Child Mortality Indicators
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Direct answer
Child mortality indicators are standard rates that count deaths per 1000 live births within defined age windows. The neonatal mortality rate counts deaths in the first 28 days, the infant rate counts deaths before one year and the under-five rate counts deaths before five years. Perinatal mortality is calculated differently, combining stillbirths and early neonatal deaths within the first seven days.
What you must remember
- Neonatal mortality rate (NMR): deaths in the first 28 days of life per 1000 live births.
- Infant mortality rate (IMR): deaths before one year of age per 1000 live births.
- Under-five mortality rate (U5MR): deaths before five years of age per 1000 live births.
- Perinatal mortality rate: stillbirths plus early neonatal deaths within seven days, per 1000 total births.
- Maternal mortality ratio: maternal deaths per 100,000 live births, a separate indicator that is often confused with child rates.
- Leading neonatal causes: complications of preterm birth, birth asphyxia, neonatal sepsis and congenital anomalies.
- Leading under-five causes: pneumonia and diarrhoea, with preterm birth complications, sepsis and malnutrition contributing.
Calculating and reading a mortality rate
A child mortality rate depends on the correct age window and the correct denominator, and both are common sources of error. The steps below show how to build the rate from its parts and then interpret it.
- Fix the age window: choose the neonatal window (0 to 27 days), the infant window (under one year) or the under-five window (under five years), since each rate uses a different window.
- Count the deaths: identify the deaths within that window among children born alive in the period under study.
- Choose the denominator: use live births for NMR, IMR and U5MR, but use total births, including stillbirths, for perinatal mortality.
- Multiply by 1000: express the result per 1000 of the chosen denominator, so the rate can be compared across populations.
- Interpret the cause mix: neonatal rates reflect birth care and preterm survival, whereas under-five rates also reflect infections, nutrition and immunisation.
- Compare with the target: the Sustainable Development Goal aims for under-five mortality of 25 or fewer and neonatal mortality of 12 or fewer per 1000 live births by 2030.
A rate falling in one window while rising in another signals that the causes are shifting, which is why each window is reported.
Where the exam tries to catch you
Mortality questions test the age window and the denominator. Each trap below misplaces one of these two.
- Trap: using total births in the denominator for IMR. Correct: IMR uses live births, and only perinatal mortality includes stillbirths in its denominator.
- Trap: counting a death on day 30 as a neonatal death. Correct: neonatal mortality covers deaths in the first 28 days, so a death on day 30 counts as an infant death but not a neonatal one.
- Trap: confusing the maternal mortality ratio with a child mortality rate. Correct: the maternal mortality ratio is per 100,000 live births and refers to deaths of women from pregnancy-related causes.
Frequently asked questions
What is the difference between the neonatal and infant mortality rate?
The neonatal mortality rate counts deaths in the first 28 days of life per 1000 live births, while the infant mortality rate counts deaths before one year per 1000 live births. The infant rate therefore includes neonatal deaths plus deaths from 28 days to one year. Both use live births as the denominator.
How is the perinatal mortality rate calculated?
The perinatal mortality rate is the number of stillbirths plus early neonatal deaths within the first seven days, divided by total births and multiplied by 1000. Its denominator includes stillbirths, unlike the infant and neonatal rates. The rate is widely used to judge the quality of antenatal and delivery care.
What is the sustainable development target for under-five mortality?
The Sustainable Development Goal target is to bring under-five mortality to 25 or fewer deaths per 1000 live births, and neonatal mortality to 12 or fewer per 1000 live births, by 2030. Countries report progress against these figures in national surveys and registration systems. The targets are used to frame national child health programmes.
What are the leading causes of neonatal deaths in India?
Preterm birth complications, birth asphyxia, neonatal sepsis and congenital anomalies are the leading causes of neonatal deaths. Pneumonia and diarrhoea dominate deaths in later infancy and early childhood. Proportions shift over time, so the latest national reports should be checked before any figure is quoted.
Which Indian source reports the infant mortality rate?
The Sample Registration System, run by the Office of the Registrar General of India, publishes infant and under-five mortality estimates. Recent bulletins have shown a steadily falling infant mortality rate, in the mid-twenties per 1000 live births in the latest report. The most recent bulletin should be checked before a figure is quoted in an examination.