHS-5 data reveals that only 43.5% of households have access to safe drinking water on premises, creating an environment where gastrointestinal infections thrive among the youngest children.
Malnutrition & Stunting
With 35.5% of children under five stunted and 19.3% wasted (NFHS-5), India's nutritional crisis directly undermines infant survival. Malnourished infants have weakened immune systems, making every infection life-threatening. Poor complementary feeding practices, low dietary diversity, and anaemia in mothers compound the problem from the very beginning of life.
"Malnutrition is not merely a lack of food — it is the compounded result of poverty, lack of education, poor sanitation, and absent healthcare. Addressing infant mortality means addressing all of these together."
Vaccine-Preventable Diseases
Despite India's Universal Immunisation Programme (UIP), full immunisation coverage remains at only 76.4% nationally (NFHS-5), with significant gaps in several states. Measles, pertussis, and other vaccine-preventable diseases continue to claim infant lives that could be protected with timely and complete immunisation schedules.
Congenital Anomalies & Birth Defects
Congenital conditions affecting the heart, neural tube, and other organs are responsible for a growing share of infant deaths as other preventable causes are addressed. Lack of pre-conception care, micronutrient deficiencies (especially folic acid), and consanguineous marriages in some communities elevate the risk. Strengthening newborn screening programmes is essential.
Maternal Health & Complications During Delivery
The health of a mother is inextricably linked to the survival of her infant. Anaemia affects 57% of pregnant women in India (NFHS-5), and complications such as eclampsia, obstructed labour, and postpartum haemorrhage directly endanger the newborn. Institutional delivery rates, though improving at 89%, vary widely — and the quality of care at delivery points still needs strengthening.
Socioeconomic Disparities & Access to Healthcare
Poverty, gender discrimination, geographic isolation, and low levels of maternal education form the structural bedrock on which all other risk factors rest. Children from the lowest wealth quintile are nearly three times more likely to die before age five than those from the highest. Without addressing these inequities, clinical interventions alone will never be sufficient.
What Can Be Done? UPHWPT's Approach
At Uttar Pradesh Health & Welfare Promotion Trust, we believe that tackling infant mortality requires a multi-pronged strategy anchored in community action, government partnership, and sustained investment. Our programmes focus on:
- Strengthening antenatal and postnatal care through community health worker networks across Uttar Pradesh and beyond.
- Promoting exclusive breastfeeding and timely complementary feeding as the most cost-effective intervention for infant survival.
- Immunisation outreach in hard-to-reach and urban-slum populations to close immunisation gaps.
- WASH interventions including safe water access, sanitation promotion, and hygiene behaviour change.
- Nutrition supplementation for pregnant and lactating mothers to address low birth weight at its root.
- Capacity building of frontline health workers — ASHAs, Anganwadi workers, and ANMs — for better newborn care and emergency recognition.
- Demand generation and social mobilisation to address gender norms, early marriage, and discrimination that drive structural risk.
Every life saved from infant mortality is a future protected — a family kept whole, a community made stronger. We urge policymakers, healthcare workers, donors, and citizens to join hands in making every child's first year the foundation of a long and healthy life.
