India’s life expectancy at birth (LEB) has doubled since independence, largely due to efforts to ensure access to nutrition, healthcare and pharmaceutical innovation. But there is no room for complacency as this is only the start of a long road ahead. India’s LEB at 69.7 years according to the sample registration survey data for 2015-2019 is still lower than the world average of 72.6 years. It took a decade to increase it from just two years at the last instance. While the gap with developed countries is quite large – LEB in Organization for Economic Co-operation and Development (OECD) countries in 2019 was 81 – India even fares poorly against Bangladesh (72 ,59 years old). Rema Nagarajan’s analysis in The Times of India shows that India must tackle child mortality to increase LEB; states with a high infant mortality rate (IMR) showed the largest gains in life expectancy change at years zero, one, and five.

While India has been admirably successful in reducing the IMR, defined as the number of deaths of children under the age of one per 1,000 live births, from 47 in 2010 to 28 in 2020 according to National Survey data on Family Health (NFHS), it still compares unfavorably with not only the OECD (4.1) but also Bangladesh (25.6). At the national level, India appears to be on track to meet the Sustainable Development Goal of 25 or less, but whether the pandemic and resulting worsening vulnerabilities have shaken the record remains to be seen, especially more than progress in reducing IMR slowed in the five years before the pandemic. After a dramatic improvement between 2009 and 2014, from 50 to 39, it has slowed down, with a sharp deceleration in some of India’s poorest states, including Madhya Pradesh, Uttar Pradesh and Chhattisgarh. There is also a strong divide between rural and urban areas.

India’s IMR Index has benefited a series of government programs aimed at strengthening health and nutrition support for pregnant and lactating women, as well as more effective implementation of programs aimed at strengthening health outcomes for women and children. However, there remain critical obstacles in terms of the availability of affordable healthcare infrastructure, logistics and adequate insurance coverage; these would explain most of the urban-rural and interstate variation in IMR performance. The shortage of skilled health personnel severely limits access to interventions that can prevent neonatal deaths from complications.

A 2020 study, published in BMJ, showed using NFHS Round IV data that the life expectancy of vulnerable groups such as SCs and STs tended to be relatively lower. State governments and the Center need to further investigate this issue. Immediate efforts must be made to improve access to health care, especially for children and women of childbearing age. Against a requirement of 202 community health centers in the tribal areas of Madhya Pradesh, there were less than half and only five obstetricians against the required 96. Anemia among Indian women also continues to be an outsized factor. According to NFHS data, more than half of women between the ages of 15 and 49 suffer from it, and their pregnancies therefore lead to serious complications for their children, at birth and later. Without a multi-pronged approach to tackling early mortality, efforts to increase life expectancy at birth will remain sisyphian.