Discussions on the Infant Mortality Rate (IMR) of Kerala have surged after an exchange between Rajeev Chandrasekhar, president of the Bharatiya Janata Party (BJP) in Kerala, and Rajya Sabha MP of the Communist Party of India (Marxist) [CPI(M)] John Brittas, went viral.
Kerala’s IMR hit an all-time low of 5 (per 1,000 births) according to the 2023 Sample Registration Survey (SRS) report, released last year, as against the national average of 25 (per 1,000 births). Kerala is the only State in India with a single-digit IMR, even lower than the USA (5.6).
Ten years ago, the Kerala Health Department aimed to bring down the IMR to a single digit from 12, Veena George, State Health Minister told The Hindu.
A project organised by the Health Department of Kerala and the State branch of the Indian Academy of Paediatrics (IAP) achieved the desired result when the SRS report came out in 2018, as the State achieved the single-digit IMR of 7 for the first time. Kerala has been steadily reducing the rate over these years.
A planned achievement
A combined effort, without compromising its importance at any point, is the main reason for this achievement, said Ms. George, adding that the Health Department has planned and implemented many schemes such as ‘Hridayam’, ‘KARE’, and ‘Shalabham’ to bring down the IMR.
The ‘Hridayam’ scheme provides treatment for heart-related diseases to children from birth till 18 years of age. Through this scheme, heart disease screening is conducted for all babies born in the government hospitals. The screenings are also conducted in homes, Anganwadis, and schools to ensure extensive care to children.
Also read: Hridyam scheme to be expanded to more hospitals
According to the government data, about 8,000 children have undergone heart surgeries since it was launched in 2017. What makes it more relevant is that 15,686 of the total registered 24,222 children are infants.
Kerala Against Rare Diseases (KARE) prevents and manages rare diseases. This ₹250-crore project, launched in 2024, provides free care to tackle rare diseases through early detection, treatment, and support. According to the World Health Organisation (WHO), there are over 5,000 rare diseases globally. More than 200 children are being offered free treatment and allied services under the scheme .
The Shalabham (butterfly in Malayalam) project screens children for any birth defects from the time they are born up to the age of 18 years. The Health Department ensures bi-annual screening in immunisation sites, Anganwadi Centres, schools, and in community settings.
According to Rahul U.R., the State Nodal Officer of Child Health and Rare Diseases, Kerala’s achievement in bringing down IMR is the result of decades of social investment and a strong health system, rather than a single intervention.
Hand in hand through the fight
“Hello… Are you alright? Do you have enough money for medicines? Please let us know if you need something.”
Also read: KARE Portal to monitor rare diseases in Kerala
Keralites who have spent quarantine days at home would have gotten a call like this from an ASHA worker at least once. The hard times of the COVID pandemic showed how organised and deep rooted the Health Department is.
Kerala has an extensive network of Public Health Centres, Community Health Centres and a robust community health workforce that are instrumental in fueling all the ventures of the Health Sector.
ASHA workers, Anganwadi workers, and Junior Public Health Nurses (JPHNs) do regular home visits for newborn babies and mothers.
The case of Attappadi is a classic example of how efficient this system is. The largest tribal settlement in Kerala had an IMR of 28.6 when the health department made its intervention ten years ago. The government analysed the reasons for infant mortality and prepared a list of women with high-risk pregnancies.
The Health Department organised a team called ‘Pendrika Kootta’ (women’s group). The team made sure that constant care was given to the pregnant women. ASHA and Anganwadi workers, along with SC/ST activists, played in unison in bringing down the IMR of Attappadi to 6.3
“A number of health centres were made in the settlements inside the forest to avoid pregnant women travelling long distances for a health check-up,” Ms. George said.
An early start
High female literacy and women’s empowerment make the job easier, said Dr. Rahul. The basic awareness in modern medical science adds to this. The foundation of this structure had been paved centuries ago.
“Opening of a Tamil class for medical study at Trivandrum,” reads the headline of a government-commissioned article in Kottayam CMS college’s magazine – Vidyasamgraham released by the, in 1864. The article invited people to learn “English” medicine – the nickname of allopathic medicine – for the use of commoners in day-to-day life.
The Travancore government, in the same period, allotted financial aid to private clinics that worked alongside the free government medical clinics. The government gave generous aid to private bodies to establish dispensaries and treat leprosy patients.
Vaccine drive in pre-independent India
Flashback to five more decades, experiments on modern medicines were conducted, when the State was ruled by three kingdoms, namely Travancore, Cochin and Kozhikode.
The queen who ruled the Travancore from 1810 to 1813 – Ayilyom Thirunal Gowri Lakshmi Bayi – started a vaccination department in her princely state when people were sceptical about using allopathic medicines. To convince her subjects to participate in this pioneering vaccine drive against small pox, she made the people from the royal family get vaccinated first.
This was a remarkable building block to the medical edifice later acclaimed as “Kerala model” health care.
The next step
Kerala’s next goal is “zero preventable infant death.” It has been closely examining “near-death cases.” Learning about every possible threat to infants can help the health department achieve it.
Also read: Registry of persons with rare diseases to be developed
“Disease caused by the changing lifestyle is one of the challenges to this goal. Sometimes, pregnant women migrating from other States is also a challenge to an extent,” said Ms. George.
Evidence-based policy making and rapid adoption of innovations are the specialities of Kerala’s health sector.
“One reason for the growth of our health system is the plans that we developed by learning from our experiences,” Ms. George said, adding that this helps in the refinement of the system.
Published – March 14, 2026 02:59 pm IST
