UNEQUAL BEGINNINGS: INTERPROVINCIAL INEQUALITIES AND SOCIOECONOMIC AND DEMOGRAPHIC DETERMINANTS OF INFANT MORTALITY IN PAKISTAN

Abstract

Infant mortality remains a critical indicator of population health and reflects the combined influence of maternal health conditions, new-born care practices, socioeconomic inequalities, and health system performance. Although Pakistan has achieved gradual improvements in child survival over recent decades, substantial disparities persist across provinces and administrative regions. This study examines provincial inequalities and determinants of infant mortality rate (IMR) in Pakistan using data from the latest available Multiple Indicator Cluster Surveys (MICS6) conducted in Punjab, Sindh, Khyber Pakhtunkhwa (KP), Balochistan, Azad Jammu and Kashmir (AJ&K), and Gilgit-Baltistan (GB). A comparative descriptive research design is employed to analyze variations in IMR according to socioeconomic characteristics, including place of residence, maternal education, and household wealth status, and demographic factors including child sex, maternal age at birth, birth order, and previous birth interval. The findings reveal considerable regional variation in infant survival outcomes, with Punjab reporting the highest IMR (60 deaths per 1,000 live births), followed by AJ&K (51), Balochistan (48), GB (43), Sindh (39), and KP (35). The analysis demonstrates strong socioeconomic gradients, where infants from poorer households and those born to mothers with lower educational attainment experience higher mortality risks. Demographic characteristics also play an important role, with adolescent motherhood, high birth order, and short birth intervals associated with increased infant mortality. The findings indicate that infant mortality in Pakistan is shaped by the interaction of regional inequality, socioeconomic disadvantage, reproductive behaviour, and health system effectiveness. The study argues that reducing infant mortality requires a region-specific strategy rather than a uniform national approach. Policy interventions should prioritize maternal education, poverty reduction, improved reproductive health services, skilled birth attendance, neonatal care, and equitable access to healthcare facilities, particularly in geographically disadvantaged and underserved regions