Long-term Trends and Rural-Urban Differential in Birth, Death and Infant Mortality rates in Haryana, India

Haryana is a high income, rapidly urbanizing state of north India that has a long experience of strong son preference. There is some evidence in the long run of the changes in its birth, death and infant mortality rates, and any narrowing of the rural-urban mortality gap. The objective of the study is to determine the long-term trend, structural change and rural-urban differentials in the crude birth rate (CBR), crude death rate (CDR) and infant mortality rate (IMR) of Haryana during 1971-2023. Fourteen Sample Registration System (SRS) observations (1971, 1980, 1990, 2000, 2010, 2015-2023) for rural, urban and combined populations were analyzed using log-linear regression (annual percent change APC), compound annual growth rates (CAGR), one-join point regression with a permutation test, Mann-Kendall and Sen's slope for 2015-2023, paired t test and Wilcoxon test for rural–urban differences, trend test on absolute and relative gaps, a baseline-trend estimate of pandemic-period excess mortality, and a Kitagawa decomposition of the change in CBR. Results: The combined CBR fell from 42.1 to 18.7 per 1,000 (-55.6%; APC -1.56%, 95% CI -1.61 to -1.51) and the combined IMR from 72 to 26 per 1,000 (-63.9%; APC -2.57%). The IMR declined slowly before 2000 (-0.63% a year), and increased at a rate of -4.49% a year after 2000 (join point 2000, permutation p = 0.002). The rural-urban gap in birth rate narrowed from 11.8 to 3.2 per 1,000, but the relative IMR gap widened from 1.21 in 2000 to 1.45 in 2023 (rural 29 vs urban 20). Mean rural excess over urban was 4.61 (CBR), 1.66 (CDR) and 13.89 (IMR) per 1,000 (all paired tests p < 0.01). In 2021 the CDR was 2.44 per 1,000 (42%) above the 2015–2019 trend, and the urban excess (3.10) exceeded the rural (1.92). Decline in the CBR between 1971 and 2023 was more attributable to the decline in rural and urban areas than to the process of urbanization. Found that, Haryana had undergone demographic transition in the least in 50 years, but the situation of urban-rural equity in infant survival is worsening in relative terms, and that infant mortality during the pandemic did not keep up the trend to 2023.