Odisha’s infant mortality paradox: Analysing the systemic gaps behind persistent high rates

On June 14, 2025, Somari (name chaged) held her baby girl for the last time. Just 17 days old, weighing barely 2.22 kilogrammes at birth, the infant's death in Keonjhar district's Harichandanpur block represents what is wrong with Odisha's maternal and child health system.

What makes this tragedy particularly damning is that Somari did everything "right"; she registered for antenatal care (ANC), accessed Integrated Child Development Services, and delivered at an institution. Yet her daughter became another number in Odisha's grim infant mortality statistics.

Paradox of progress

Somari's loss encapsulates Odisha’s healthcare paradox. The latest Sample Registration System (SRS) report 'SRS bulletin Volume 57 No 1', which captures annual estimates on Infant Mortality Rate (IMR), birth and death rates and other demographic indicators, showed the state's IMR at 32 per 1,000 live births, a decline from 51 in 2013. It is a steady progress for the state, yet it is significantly behind the national average of 26. 

The persistence of high infant mortality in Odisha isn't just a health indicator but it reflects socio-economic health realities of the state. We have listed four major reasons for the same. 

First, deficiencies in maternal health and nutrition. The health of a mother directly impacts the survival of her infant. As per National Family Health Survey (NFHS-5) 2019-21, in Odisha around 77 per cent of mothers received ANC in the first trimester, with around one in four mothers left without the process critical for identifying and managing risks during pregnancy. On the other hand, high prevalence of anemia among women (64.3 per cent) in the state is a major risk factor associated with low birth weight children like Somari’s daughter. 

The second reason comprises challenges in access and timeliness of health care. Nearly 9 per cent of births still take place at home in the state. Among these, only one in 10 of those newborns are taken to a health facility within the first 24 hours. That first day can mean the difference between life and death, yet for many families in rural and tribal areas, distance, poor infrastructure, and cultural norms keep them away from timely care. 

The third factor is post-natal nutrition and feeding practices gaps. The first two years of a child’s life are critical, but feeding and nutrition practices often fall short. NFHS-5 data highlighted that around 73 per cent of infants under six months of age are exclusively breastfed in the state, but only 67.5 per cent of children aged 6-8 months receive solid or semi-solid food alongside breast milk, indicating delays in introducing complementary feeding.

Also, one in five children aged 6-23 months receive an adequate diet. Although this is above than national average (11.1 per cent) but it still reflects poor dietary diversity and meal frequency. It is more of a representation of challenges in accessing food and poverty among the families. The result is stark: Nearly two-thirds of Odisha’s children under five are anemic, leaving them vulnerable to illness and stunted growth as well as their survival. 

Finally, socio economic and cultural determinants have an effect on the state's IMR. Behind these statistics lie deep social barriers. A fifth of women in the state are married before turning 18, and adolescent pregnancies remain high at 20.5 per cent in the state. With one-third of women still unable to read or write, many young mothers lack the information and support needed to safeguard their own health and that of their children leading to poor survival outcomes. 

State intervention

The state has not remained a silent spectator. Over the years, Odisha has rolled out a range of programmes to address these challenges. These include cash incentive schemes like Maternity Benefit Scheme and Janani Suraksha Yojana to support pregnant and lactating women for better nutrition, compensation against wage loss and to promote institutional deliveries, breast feeding and child immunisation.

The Janani Shishu Suraksha Karyakram was rolled out with the aim of reducing the financial burden by covering medicines, diagnostics, and transport. The Village Health and Nutrition Days bring check-ups, immunisation and counseling closer to families.

There are also community-based efforts, such as the Sishu Abong Matru Mrityuhara Purna Nirakaran Abhiyan to reduce maternal and child mortality, Community Management of Acute Malnutrition for managing severe acute malnutrition, and the Pada Pushti Karyakram for the children in remote communities with poor access to Anganwadi services. 

Way forward

Odisha has made significant strides in reducing infant mortality over the past decade, but persistent challenges remain. Bridging these gaps is crucial for sustaining momentum and ensuring equitable health outcomes across the state.

To accelerate the reduction of IMR in Odisha, the first step should be to strengthen maternal, child and adolescent health services. This can be achieved by ensuring timely and quality antenatal, postnatal and newborn care, especially for home deliveries through early registration, regular check-ups and follow-ups.

Adolescent health must also be addressed and early marriages reduced by promoting education, reproductive health services and community awareness to delay marriage and prevent adolescent pregnancies.

The second area of focus must be enhancing nutrition and community-based interventions. Promoting exclusive breastfeeding, timely complementary feeding and dietary diversity through platforms like Village Health Sanitation and Nutrition Days, home visits and counseling by frontline workers, and investment in broadening food basket for the target group are imperative.

Tailored behaviour change communication strategies and services for illiterate and marginalised populations to encourage safe maternal and child health and nutrition practices are also essential.

Finally, there is the need to strengthen systems and convergent action in underserved areas. The foremost step towards this goal is to bridge health system gaps in remote regions by improving frontline worker capacity, infrastructure and essential services.

This has to be complemented with action to ensure last-mile delivery in tribal and inaccessible areas using equity-focused approaches, and to foster multi-sectoral convergence across health, nutrition, WASH, education, and women’s empowerment to address infant mortality comprehensively.

Odisha’s policy frameworks are in place and programmes have laid a strong foundation. But until these systemic gaps are addressed, Somari Juanga’s 17-day tragedy will continue to be repeated across the state. Only through continued investment, adaptive strategies and community-centered approaches can the state administration ensure that every child not only survives but thrives. 

Ramesh Sahu is an Odisha-based independent researcher working on maternal & child health and nutrition. Sameet Panda, also from the state, is associated with the Right to Food Campaign and LibTech India, a centre at Collaborative Research and Dissemination. Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.