Kerala Infant Mortality Rate Success Explained: Decades of social investment, targeted interventions and an effective public distribution system are among the key reasons Kerala achieved a major health milestone – lowering its Infant Mortality Rate to 5 deaths per 1,000 live births.
As the Union Ministry of Health and Family Welfare (MoHFW) marks National Newborn Week from November 15 to 21, 2025, government data shows that Kerala’s feat not only outpaces the national IMR of 25 but surpasses some developed nations – including the US (5.6 deaths per 1,000 births last year).
The data was released in September. For Kerala, the numbers underline the strength of its public health system and its maternal and child health policies, along with targeted interventions focusing on early detection of high-risk pregnancies, strengthening facility-based newborn care, promoting exclusive breastfeeding, and ensuring timely referral and treatment of sick neonates.
The hurdles
IMR is the number of deaths of children below the age of one per 1,000 live births. In an emailed response to The Indian Express, the state health department said one of the key challenges was the stubbornly high neonatal deaths — babies dying within the first 28 days.
The major causes, according to officials, were premature births, low birth weight, and birth asphyxia — when a newborn doesn’t get enough oxygen before, during, or just after birth, potentially affecting vital organs. The state also faced rural-urban disparities, with tribal and coastal populations reporting higher infant mortality.
Cultural factors such as myths around breastfeeding and resistance to vaccination had to be tackled, prompting the setting up of Comprehensive Lactation Management Centres to collect and store milk for babies.
Budgeting posed another challenge — with Kerala’s ageing population demanding higher allocations, IMR programmes faced financial constraints.
The interventions
To reduce IMR, the state health department, along with the National Health Mission (NHM) and the Indian Academy of Paediatrics (IAP), launched a focused programme across state and district hospitals, both public and private.
Officials said the programme helped institutionalise deliveries, ensuring that about 99.5 per cent of births occurred at healthcare facilities.
The state also launched schemes such as Shalabham, LaQshya, MusQan, and KARE, each addressing different aspects of maternal and child health.
A comprehensive programme for birth defects in newborns, Shalabham covers four areas — visible birth defects, functional birth defects, metabolic defects, and neuro-developmental defects. It helps detect congenital hypothyroidism, congenital adrenal hyperplasia, haemoglobinopathies, and other metabolic or genetic disorders.
Kerala United Against Rare Diseases, or KARE, manages and treats rare diseases in children. It provides access to specialised treatments, free life-saving drugs for diseases such as Spinal Muscular Atrophy (SMA), and free growth hormone therapy, with a focus on early detection and comprehensive care.
LaQshya focuses on improving infrastructure and quality processes in labour rooms and on skill development of healthcare workers. Under this, layouts of labour rooms and maternity OTs were reorganised, and all government medical colleges and district hospitals were required to have dedicated obstetric high dependency and intensive care units in line with MoHFW guidelines.
Healthcare facilities were branded ‘LaQshya-certified’ – meaning they met the National Quality Assurance Standards framework. A total of 12 facilities received this certification.
Under MusQan – a National Health Mission initiative to improve public health services for children up to 12 – a multi-pronged strategy was adopted to improve quality in Special Newborn Care Units (SNCUs), Newborn Stabilisation Units (NBSUs), postnatal wards, paediatric OPDs, and nutritional rehabilitation centres. Facilities at state and district levels were encouraged to undertake Rapid Improvement (RI) cycles to identify gaps, strengthen clinical protocols, and review progress to achieve better newborn health outcomes.
Another scheme, Mathruyanam, provided free drop-off for mothers and babies after delivery from all government facilities.
The Hridyam initiative
To address one of the biggest hurdles to lowering IMR — congenital heart diseases — the web platform Hridyam was launched in August 2017 for early identification, treatment, and follow-up.
A total of 24,222 children were registered for treatment under the scheme, of whom 15,686 are below the age of one. More than 8,335 surgeries and interventions were carried out, and major hospitals in the state — including SAT (Sree Avittom Thirunal Hospital) Thiruvananthapuram, Medical College Kottayam, Medical College Kozhikode Hospital, and private hospitals like Amrita Institute of Medical Sciences Kochi, Lisie Hospital Ernakulam, and Believers Church Hospital Thiruvalla — have been empanelled as per RBSK guidelines.
Special care is taken to detect and treat heart problems in children, with emergency treatment ensured within 24 hours and ventilator/ICU ambulance services provided. For early and effective detection, children born in government hospitals, at home, in anganwadis, and in schools are screened. If symptoms appear, specific tests — including echocardiograms — are conducted, and if heart disease is confirmed in the foetus, treatment begins at birth.
Eight government and private hospitals have been empanelled under Hridyam. In the last three years, more than 1,000 children received specialist treatment at SAT Hospital in Thiruvananthapuram, where a paediatric heart surgery department has been set up with facilities for ECMO and complex heart surgery.
For Kerala, the numbers underline the strength of its public health system and its maternal and child health policies, along with targeted interventions. (Representational Image - Freepik) 
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