Naima Onamika
Commissioning Editor – The Oniket Bulletin
Since independence, Bangladesh has earned international recognition for several development achievements, among which the reduction of infant and newborn mortality stands out as one of the most remarkable. Once considered one of the world’s poorest nations, the country has made substantial progress over the past few decades through improvements in public health, nationwide immunization programs, maternal healthcare services, and community-based health initiatives.
These efforts have helped Bangladesh achieve significant reductions in infant mortality. Yet behind this encouraging progress lies a more complex reality. Regional disparities, social inequalities, and unequal access to quality healthcare continue to pose serious challenges, limiting the country’s broader human development ambitions.
The Current Picture
Infant mortality refers to the number of children who die before reaching their first birthday for every 1,000 live births. According to recent data, Bangladesh’s infant mortality rate declined to approximately 20.76 deaths per 1,000 live births in 2024 and is projected to fall further to about 19.95 in 2025.
The significance of this achievement becomes clearer when viewed against the country’s historical trajectory. In 1990, Bangladesh recorded an infant mortality rate of roughly 100 deaths per 1,000 live births. Over the past three and a half decades, the country has therefore reduced infant mortality by nearly 80 percent. Within the South Asian context, this represents an extraordinary accomplishment and has frequently been cited as a development success story by the international community.
Progress has not been limited to infant mortality alone. Bangladesh has also achieved substantial reductions in mortality among children under the age of five. In 2019, the under-five mortality rate stood at 31 deaths per 1,000 live births in Bangladesh, compared with 34 in India and 65 in Pakistan. Achieving better health outcomes than larger neighboring economies despite more limited resources is a significant accomplishment.
Progress Over the Last Decade
Although infant mortality has continued to decline over the past decade, the pace of improvement has not remained consistent. In 2015, the infant mortality rate was approximately 33 per 1,000 live births. This figure declined to 22.6 in 2022 and is projected to reach around 20.8 in 2024.
However, several studies have found that progress slowed considerably between 2014 and 2017-18. During that period, under five mortalities declined by only 2 percent, compared with an 18 percent reduction during 2007 to 2011 and a 13 percent reduction during 2011 to 2014.
Researchers have identified several key factors behind this slowdown:
- An increase in adolescent motherhood
- Low levels of maternal education
- Maternal malnutrition and obesity
- Poor household hygiene practices
- Lack of handwashing facilities
- Inadequate quality of healthcare services
Studies also indicate that improvements in maternal and newborn healthcare coverage and quality have not been sufficient. As a result, while more women have accessed healthcare facilities, the expected improvements in health outcomes have not always followed.
The Reality of Inequality
National averages often conceal significant inequalities within a country, and Bangladesh is no exception. Regional and social disparities in infant mortality remain evident across the country. Sylhet Division has long recorded the highest neonatal mortality rates in Bangladesh. In 2000, neonatal mortality in Sylhet stood at 81.7 deaths per 1,000 live births. By 2017, the rate had fallen to 37.5, representing substantial progress. Nevertheless, it remained considerably higher than the national average.
Similar disparities are visible across other social indicators:
- Children living in rural areas face a higher risk of death than those in urban areas.
- Children from poor household experience mortality rates roughly three times higher than those from wealthier families.
- Families with limited access to education face significantly greater risks of infant mortality.
Infant mortality is therefore no longer simply a health issue. It has become a reflection of broader challenges related to poverty, education, infrastructure, and social inequality.
Infant Mortality and the Human Development Index
According to the Human Development Index (HDI) published by the United Nations Development Programme (UNDP), Bangladesh ranked 129th among 191 countries in both 2021 and 2022. The country currently falls within the category of “medium human development.” The health dimension of the HDI is closely linked to life expectancy at birth. As infant mortality has declined, life expectancy in Bangladesh has increased to approximately 73 years, surpassing that of both India and Pakistan.
Bangladesh’s HDI value rose from 0.394 in 1990 to 0.632 in 2019, representing one of the fastest improvements recorded globally. Yet despite this progress, the country’s HDI ranking remains relatively modest. One major reason is that the benefits of development have not been distributed equally across society. When income and social inequalities are considered, Bangladesh’s effective HDI value declines by approximately 24 percent. Similar inequalities are reflected in health outcomes, particularly in infant mortality.
Where Improvement Is Needed
1. Prioritizing Quality Over Coverage
Expanding maternal and newborn healthcare services remains important, but improving quality must become a greater priority. Ensuring high quality antenatal and postnatal care requires regular supervision, quality assurance mechanisms, and stronger accountability among healthcare providers.
2. Reducing Infant Marriage and Adolescent Pregnancy
Adolescent pregnancy remains one of the most significant risk factors associated with child mortality. Preventing child marriage should therefore be viewed not only as a social objective but also as an essential public health strategy.
3. Strengthening Community Health Workers
Community health workers serve as the first point of contact for healthcare in many remote and vulnerable communities. Increasing their numbers, enhancing training, and ensuring adequate compensation are critical for sustaining progress.
4. Integrating Maternal Nutrition into Primary Healthcare
Both under nutrition and excessive weight during pregnancy can increase health risks for children. Nutrition assessments and counseling should therefore become a routine component of antenatal care services.
5. A Special Action Plan for Sylhet
The persistently high infant mortality rates in Sylhet highlight the need for region specific interventions alongside national policies. Mobile healthcare services, improved infrastructure, and programs tailored to local social realities should form the foundation of a targeted strategy.
6. Linking Health and Sanitation
Research consistently shows that inadequate sanitation, particularly the absence of handwashing facilities, increases the risk of child mortality. Safe water, sanitation, and hygiene (WASH) initiatives must therefore be integrated into infant health programs.
Conclusion
Bangladesh’s achievements in reducing infant mortality represent one of the country’s most important development successes. The experience of the past three decades demonstrates that effective policies, community engagement, and sustained commitment can produce transformative results even in resource constrained settings. However, the success reflected in national averages should not obscure the challenges that remain. Regional disparities, poverty, adolescent motherhood, and weaknesses in healthcare quality continue to hinder further progress.
Advancing on the Human Development Index will require more than simply lowering mortality rates. The benefits of progress must reach every region, every community, and every segment of the population. Because the death of an infant from preventable causes is not merely a personal tragedy for a family. It is also a loss of human potential and a barrier to the development of an entire nation.
