Kerala’s stellar health indicators now stare at ageing and NCD challenges

Kerala possesses some of India’s best health indicators, which significantly exceed the national average and are comparable to those of many developed countries.

Kerala is widely recognised, both nationally and internationally, for its exemplary health sector. The Statec

Key health indicators include the infant mortality rate (IMR), which measures the number of infant deaths per 1,000 live births; life expectancy at birth, representing the average number of years a person is expected to live; and the maternal mortality ratio (MMR), defined as the number of maternal deaths during pregnancy or within 42 days post-delivery per 100,000 live births.

According to India’s Sample Registration System – the country’s most reliable source of demographic data – Kerala’s 2023 infant mortality rate (IMR) was five per 1,000 live births, compared to the national average of 25. The State reported the lowest IMR among large Indian States (those with populations exceeding 10 million), slightly better than the United States’ IMR of 5.6 in the same year. Kerala’s life expectancy at birth stood at 75 years, against the national average of 70 and the U.S. average of 77. The State’s maternal mortality ratio (MMR) was 19, compared with the national average of 97 and the U.S. rate of 18.7.

Kerala attained universal literacy status in 1991 following a robust grassroots total literacy movement. Currently, Kerala’s literacy rate stands at 93%, with female literacy at 92% closely approaching male literacy at 94%. This high level of female literacy has been instrumental in enhancing the State’s health outcomes. Female literacy has fostered widespread awareness of childhood illnesses, particularly vaccine-preventable diseases such as polio, diphtheria, whooping cough, tetanus, tuberculosis, and measles. This awareness enabled mothers to ensure their children under five received vaccinations, achieving near-universal immunisation coverage until recently. Furthermore, acute diarrhoeal diseases, a major cause of infant and child mortality, were effectively controlled through the administration of oral rehydration therapy at home. Acute respiratory diseases constitute another major group of childhood illnesses. The early detection of these ailments and prompt treatment-seeking behaviour contributed to reduced infant and childhood mortality. There is widespread consensus among national and international researchers that high female literacy is a primary factor driving Kerala’s superior health status.

Female literacy has fostered widespread awareness of vaccine-preventable childhood illnesses. The photo shows pulse polio drops being administered to a child at Government Hospital, Palakkad. | Photo Credit: K.K. Mustafah

High female literacy, combined with improved access to healthcare, has also been pivotal in reducing maternal mortality in Kerala. With the total fertility rate (the average number of children per couple) reduced to 1.5, pregnancies are highly valued, and expectant mothers ensure they receive comprehensive care throughout pregnancy, delivery, and the postnatal period. Unlike in many other Indian States, most deliveries in Kerala are attended by gynecologists. Hospital deliveries are universal in the State. These factors are collectively responsible for decreasing maternal deaths to the previously mentioned level of 19.