The state in India with the highest infant mortality rate (IMR) is Assam.

Factors contributing to high IMR in Assam:
1. Healthcare Infrastructure:
- Assam faces challenges in terms of healthcare infrastructure, with limited access to healthcare facilities in remote areas.
- Lack of well-equipped hospitals, clinics, and healthcare centers in rural areas affects the availability and quality of healthcare services.

2. Maternal Health:
- Assam has a high maternal mortality rate (MMR), which directly affects IMR.
- Poor maternal health during pregnancy, lack of proper antenatal care, and inadequate access to skilled birth attendants contribute to high IMR.

3. Malnutrition:
- Assam has a high prevalence of malnutrition among children, which further increases the risk of infant mortality.
- Lack of proper nutrition during pregnancy and early childhood can lead to weak immune systems and increased susceptibility to diseases.

4. Sanitation and Hygiene:
- Poor sanitation and hygiene practices in many areas of Assam contribute to the spread of diseases.
- Lack of access to clean water, proper sanitation facilities, and hygiene education increases the risk of infections and diseases among infants.

5. Socioeconomic Factors:
- Assam faces socioeconomic challenges, including poverty, which affects the overall health and well-being of the population.
- Limited access to education, healthcare, and nutrition exacerbates the problem of high IMR.

Efforts to reduce IMR in Assam:
1. Government Initiatives:
- The government of Assam has implemented various initiatives to address the high IMR, such as the National Health Mission and the Assam State Health Policy.
- These initiatives focus on improving healthcare infrastructure, providing better maternal and child health services, and promoting awareness about healthcare practices.

2. Immunization Programs:
- Immunization programs have been intensified to increase the coverage of vaccines among infants and children.
- Vaccines protect against various diseases and reduce the likelihood of infant mortality.

3. Nutrition Programs:
- The government has also initiated nutrition programs, such as the Integrated Child Development Services (ICDS) scheme, to address malnutrition among children.
- These programs aim to provide nutritious meals, supplements, and health education to pregnant women and children.

4. Awareness Campaigns:
- Awareness campaigns are conducted to educate communities about the importance of healthcare practices, sanitation, hygiene, and nutrition.
- These campaigns aim to change behaviors and promote positive health practices.

Overall, while efforts are being made to reduce the infant mortality rate in Assam, addressing the underlying challenges of healthcare infrastructure, maternal health, malnutrition, sanitation, and socioeconomic factors remains crucial to achieve significant improvements in infant survival rates.