Discussions on infant mortality rate (IMR) in Kerala have escalated following an exchange between Bharatiya Janata Party (BJP) Kerala president Rajeev Chandrasekhar and Communist Party of India (Marxist) (CPI(M)) Rajya Sabha member John Brittas.
Kerala’s IMR reached an all-time low of 5 (per 1,000 births) as per the 2023 Sample Registration Survey (SRS) report released last year, 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 US (5.6).
A decade ago, the Kerala health department was trying to reduce the IMR to one digit from 12, Veena George, state health minister, told The Hindu.
Organized by the Kerala Health Department and the state branch of the Indian Academy of Paediatrics (IAP), the project achieved the desired result when the SRS report came out in 2018 as the state achieved a single-digit IMR of 7 for the first time. Kerala has consistently reduced the rate over the years.
Planned success
The main reason for this success is the joint effort without compromising its importance at any point, said Ms. George, adding that the Health Ministry has planned and implemented many programs like ‘Hridayam’, ‘KARE’ and ‘Shalabham’ to reduce IMR.
The “Hridayam” program provides treatment for heart diseases to children from birth to 18 years. Through this program, all babies born in state hospitals are screened for heart disease. Screenings are also conducted in homes, Anganwadis and schools to ensure widespread child care.
Also Read: Hridyam scheme to expand to more hospitals
About 8,000 children have undergone heart surgery since its launch in 2017, according to government figures. More relevantly, 15,686 of the total 24,222 registered children are infants.
Kerala Against Rare Diseases (KARE) prevents and manages rare diseases. Launched in 2024, this ₹250 crore project provides free care to address rare diseases through early detection, treatment and support. According to the World Health Organization (WHO), there are more than 5,000 rare diseases worldwide. More than 200 children are offered free treatment and related services under the program.
Project Shalabham (butterfly in Malayalam) screens children for any birth defects from birth to 18 years of age. The health department provides screening twice a year at immunization sites, Anganwadi centers, schools and community facilities.
According to Rahul UR, the state’s child health and rare diseases officer, Kerala’s success in reducing IMR is more the result of decades of social investment and a strong health system than a single intervention.
Hand in hand through the fight
“Hello… Are you okay? Do you have enough money for medicine? Please let us know if you need anything.”
Also Read: KARE Portal for Rare Disease Monitoring in Kerala
Keralites who have spent their quarantine days at home would have received such a call from an ASHA worker at least once. The difficult times of the COVID pandemic have shown how organized and deeply rooted the Ministry of Health is.
Kerala has an extensive network of public health centres, community health centers and a robust community health workforce that helps support all healthcare ventures.
ASHA, Anganwadi and Junior Public Health Nurses (JPHN) workers regularly visit newborns and mothers at home.
The Attappadi case is a classic example of how effective this system is. Kerala’s largest tribal settlement had an IMR of 28.6 when the health department intervened a decade ago. The government analyzed the reasons for infant mortality and prepared a list of women with high-risk pregnancies.
The Ministry of Health organized a team called “Pendrika Kootta” (women’s group). The team ensured continuous care for pregnant women. ASHA and Anganwadi workers along with SC/ST activists played in unison in reducing Attappadi IMR to 6.3
“Several health centers have been built in settlements inside the forest to prevent pregnant women from traveling 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. A basic awareness in modern medical science contributes to this. The foundation of this building was paved centuries ago.
“The opening of a Tamil class for medical studies at Trivandrum,” read the headline of a government-commissioned article in the Kottayam CMS College journal – Vidyasamgraham published in 1864. The article called for people to learn “English” medicine – a moniker for allopathic medicine – for use by the common people in everyday life.
During the same period, the Government of Travancore allocated financial assistance to private clinics that worked alongside free government medical clinics. The government provided generous assistance to private entities in setting up dispensaries and treating leprosy patients.
Vaccination in pre-independent India
Going back to another five decades, experiments were done with modern medicines when the State was ruled by three kingdoms namely Travancore, Cochin and Kozhikode.
The queen who ruled Travancore from 1810 to 1813 – Ayilyom Thirunal Gowri Lakshmi Bayi – established a vaccination department in her princely state when people were skeptical about the use of allopathic medicines. In order to convince her subjects to participate in this pioneering smallpox vaccine, she first had people from the royal family vaccinated.
This was a notable building block of the medical edifice later recognized as the “Kerala model” of healthcare.
Next step
Another target for Kerala is “zero preventable infant mortality”. He carefully examines “near death cases”. Learning about all possible threats to infants can help the health department achieve this.
Read also: A register of people with rare diseases will be created
“Diseases caused by changing lifestyles are one of the challenges to achieving this goal. Sometimes pregnant women migrating from other states are also a problem to some extent,” Ms George said.
Evidence-based policy making and rapid adoption of innovation are specialties of the Kerala health sector.
“One of the reasons our health system has grown is because of the plans we’ve developed based on our experience,” Ms. George said, adding that it helps improve the system.
Published – 14 March 2026 14:59 IST
