Democracy and Infant Mortality in India’s ‘Mini-democracies’: A Preliminary Theoretical Inquiry and Analysis*

A number of cross-national studies find that democratic rule has beneficial effects on the health of nations. These studies, however, sidestep the key role of state governments—especially in federal systems like India—in providing those public goods and services that have an impact on health outcomes. Like national governments, state governments differ in the quantity and quality of public goods they provide. Consequently, interstate variations in health outcomes are quite common and even substantial. This article examines infant mortality rates (IMRs) in India’s 29 states—or ‘mini-democracies’—to show that many Indian states have achieved good/moderate IMRs, but others lag behind. To explain such divergent health outcomes across India’s states despite six decades of democratic rule, the article scrutinises the causal logic of three mechanisms that are said to activate the democracy-good health link: (1) political competition; (2) civil society activism; and (3) ideational changes. The discussion points to a long list of other enabling factors—whose presence varies across India’s states—that are necessary for democracy’s virtuous effects to be realised.