India has reduced its Infant Mortality Rate (IMR) from 30 to 24 deaths per 1,000 live births between 2019 and 2024, reflecting an average annual decline of about one point and a faster pace of improvement than in the previous decade. However, despite this overall progress, the latest Sample Registration System 2024 report shows sharp disparities across states, with Chhattisgarh recording the highest IMR at 36, followed by Uttar Pradesh and Madhya Pradesh at 35, while Kerala has brought its IMR down to 8 and Himachal Pradesh, Tamil Nadu and Delhi stand at 11.
The report highlights that one in every 42 infants at the national level still dies before completing one year of life, with the risk rising to one in 37 in rural areas compared to one in 59 in urban regions, underscoring a persistent rural–urban gap. Rural IMR has fallen slightly more than urban IMR (around 36 per cent versus 35 per cent), yet states such as Assam continue to show wide differences between rural and urban infant survival, indicating uneven gains in access and quality of care.
A key driver of the decline has been the surge in institutional deliveries, with the share of live births where mothers received medical attention in government or private facilities rising from under 83 per cent in 2019 to over 95 per cent in 2024, significantly improving immediate care around childbirth. But the experience of Chhattisgarh, where institutional deliveries jumped from 77 per cent to 97 per cent while IMR dropped only about 18 per cent, suggests that hospital births alone are not enough without parallel improvements in neonatal care, postnatal follow-up and community health systems.
The data also point to notable gender and regional differences, with many states reporting higher IMR for female infants and Bihar showing one of the widest gender gaps, while in Jammu & Kashmir, the rate is higher for male babies, illustrating how socio-cultural and biological factors intersect with health services. Further, infant deaths are increasingly concentrated in the neonatal period: neonatal mortality now accounts for nearly 73 per cent of all infant deaths, with India’s Neonatal Mortality Rate at about 18 per 1,000 live births, and states such as Kerala recording the lowest neonatal rate at 6, compared to 26 in Madhya Pradesh and Chhattisgarh.
Public health experts stress that sustaining and deepening the gains will require targeted interventions in high-burden states, including scaling up special newborn care units, strengthening primary healthcare in rural and tribal areas, and addressing social determinants such as maternal nutrition and early marriage. They warn that without focused action to close the wide interstate gaps and improve care in the first 28 days of life, India risks a plateau in infant mortality reduction even as national averages continue to improve, masking pockets of preventable deaths.
