"Development" is not essential to reduce infant mortality rate in India: experience from the Ballabgarh project

Background-India aims to reduce the infant mortality rate (IMR) to below 60 per 1000 live births by 2000. IMR is higher in northern India as compared with south Indian states like Kerala. Any further reduction in IMR needs id entification of new strategies. The Ballabgarh project with an LMR of 36 in 1997 can help identify such strategies. Objective-To see the trend in reduction of neonatal mortality rate (NNMR) a nd IIMR at the Ballabgarh project, compare it with Kerala and rural India's trend and look at the causes of neonatal and infant mortality. Design-The Comprehensive Rural Health Services Project, Ballabgarh, run by the All India Institute of Medical Sciences, covered an estimated populatio n of 70 079 in 1997. The health care delivery system is on the national pat tern. All the deaths are identified during the house visits by the male wor kers. The cause of death is ascertained by the health assistant based on th e symptomatology at the time of death. Results-The trends in reduction of IMR for Ballabgarh, Kerala and rural Ind ia are roughly parallel with the IIMR of Ballabgarh lying somewhere in betw een the two. However, the NNMR of Ballabgarh (10.6 in 1996) was comparable to Kerala's NNMR (10.9 in 1992). The proportion of infant deaths occurring during the neonatal period had fallen from 50% in the early seventies to 30 % during 1996-97. In 1992-1994, 33.8% of all neonatal deaths were attributa ble to low birth weight and 37.3% to infective causes. Acute respiratory in fection and diarrhoea continue to be the chief cause of postneonatal mortal ity. Conclusion-It is possible to bring down neonatal mortality before postneona tal mortality. The Kerala model, which focuses on social development, may n ot apply to northern India for sociocultural reasons.