RB-86

RESEARCH PAPER

Diversity in Child Mortality and Life Expectancy at Birth Among Major

Tribes in Selected States of India
ARVIND VERMA1, RAVENDRA K SHARMA2 AND KALYAN B SAHA1
From 1Indian Council of Medical Research (ICMR) – National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh,
India and, 2ICMR-National Institute of Medical Statistics, New Delhi, India.

Correspondence to: Dr Arvind Verma,
Principal Technical Officer, ICMR-
National Institute of Research in Tribal
Health, PO-Garha, Nagpur Road,
Jabalpur 482 003, Madhya Pradesh,
India. vermaarvind1@rediffmail.com
Objective: To provide tribe- specific child mortality rates and health indicators from selected
states in India. Methods: We used Census 2011 data and Coale Demney methodology to
estimate the infant mortality rate (IMR), under-five mortality rate (U5MR) and expectation of
life at birth (LEB) for 123 tribes of selected states of India. Results: The estimated IMR and
U5MR were higher in scheduled tribe population compared to respective state’s total
population. The IMR varied from 124 in the Birhore tribe of Chhattisgarh and Jharkhand, and
the Bharias of Madhya Pradesh to 48 per 1000 live births in the Gamit tribe of Maharashtra.
Similarly, the U5MR varied from the highest (203) in the Birhore tribe of Chhattisgarh to the
lowest (57/1000 live births) in the Gamit tribe. The LEB varied from 72 years in the Gamit tribe
of Maharashtra to 51 years in the Birhore tribe of Chhattisgarh. The study reveals that tribes
have gross variation in child mortality rates and there is pressing need to prioritize tribe-
specific action plans to improve their health indicators.
Key words: Health, Indigenous population, Infant mortality, Neonatal care, Under-5
mortality rate.

I
ndia has 705 Scheduled Tribal groups (ST) with a
population of 104 million (8.6% of total population)
as per 2011 census. These tribal groups constitute
the second largest tribal population in the world
after the Africa continent. These tribal groups belong to
different ethnic groups and are at different levels of
development. The tribal population contributes
considerably to infant and under five deaths. As per
recent NFHS-4 survey in 2015-16, infant mortality rate
(IMR) and under -five mortality rate (U5MR) were 44 and
57 among the ST population compared to national
average of 32 and 38, respectively [1]. Poorer health and
social outcomes for indigenous peoples than for non-
indigenous populations have been reported from across
the world [2].
The Indian population census in 2011 enumerated ST
population in 30 states and union territories of the
country. ST population residing in Chhattisgarh, Gujarat,
Jharkhand, Madhya Pradesh, Maharashtra, Odisha and
Rajasthan states accounts for two-third of the tribal
population of rural India [3], and are in a critical state and
consistently reporting poor vital parameters which varied
in tribal sub-groups [4]. The mortality rates for STs of
these states are much higher compared to tribes residing
in the other states [1]. However, no data is available on
tribe-specific child mortality and life expectancy in India.
Hence, in the present analysis, we estimated the IMR,
U5MR and life expectancy at birth (LEB) for major tribes
residing in Chhattisgarh, Gujarat, Jharkhand, Madhya
Pradesh, Maharashtra, Odisha and Rajasthan states of
India.
METHODS
The census, 2011 of India enlisted 705 tribes/tribal groups
in the country and out of them 75 tribes/tribal groups/
sub-groups were classified as particularly vulnerable
tribal groups (PVTG), formerly known as primitive tribes
[3]. Of these, 268 tribes, including 38 PVTGs, reside in the
selected seven states. However, only 106 tribes/ tribal
groups, each having at least 5,000 women, and 17 PVTGs,
each having at least 1,000 women in the age group (15-49),
are included in the study, so as to have relatively robust
estimates. Overall, these selected tribes encompassed
about 94-97% of the respective state’s total ST
population. The data on Children Ever Born (CEB) and
Children Surviving (CS) are used for the estimation of
IMR, U5MR and life expectancy at birth LEB, and
compiled from tribes-specific tables of census, 2011 [5].
We used the Brass method for estimating the child
mortality rates. The Brass method estimates the mortality

INDIAN PEDIATRICS 1 VOLUME 58__JANUARY 15, 2021

VERMA, ET AL
q(x)-the probability of dying between birth and exact age
x, from the proportion of children dead among those ever
born by women in different age groups [8]. Trussell [8]
version of Brass method which uses Coale Demeny south
model life tables to simulate mortality was adopted to
estimate the child mortality. The estimates of IMR, U5MR
and LEB are calculated by MORTPAK 4.3 software
(United Nation) [7]. The MORTPAK provides age group
specific estimates of IMR, U5MR and LEB. The weighted
average of estimates for women age groups 20-34 years
are considered using CEB as weights and refer to 4.6
years prior to census reference date, i.e. 2006-07 year. The
estimates of IMR, U5MR, and LEB were calculated for
Indian total population and total ST Population, selected
seven states’ total population and total ST population,
and 123 selected major tribes residing in these states.
RESULTS
The IMR, U5MR, and LEB estimates are summarized in
Fig. I and Table I. The tribe specific estimates of IMR,
U5MR and LEB for all 123 tribes are given in Web
Annexure I (available at www.indianpediatrics.net).
The estimated IMR for India’s total population was 65
compared to 76 per 1000 live births for country’s total
scheduled tribe (ST) in year 2006-07. The IMR for total
population varied from lowest (53) in Maharashtra to
highest (76) in Madhya Pradesh, whereas in case of total
ST population it varied from lowest (60) in Maharashtra to
highest (89) in Madhya Pradesh. Overall, ST population
in Chhattisgarh, Madhya Pradesh, Jharkhand, Odisha
and Rajasthan states had 11-14 extra infant deaths per
1000 live births compared to respective state’s averages
(Fig. I). In the studied 123 tribes, 66 tribes had higher IMR
than the national ST average (76 per 1000 live births). The
mean (SD) of estimated IMR for 123 tribes/tribal groups
was 80.9 (19.7) per thousand live births, ranging from
highest 124 in the Birhore tribe of Chhattisgarh and
Jharkhand states, and the Bharia tribe of Madhya Pradesh
to lowest 48 in the Gamit tribe of Maharashtra, depicting
that on an average 76 extra infants died during first year of
life in the Birhors and the Bharia tribes compared to the
Gamits of Maharashtra. The difference in IMR was not
only observed between tribes residing in different states
but also among tribes residing within the states. A
difference of 49-62 extra infant deaths was observed
among the tribes of Chhattisgarh, Madhya Pradesh,
Jharkhand, Odisha, and Rajasthan states (Table I).
The U5MR for India as a whole was estimated at 82
deaths per 1000 live births, whereas it was 101 for total
scheduled tribe (ST) of the country i.e., on an average 19
extra deaths among children under five years in ST
population compared to the national average. The U5MR
INDIAN PEDIATRICS
CHILD MORTALITY AMONG TRIBAL CHILDREN
for total population varied from lowest (64) in
Maharashtra to highest (100) in Madhya Pradesh.
However, in case of total ST population U5MR varied
from lowest (76) in Maharashtra to highest (123) in
Madhya Pradesh. Overall, ST population in Chhattisgarh,
Madhya Pradesh, Jharkhand, Odisha and Rajasthan
states had 21-24 extra deaths per 1000 children under- five
years age compared to respective state averages (Fig. I).
Among 123 tribes, 65 tribes had higher U5MR than the
national average for ST population (101). The mean (SD)
U5MR was 112.0 (36.5) per thousand live births ranging
from highest (203) in the Birhore tribe of Chhattisgarh to
the lowest (57) in the Gamit tribe of Maharashtra,
reflecting 146 extra under five deaths in the Birhore
compared to the Gamit tribe (Table I).
The estimated LEB for total population and total ST
population of India was respectively 67 and 65 years. This
shows that on an average a tribal individual survives two
years lesser than the national average. Among the
selected seven states, the LEB for total population varied
from 65 years in Madhya Pradesh to 70 years in
Maharashtra state. However, in case of total scheduled
tribe population, the LEB varied from 61 years in Madhya
Pradesh to 69 years in Maharashtra (Fig. 1). Among 123
selected tribes, 70 tribes had lower LEB than the national
average for ST population (65 years).The mean (SD) of
estimated LEB for 123 tribes was 63.0 (5.3) years, ranging
from highest 72 years in the Gamit tribe of Maharashtra to
lowest 51 years in the Birhore tribe of Chhattisgarh. The
difference in LEB was not only very high between the
tribes residing in different states, but also among tribes
residing within the state. In Chhattisgarh state, the LEB
varied from 51 years in the Birhore tribe to 68 years in the
Oraon tribe. A difference of 13-17 years was observed in
tribes of Chhattisgarh, Madhya Pradesh, Jharkhand,
Odisha, and Rajasthan (table I).
DISCUSSION
Vast difference was noted to prevail in child mortality by
tribal groups. The IMR and U5MR was 44.4 and 57.7,
respectively among STs compared to national averages of
40.7 and 49.7, respectively. These child mortality rates
also vary considerably among ST population of different
Indian states. However, there is dearth of information on
different tribal communities, especially on demographic
and health indicators. The expert group on Tribal Health,
Government of India [8] and Saha, et al. [9] highlighted
the need to generate tribe-specific data to formulate
developmental programs accordingly.
Our estimate of IMR for total ST population of the
country is slightly higher as compared to previous
reports [2] which estimate 74.3 deaths per 1000 live births.
2 VOLUME 58__JANUARY 15, 2021
 VERMA, ET AL CHILD MORTALITY AMONG TRIBAL CHILDREN

The difference between two rates of IMR based on

Total‡

for total scheduled tribe population

62
61
63

63
67
69
62
census 2011 data is due to different methodologies
adopted. Anderson, et al. [2] have used Coale-Demeny

64.7 (Pradhan)
64.4 (Dhanka)
51.2 (Birhore)

52.0 (Birhore)

53.4 (Saharia)
52.1 (Bharia)
model (Palloni Heligman equation) with South Asian life-

54.9 (Koya)
Lowest table and taken simple average of estimates for age
groups 20-34 years. Whereas, we have used Coale-
Demeny model (Trussell equation) with South life-table
Table I Tribe-specific Estimates of Infant Mortality Rate (IMR), Under-5 Mortality rate and Life Expectancy at Birth in the States
Life expectancy at

and taken weighted average of estimates for age groups

birth (y)

68.9 (Bathudi, Sounti) 20-34 years. The study has not only demonstrated the
huge differences in child mortality and life expectancy at
birth among tribes residing in different states, but also

‡Estimates
66.8 (Karmali)

66.1(Dhanka)
67.8 (Oraon)

71.8 (Gamit)
66.4 (Majhi)

among tribes residing within the state. The tribes residing

71.3 (Rabri)
in economically backward states like Chhattisgarh,
Highest

number of tribes for which tribe specific estimates computed; Madhya Pradesh, Jharkhand, Odisha and Rajasthan were
having higher child mortality indicators compared to
those residing in relatively well-off states of Gujarat and
Maharashtra. The study also shows that most of the
Total‡
118
123
109

113
120

86
76

PVTGs residing in different states have relatively higher

mortality rates and lower life expectancy compared to
86.0 (Karmali)
72.9 (Bathudi)
90.4 (Dhanka)

other tribal communities residing within the states. A gap

80.3 (Oraon)

57.2 (Gamit)
88.8 (Majhi)

60.2 (Rabri)
(per 100 live births)

of 76 in IMR and 146 in U5MR among tribal communities

Lowest

is a matter of serious concern and needs immediate

U5MR

attention. Similarly, a variance of 21 years in life

expectancy at birth reflects an extremely poor health
status among some tribal communities.
101.5 (Dhanka)
195.8 (Birhore)
203.0 (Birhore)

183.5 (Saharia)

99.4 (Pradhan)
194.8 (Bharia)

171.4 (Koya)

The child mortality rates may be higher among tribal

communities because of their poor socio-economic
Highest

status, geographical isolation, poor availability and

inaccessibility, and underutilization of modern health
services. Sahu, et al. [10] recorded high IMR and U5MR
#Total

among scheduled tribes of rural India and reported that

Total‡

89
81

60
67
84

83
87

the factors associated with mortality remained more or

*Total number of tribes/tribal groups enumerated in the state in census 2011;

less same over the period of 1992-2006. The NFHS-4

67.0 (Karmali)
58.5 (Bathudi)
69.8 (Dhanka)

shows that one-third pregnant women from ST

(per 1000 live births)

47.5 (Gamit)
62.0 (Oraon)
68.5 (Majhi)

49.5 (Rabri)

community in India did not receive any antenatal care

Lowest

during pregnancy and majority of the deliveries (73.2%)

IMR

are performed with assistance of midwife at home; lack of

proper training and low frequency of postnatal check-ups
(68.6%) pose serious threat to the health of newborns [4].
124.3 (Birhore)
124.3 (Birhore)

118.5 (Saharia)

75.0 (Pradhan)
123.8 (Bharia)

76.3 (Dhanka)

Inequalities in the proximate determinants of child

112.6 (Koya)

mortality, which vary according to their beliefs and

Highest

multiplicity of cultures, and in turn influences antenatal

care, delivery practices and postnatal care of infants [11].
Culture, ritual and traditional beliefs of the tribes also acts
Total studied

as hindrance in utilization of maternal and child health

tribes#

22

17
19
Madhya Pradesh (46) 14

24
20

(MCH) facilities [4]. Many tribal communities still believe

in various taboos and traditional practices. Delayed
breastfeeding and pre-lacteal, supplementary feeding
Maharashtra (47)
Chhattisgarh (42)

practices like honey and goat’s milk are also widespread

Jharkhand (30)

Rajasthan (12)
(Total tribes*)

Gujarat (29)

among them [12,13]. The presence of malnutrition,

Odisha (62)

of the state.

anemia, higher incidence of infectious diseases like

malaria, tuberculosis and diarrheal diseases may further
State

INDIAN PEDIATRICS 3 VOLUME 58__JANUARY 15, 2021

VERMA, ET AL
WHAT THIS STUDY ADDS?
• We provide tribe-specific estimates of infant mortality rate, under-five mortality rate and life expectancy at birth
for 123 tribes of seven states of India.
Fig. I Estimated infant mortality rate (IMR), under-5 mortality rate (U5MR), life expectancy at birth (LEB) for total and scheduled tribes
population of India and selected states.
worsen the child mortality in these tribal communities.
These estimates are derived from census 2011 data
using Trussell version of Brass method, which has its
own limitations, as it assumes that age-specific fertility
and mortality rates remained constant in the recent past,
and no strong relation exists between the age of mother
and infant mortality, etc., and these estimates are referred
for the year 2006-07. In the absence of any other tribe
specific data source, these estimates will provide valuable
information which may guide the program managers.
In India, tribes are classified as scheduled tribes and
clubbed together for implementation of socio-
development program for their upliftment. However,
tribes are not a homogenous group and enormous
variation is observed in the estimates of IMR, U5MR and
LEB. Hence there is a need for tribe-specific approach to
bridge the gap. The present study also affirms the need to
generate tribe-specific data, prioritize the tribal group on
the basis of their vulnerability, health and mortality
parameters. Accordingly, tribe-specific developmental
programs may be formulated to improve the childhood
health and quality of life so that country can achieve
SDGs targets within the stipulated time frame.
INDIAN PEDIATRICS
CHILD MORTALITY AMONG TRIBAL CHILDREN
Acknowledgments: Dr Aparup Das, Director, ICMR-National
Institute of Research in Tribal Health, Jabalpur (MP) for his
support and guidance. Prof Chander Shekhar, IIPS, Mumbai for
his valuable suggestions to improve the quality of the paper.
Contributors: AV: Concept and design of study, data compilation
and analysis, manuscript writing; RKS: Data analysis, literature
review and manuscript writing; KBS: Data interpretation,
manuscript writing and final editing. All authors have read final
version of the manuscript.
Funding: None; Competing interest: None stated.
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4 VOLUME 58__JANUARY 15, 2021
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