There are few markers of a nation’s progress more telling than the survival of its youngest citizens. The latest Sample Registration System report offers reason for cautious optimism: India’s infant mortality rate (IMR) has fallen to a historic low of 25 deaths per 1,000 live births in 2023, a dramatic 37.5 per cent decline from 40 in 2013. This is not just a statistic. It is an index of improved healthcare delivery, expanded immunisation coverage, better nutrition, and increased awareness among parents. Every decimal point here represents countless children who live beyond their first year, families spared grief, and futures that may now unfold. For decades, infant mortality has been a stubborn blot on India’s development narrative, reflecting the gaps between policy ambition and lived reality. A decade ago, international agencies routinely compared India’s performance unfavourably to that of some of its smaller neighbours. Today, while much remains to be done, the tide appears to be turning. Improvements in institutional deliveries, wider availability of neonatal care, and interventions like Janani Suraksha Yojana and Poshan Abhiyan have borne fruit. The push for full immunisation, particularly through the Intensified Mission Indradhanush, has ensured that fewer children succumb to preventable diseases. Clean water initiatives and wider access to sanitation under Swachh Bharat have also contributed indirectly to reducing infant mortality by lowering infection risks.
Still, while India celebrates this progress, comparisons with South Asia underline that the journey is incomplete. Bangladesh, often lauded as a quiet achiever in public health, has already surpassed India. Its IMR, according to UNICEF and World Bank data, hovers around 24 per 1,000 live births. Bangladesh’s success owes much to grassroots innovations: a strong network of community health workers, emphasis on female education, and rapid diffusion of basic healthcare practices like oral rehydration therapy. It is striking that a country with fewer resources has delivered outcomes at par with or slightly better than India, suggesting that governance and last-mile delivery are as critical as budgets. On the other hand, Pakistan continues to struggle, with an IMR estimated at around 55 per 1,000 live births—more than double India’s. The reasons are painfully familiar: weak health infrastructure, low investment in maternal and child health, political instability, and inadequate access to safe water and sanitation. For India, this comparison with Pakistan is sobering but also instructive. It reminds us that progress is not guaranteed by size or aspiration alone. Institutional focus, political will, and social mobilisation matter profoundly. Where Pakistan falters and Bangladesh excels, India must learn to consolidate and innovate further. The broader lesson is that infant mortality is more than a health statistic; it is a mirror to social equity. High IMR often reflects layered disadvantages: poverty, malnutrition, lack of women’s empowerment, and poor access to public services. Even within India, the national average of 25 masks sharp regional variations. States like Kerala, Tamil Nadu, and Maharashtra record IMRs close to developed-country standards, while Madhya Pradesh, Uttar Pradesh, and parts of the Northeast lag behind. Rural areas still fare worse than urban centres, and disadvantaged communities—tribals, scheduled castes, and minorities—bear a disproportionate burden. These disparities call for targeted interventions, not just aggregate improvements. Moreover, the decline in IMR should not lull policymakers into complacency. Infant survival is the first step, but the quality of that survival matters too. Malnutrition, stunting, and lack of cognitive development remain pressing challenges. India may have saved more infants, but too many still face diminished opportunities because of poor early childhood care. Schemes like ICDS and Anganwadi services need strengthening and better monitoring. A focus on maternal health is equally vital, for healthier mothers mean healthier infants.
Another dimension often overlooked is the role of technology and innovation. India has piloted low-cost neonatal care equipment, digital tracking of pregnant women, and tele-medicine support for remote areas. Scaling these up could accelerate progress. At the same time, investment in primary healthcare infrastructure—sub-centres, PHCs, and district hospitals—remains indispensable. Without a reliable public health backbone, gains may plateau. The comparative South Asian picture also reveals a paradox: countries with fewer resources can outperform wealthier neighbours if community mobilisation and governance are robust. India should take this lesson seriously. Training and empowering Accredited Social Health Activists (ASHAs), incentivising community participation, and sustaining behavioural change campaigns can multiply the effect of government schemes. In the long run, building trust between citizens and the health system may prove as important as any fiscal allocation. The decline in IMR is, ultimately, a reminder of what is possible when public policy aligns with human need. But it is also a reminder of fragility. Gains can be reversed by complacency, poor nutrition trends, climate-related health stresses, or uneven state performance. India cannot afford to rest on laurels when thousands of infant lives are still lost every month. If anything, this milestone should embolden us to set sharper targets, invest more in maternal and child health, and learn consciously from neighbours. A society is judged not merely by its economic growth but by how it treats its most vulnerable. By lowering infant mortality, India has moved closer to honouring its constitutional promise of justice and dignity. But true progress will come only when every Indian child, regardless of caste, class, or geography, has an equal chance to live, thrive, and dream. That is the unfinished mission behind the milestone.