Decomposing Wealth-Based Inequalities in Neonatal Mortality in India: Evidence from National Family Health Survey (2019–2021)

India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019–2021) to examine wealth-based inequalities in neonatal mortality. Socioeconomic disparities were assessed using Erreygers’ Normalized Concentration Index (ECI) and concentration curves, with subgroup analyses by residence, state development status (Empowered Action Group (EAG) vs. non-EAG), district typology, and region. Inequality was further decomposed using the Wagstaff method. Analysis of 176,843 most recent live births revealed marked rural–urban disparities, with neonatal mortality in rural areas (18.3 per 1000 live births) 1.6 times higher than in urban areas (11.5). Neonatal mortality was significantly concentrated among poorer households (ECI: −0.0123; p < 0.001), with greater inequality in urban areas, EAG states, and non-aspirational districts. Regional variation was evident, with the highest inequality in the Western and Central regions. Decomposition analysis showed that inequality was primarily driven by adverse household conditions and maternal risk factors concentrated among poorer populations. Key contributors included unclean cooking fuel, higher parity, large family size, normal delivery and inadequate antenatal care. These findings highlight the need for equality-focused strategies addressing both social determinants and gaps in access to quality maternal and newborn care.