Factors Influencing Under-Five Mortality in India: A Survival Analysis Approach

Abstract

Infant and child mortality remains a major public health concern in developing countries such as India, where socioeconomic and demographic disparities substantially influence health outcomes. This study examines the determinants of under-five mortality using data from the National Family Health Survey (NFHS). Survival patterns were analyzed using Kaplan–Meier survival curves and associated risk factors were quantified using the Cox proportional hazard model. The results indicate that size at birth, mother’s education, household wealth, and birth order are the most influential determinants of child survival. Children born small experienced substantially higher mortality risk, while higher maternal education and improved household wealth were associated with significantly better survival outcomes. Second and third-born children exhibited lower mortality risks compared to first born and higher order births. Additionally, children who resided in urban areas showed better survival prospects than those in rural areas. These findings highlight the combined influence of biological vulnerability at birth and socioeconomic disadvantage on under-five mortality. Policies aimed at improving maternal nutrition, expanding women’s education, reducing poverty, and strengthening healthcare access particularly in rural areas are essential for reducing child mortality and achieving equitable child health outcomes in India.