Determinants of infant mortality in Pakistan: evidence from Pakistan Demographic and Health Survey 2017-18

Background The infant mortality rate was very high in Pakistan until the early 1990s, at 86 deaths/1000 live births. It has decreased 24 points and declined to 62 deaths/1000 in the last 3 decades, but Pakistan is still in the group of countries with highest infant mortality rate. The present study aimed to assess the magnitude of infant mortality in Pakistan and its causes and associated risk factors. Methods For this study, data from the 2018 Pakistan Demographic and Health Survey were used. Risk factors for infant mortality were first examined in bivariate analyses. Chi-square test was employed to understand the significance level of the categorical difference of independent variables. The Cox proportional hazard model was used to account for potential confounders that function as risk factors for infant deaths. Results Large differentials in infant survival by socioeconomic and demographic factors indicate poor coverage of social and health schemes for the public. Mothers who did not use the ANC services experienced about 1.5 times higher infant mortality than those who did (52 vs. 36/1000 LB; p = 0.007). The hazard model shows that rich households experienced about 30% (HR = 0.735; 95% CI = 0.614-0.878) less infant mortality than poor ones. The rural-urban differential in public health services and gender inequities are the underlying causes of the stagnation of infant mortality in Pakistan. Conclusion The low status of women's education, poor economic conditions and low level of using public health care services are closely tied to higher infant death rates in Pakistan. Health interventions in Pakistan should be designed to reach the most under-served-women and children-especially in rural areas.