The Infant Mortality Rate (IMR) is a sensitive indicator of infants health population health as well as socio-economic development. In addition, IMR is a sensitive indicator of the availability, utilisation and effectiveness of health care, particularly perinatal care (WHO,1981).

The IMR of the state registered a consistent decline from 110-120 in 1970s to 66-70 in 1990s (Figure 1). The All India (dark green line in fig 1) estimate of IMR was about 130 during the 1970s and declined to about 70-80 during the 1990s. The reduction of IMR in AP (red line in fig 1) has been keeping pace with the national trend. However performance of the state has been much less than that of the neighboring states. Kerala started with a lower level of IMR during the 1970s and has experienced consistent improvements over time. Tamil Nadu started with a level of IMR similar to AP. The decline of IMR in Tamil Nadu is higher than in AP. Both states started with similar levels of IMR in 1970s and improved the same more or less similarly during the 1980s. During 1990s, Tamil Nadu continued its improvements in IMR but Andhra Pradesh appears to have slowed down, resulting in a gap of about 10 infant deaths per 1000 live births between the two states. Orissa (light blue line in fig 1) also shows decline in IMR from 149 in 1975 to 97 in 1999. In Madhya Pradesh (brown line in fig 1) there was an increase in IMR in 1975 but again declined in 90s to about 97 in 1999.

Figure 1: Infant mortality trend in AP and other neighbouring states

Source: SRS Annual Reports, 1971 - 1999.

Though AP has performed reasonably well in reducing IMR, it has definitely not been able to exploit the full potential available to it. Of particular concern is the slow down in reduction of IMR in the state, during the 1990s.

The NFHS surveys in 1992-93 and 1998-99 provide an independent estimate of IMR and its trend. The figure 2 shows IMR from the two NFHS surveys. The time trend and comparative position of AP vis a vis to other South Indian states is similar to the estimate from the SRS presented earlier in Figure 1. IMR in AP is slightly lower than the national average and is higher than other south Indian states. The decline in IMR between NFHS 1 and 2 is more marked for Kerala, Tamil Nadu, and Karnataka.

Infant mortality in AP declined from 85 deaths per 1000 live births during 1984-88 to 66 deaths per 1000 live births during 1994-99, an average rate of decline of nearly 2 infant deaths per 1000 live births per year. A comparison of the IMR for the period of NFHS-1 and NFHS-2 suggests a similar rate of decline of 11 deaths per 1000 live births. NFHS-1 suggests a much slower decline of only 4 deaths per 1000 live births.

Figure 2: IMR trend in AP and other states according to NFHS-1&2

Source: NFHS-1 data from IIPS(1995) Table-8.8 p221; NFHS-2 data from IIPS(2000) Table-6.6 p194

Despite the overall decline in infant and child mortality, 1 in every 15 children born during the mid 1990s i.e., five years before NFHS-2 died within the first year of life. Clearly, child survival programmes in AP need to be intensified to achieve further reductions in infant mortality.

In Andhra Pradesh rural infant mortality rates are considerably higher than urban mortality rates. Infant mortality in rural areas is almost double that of urban areas. There was a sharp decline in IMR during the 1970s both in the rural and urban areas. The decline in rural areas must have been greater since the rural urban gap has reduced from about 43 infant deaths per 1000 live births during the 1970s to about 15 infant deaths per 1000 live births in 1980s. However the trend of reducing rural urban gap in the 1980s appears to have been lost or probably reversed during the 1990s.

Figure 3: IMR in Urban and Rural areas of Andhra Pradesh

Source: SRS 1970 to 1999.

Figure 4 shows that IMR in urban areas declined from around 62 in 1992-93 to 46 around 1998-99. But the rural IMR stagnated around 79 between the two surveys. As a result the rural urban gap increased. The NFHS estimate of increasingly urban rural difference is consistent with SRS estimate of widening rural urban gap during the late 1990s. The widening rural-urban gap is also evident from two NFHS conducted during the 1990s.

 Source: NFHS-1 data from p-132, table no:8.4. and NFHS-2 data from p-120 table- 6.3

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