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Socioeconomic and gender inequalities in neonatal, postneonatal and child mortality in India: a repeated cross-sectional study, 2005–2016
  1. Omar Karlsson1,2,
  2. Rockli Kim3,
  3. William Joe4,
  4. S V Subramanian3,5
  1. 1 Centre for Economic Demography, Lund Universitet Ekonomihogskolan, Lund, Sweden
  2. 2 Department of Economic History, Lund Universitet Ekonomihogskolan, Lund, Sweden
  3. 3 Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
  4. 4 Population Research Centre, Institute of Economic Growth, Delhi, India
  5. 5 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Omar Karlsson, Centre for Economic Demography, Lund Universitet Ekonomihogskolan, Lund 223 63, Sweden; omar.karlsson{at}


Background In India, excess female under-5 mortality is well documented. Under-5 mortality is also known to be patterned by socioeconomic factors. This study examines sex differentials and sex-specific wealth gradients in neonatal, postneonatal and child mortality in India.

Methods Repeated cross-sectional study of nationally representative samples of 298 955 children 0–60 months old from the National Family Health Surveys conducted in 2005–2006 and 2015–2016. The study used logistic regression models as well as Cox proportional hazards models.

Results Overall, boys had greater neonatal mortality than girls and the difference increased between 2005–2006 and 2015–2016. Girls had greater postneonatal and child mortality, but the difference decreased between the surveys and was not statistically significant for child mortality in 2015–2016. A negative wealth gradient was found for all mortality outcomes. Neonatal mortality was persistently greater for boys. Girls had higher child mortality than boys at low levels of wealth and greater postneonatal mortality over much of the wealth distribution. The wealth gradient in neonatal mortality increased between surveys. Females had a stronger wealth gradient than boys for child mortality.

Conclusion Not distinguishing between neonatal, postneonatal and child mortality masks important gender-specific and wealth-specific disparities in under-5 mortality in India. Substantial gains towards the Sustainable Development Goals can be made by combating neonatal mortality, especially at low levels of wealth. Although impressive improvements have been made in reducing the female disadvantage in postneonatal and child mortality, concerted engagements are necessary to eliminate the gender gap—especially in poor households and in north India.

  • gender
  • inequalities
  • mortality

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  • Contributors All authors contributed to the study concept and design, the interpretation of findings and the drafting of the manuscript. OK acquired the data and performed the statistical analysis. OK is the guarantor for the overall content of this article. All authors approved the final version of the submitted manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.