Karnataka has recorded steady declines in infant and neonatal deaths over the past decade, reflecting improvements in maternal and child health services, institutional deliveries and antenatal care. NFHS-5 (2019–21) reports an IMR in Karnataka substantially lower than the national average, while SRS and Ministry releases show continued national downward trends through 2021–22. However, intra-state disparities, neonatal concentration of infant deaths, and persistent gaps in rural and disadvantaged populations indicate unfinished business. This paper provides an economic analysis linking mortality trends to health investments, service utilization, and socio-economic determinants. Policy implications stress targeted neonatal interventions, strengthening primary care and equity-focused financing to accelerate progress toward SDG child-mortality targets.