THIRUVANANTHAPURAM: The infant mortality rate (IMR) in the state has risen to eight deaths per 1,000 live births in 2024, from five recorded in the previous year, indicating possible cracks in the Kerala healthcare model.
The Sample Registration System (SRS) Statistical Report 2024, released by the Office of the Registrar General of India, also shows that cities have become significantly riskier for newborns, with the urban IMR now twice that of rural areas in the state. While Kerala retains its long-standing rank as the state with the lowest IMR in the country — outperforming Delhi, Tamil Nadu, and Himachal Pradesh, which sit at 11 each — this spike dramatically narrows the gap between Kerala and the rest of India.
The setback is particularly striking given that the national overall IMR continued its steady downward trend, dropping from 25 to 24 deaths per 1,000 live births over the same period.
The sharp reversal interrupts a decade of near-continuous progress built on robust public investments in female literacy and targeted healthcare programmes like the Hridyam scheme for congenital heart defects and the Matruyanam newborn transport initiative.
Public health experts and demographers, however, are divided on whether this jump signals a systemic failure or a statistical anomaly. Dr Purushothaman Kuzhikkathukandiyil, professor of paediatrics at MES Medical College, Malappuram, said while programmes like Hridyam successfully drove the IMR into single digits, the previously reported low of 5 may have been “too good to be true” due to potential sampling errors.
Urban IMR twice that of rural areas: Report
According to experts, in SRS 2023, when Kerala’s IMR stood at 5, the comparison drawn was that the figure was even lower than United States’ IMR of 5.6 at the time. The government machinery was quick to highlight the Kerala healthcare model, though the health experts were not fully convinced of it.
Meanwhile, demographers opined that since Kerala’s birth rate is the lowest in the country, the sample size is smaller, which means even minor year-to-year changes in infant deaths can swing the rate significantly. Hence, the report calls for cautious reading, they said.
However, Dr Kuzhikkathukandiyil said a rate of 8 or 9 likely reflects the true underlying situation, highlighting real gaps and a deterioration of care for mothers and newborns, which “policymakers must address by actively involving paediatricians and gynaecologists in future strategy”.
Compounding these concerns is a widening divergence between rural and urban sectors, with Kerala’s urban pockets shouldering an alarming concentration of neonatal deaths.
Paradoxically, the urban IMR has risen to twice that of rural areas, despite the fact that 100% of live births in urban Kerala are attended by medical professionals, with nearly 70% occurring in private hospitals.
Dr Althaf A, a member of the State High-Power Committee for Epidemic Control and professor of Community Medicine at Government Medical College, Thiruvananthapuram, views this specific urban spike as a warning sign, stating that the near-doubling of these rates within a single year points to visible, structural cracks appearing within the healthcare delivery system.
Health officials note that Kerala’s rapidly ageing population — with 15.1% of residents now aged 60 or above — may be shifting vital resources and specialist attention towards elderly care at the expense of neonatal and obstetric services. Ultimately, the next few SRS cycles will determine whether this 2024 figure is a temporary statistical blip or the start of a sustained plateau for a celebrated healthcare model facing unprecedented demographic strain.