According to WHO, Life expectancy at birth reflects the overall mortality level of a population. It summarizes the mortality pattern that prevails across all age groups – children and adolescents, adults and the elderly. It refers to the average number of years that a newborn is expected to live if current mortality rates continue to apply. According to the 2011 census, Indian life expectancy has merely increased from 60 years in 1992 to 67.9 years in 2012.

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Life expectancy at birth as a concept differs on the basis of various factors:

• First, it varies across time horizons based on varying conditions such as war, spread of epidemics and environmental conditions.
• Second, it varies across age cohorts, again given mortality rates.
• Third, it also differs across space for the same time, depending on variations in geographical, economic, social and gender factors.

Despite consistent improvements in life expectancy at birth, India’s life expectancy at birth is still lower than the global average.

The paradox in India:

• Life expectancy declines as age increases.
• For instance, life expectancy at age 1 for females and males is 71.9 and 68.3 respectively.
• Thereafter, as one attains age 5, life expectancy declines to 68.8 for females and 64.9 for males and, subsequently, at age 20, it further declines to 54.6 and 50.6 respectively.
• This is consistent with the fact that as one ages, the number of years one is expected to survive thereafter declines.
• However, if one observes India’s life tables for age cohort 0-1, life expectancy does not adhere to the above logic, which is otherwise applicable throughout the ages of 1 to 70. The age cohort 0-1, therefore, presents a paradox.
• The life expectancy for females and males at birth is 69.6 and 66.4 respectively, which increases to 71.9 and 68.3 years once they attain the age of 1. Clearly, instead of declining, life expectancy is increasing with age.
• A newborn in India has a lower probability of surviving in the first year as compared to the probability of survival after the age of one year.

Reasons for the above paradox:

• High infant mortality rates (IMR): Statistics of the Organisation for Economic Co-operation and Development (OECD) show a strong correlation between IMR and life expectancy at birth.
• Neonatal mortality rate (NNMR): The rate of deaths occurring in the first 28 days, is the primary factor impacting IMR. Studies show that risk of such a death is almost 30 times higher than in the post-neonatal period.
• High infant malnutrition in India: National Family Health Survey 4 (2015-16) data show high incidence of stunting, atrophy and underweight under-five children (38.4%, 21% and 35.8% respectively).
• Other causal factors broadly include immunizable diseases, poor sanitation and breastfeeding practices.
• Lack of Maternal Education and State intervention at the right intervals. The former relates to awareness and latter to state-administered health supplements, immunization and sanitation access.

Government’s efforts to reduce the above paradox:

The government has accelerated progress through programmes such as Mission Indradhanush, Swachh Bharat Mission, National Rural Health Mission and Poshan Abhiyan. Despite these measures, however, the progress has been rather slow.

Conclusion:

Undoubtedly, the impact that interventions focused on the first year of birth can have on the survival of individuals is profound. That being recognized, any strategy to raise life expectancy at birth should be aimed at tackling causal factors of IMR and NNMR by designing an appropriate microstructure of interventions.