In Kerala, only 34.2 percent of births occur in public hospitals. This places the state in sharp contrast not only with the rest of India but also with its southern neighbours.
Published May 24, 2025 | 7:00 AM ⚊ Updated May 24, 2025 | 7:00 AM
Across India, most babies are born in government hospitals
Synopsis: Despite Kerala’s reputation for a strong public health system, only 34.2 percent of childbirths occur in government hospitals – the lowest rate in India – while nearly 66 percent take place in private facilities. This long-standing preference is driven by perceptions of better care, comfort, and trust in private hospitals, along with better infrastructure, lower doctor-patient ratios, and personalised attention.
Kerala is often praised for having one of the best public healthcare systems in India, with strong primary care, local governance, and active community involvement.
Yet, the latest Sample Registration System Statistical Report 2021 reveals a surprising trend. When it comes to childbirth, most mothers in Kerala are turning to private hospitals instead of public ones.
Across India, most babies are born in government hospitals – 66.2 percent of all live births, according to the report. But Kerala stands out. Only 34.2 percent of births in the state happen in public hospitals.
Instead, 65.7 percent of deliveries take place in private hospitals – the highest rate in the country.
This puts Kerala in sharp contrast not only with the rest of India but also with its neighbours in the South, where public hospitals still play a major role in maternal care, particularly in rural areas.
For example, Tamil Nadu and Karnataka continue to rely heavily on public hospitals for childbirth. In Tamil Nadu, 66.3 percent of babies are born in government facilities; in Karnataka, the figure is 65.5 percent. In rural Karnataka alone, nearly 70 percent of deliveries take place in government hospitals.
Telangana and Andhra Pradesh sit somewhere in the middle, with 60.2 percent and 57.6 percent of births occurring in government hospitals, respectively.
In both these states, private hospitals play a significant role, especially in urban centres – but public hospitals still handle most deliveries.
Figures from Kerala’s Health Department reveal an even stronger dependence on private hospitals for childbirth than national data suggests.
This trend has continued for nearly a decade, showing a clear and lasting preference for private maternal care in the state. From 2015–16 to 2024–25, the percentage of births in government hospitals changed only slightly – rising from 29.82 percent in 2015–16 to 31.72 percent in 2019–20, before dropping again to 27.91 percent by 2024–25.
At the same time, private hospitals have consistently handled the majority of deliveries, ranging between 68 and 72 percent. Even during the height of the COVID-19 pandemic in 2020–21 and 2021–22, when public hospitals were under major pressure across India, more than 68 percent of births in Kerala still took place in private facilities.
So why are so many families in Kerala choosing private hospitals over public ones when it matters most?
Former Indian Medical Association (IMA) President Dr RV Asokan offers one explanation:
“In Kerala, Mission hospitals are not charitable hospitals. They’re just like any other hospital, providing services in an organised, multidisciplinary way, often run by the church. People in the community prefer to go to these hospitals because they feel familiar with them. And, interestingly, they also tend to choose hospitals based on the denomination of the community. In Kerala, there are many different denominations, and people have their preferences.”
He added that many of these private hospitals fall somewhere between secondary and tertiary care. They’re affordable, located nearby, and often right within the same neighbourhood.
“It’s about convenience, and it’s why people prefer them. Even in district hospitals, the infrastructure and facilities may be good, but there’s often a shortage of trained human resources to handle more complicated cases,” he told South First.
“But, you know, people stick to what’s familiar. They know the doctors, they trust them – it’s a comfort zone. And today, going to a hospital is a big challenge. People are afraid because of unexpected bills, the tests they need to undergo, and the overall experience. A lot of people have told me openly that they’re scared to visit hospitals because of this. But when it comes to pregnancy, there’s no other choice. You have to go to the hospital,” he pointed.
Dr Asokan also noted that Kerala has strong systems in place to ensure accountability – whether in public or private hospitals. Every maternal death is closely reviewed.
“If there’s a maternal death during delivery, there’s an audit within a week or two. The district medical officer conducts a thorough inquiry to understand why it happened and whether all protocols were followed. This is true for both private and public hospitals. So, everything is audited, and there’s accountability. Even small cases can come to light and be investigated.”
For many families, though, comfort, trust, and familiarity with the hospital seem to matter more than anything else.
Dr Sareena Gilvaz, former President of the Kerala Federation of Obstetrics and Gynaecology (KFOG), has seen this trend hold steady for years:
“In our reviews and statistical analyses, it consistently shows that around 65 to 70 percent of deliveries happen in the private sector, and only 30 to 35 percent take place in government hospitals. And when it comes to institutional deliveries, it’s over 99 percent – almost everyone now delivers in some facility.”
But she also points to a deeper issue:
“There’s something I find interesting – and a bit concerning. There’s this attitude among people that if something comes without a payment, it has less value. I’ve heard many patients tell us things like, ‘Oh, we already did that test in the government hospital, but you tell us what you think.’ It’s almost like they feel it’s not trustworthy unless they’ve paid for it. I think it reflects a deeper mindset – that paid services are inherently better. That perception really sticks.”
She explained that patients often begin their care in government hospitals, but then shift.
“Once everything is done there – all the scans, tests, procedures – they come to us with the reports and say, ‘Now you check, doctor.’ Even if the government facility has top equipment like CT or MRI, there’s still this ingrained belief that the private hospital will do a better job. That mindset has been around for years, and I see it continuing.”
Dr Gilvaz added that in private hospitals, there is more effort to build a personal bond with patients.
“There’s more attention, more one-on-one interaction. And I think patients really value that. The care feels more personalised.”
Dr Alsiha Shafjeer, a Senior Consultant in high-risk obstetrics at CRAFT Hospital in Thrissur, told South First the shift is about more than just perception. Affordability and infrastructure also matter.
“Government hospitals in Kerala are good – no doubt – but the thing is, many people here can afford private healthcare. I’m not saying they’re rich, but maybe because of the Gulf connection – like even if the woman’s husband is a driver in the Gulf – they still want the best services. People in Kerala are very health-conscious.”
She said that many families now plan ahead and come with health insurance.
“They’ve planned their pregnancy, taken insurance beforehand, and are very clear about their reproductive choices. We even have an exclusive insurance desk that handles all the paperwork.”
Dr Alsiha also pointed out the role of infrastructure and support staff.
“In private hospitals, it’s definitely better. It’s cleaner, more organised, and the environment feels more holistic. And not just the doctors – even the supporting staff like nurses are more polite, they respond faster, and they listen. That makes a huge difference. Patients feel like they’re being heard.”
She added that the lower doctor-to-patient ratio in private hospitals means more time and personalised care.
“Another reason people prefer the private sector is the doctor-patient ratio. In government hospitals, you often have too many patients and very few doctors. But in private, we’re able to give more time and personalised care.”
There’s also a growing demand for comfort during the birthing process.
“For example, many women now ask if we have a delivery suite where their husband can be present.”
Digital access to care is another factor. Online consultations are becoming more common, especially for patients in remote areas.
“We’ve started doing a lot of online consultations. People have opened up to it. Patients from far-off places just call us for minor issues. We even send prescriptions digitally.”
Dr Alsiha said much of the trust patients place in private care comes down to simple human interaction.
“Honestly, it’s about interpersonal skills. If I want more patients, I need to be kind, explain everything properly, hold antenatal classes. In government hospitals, with the kind of patient load they have, I don’t think they can manage all this,” she explained.
“Even in the OPD, we’ve tried to cut waiting times. If a woman is on half-day leave, or has just delivered and is breastfeeding, we make sure she doesn’t have to wait. These small things really matter. When you’re the one on the receiving end, it touches your heart – you feel like, ‘this hospital cares.’”
She listed the wider support network available in private facilities:
“We even have a lactational nurse who helps new mothers with breastfeeding, plus a physiotherapist, nutritionist, dietician – the whole team. That’s the kind of support we try to provide in the private setup.”
Dr Gilvaz added that private doctors also have more flexibility and a stronger sense of ownership over patient care.
“Another thing is the flexibility we have in private practice. For instance, I’m not duty-bound to see a certain number of patients, yet I often find myself working from 8.30 in the morning till nearly 7 in the evening,” she said.
“We stay back for patients, and we personally attend every delivery. We feel accountable, not just to the patient, but to the institution we work for. There’s a shared sense of ownership.”
She contrasted this with the structure of public hospitals.
“In government hospitals, many doctors wind up early, and that’s the system. It’s not their fault, but the structure itself is more rigid. In private setups, we can even start surgeries at 6 am if needed – we have anaesthetists on call round the clock. That kind of flexibility isn’t always possible in the public sector.”
Across India, government hospitals remain the mainstay of maternal healthcare. About 66.2 percent of all live births happen in public hospitals.
This reliance is even stronger in rural areas, where 68.4 percent of deliveries take place in government facilities, compared to 59.1 percent in urban areas. By contrast, private hospitals handle 24.9 percent of births nationwide – with a much higher share in cities (36.4 percent) than in villages (21.3 percent). The figures point to a clear urban-rural divide in healthcare choices.
Some deliveries still happen outside hospital settings but are attended by qualified professionals. These account for 5 percent of births across the country – again more common in rural areas (5.8 percent) than in cities (2.4 percent).
Meanwhile, 2.7 percent of live births are managed by untrained individuals or others not medically qualified. And 1.3 percent of births receive no medical attention at all – a gap that mostly affects rural India, where the rate is 1.5 percent, compared to just 0.5 percent in urban areas.
Jammu & Kashmir has the highest rate of government hospital births in the country, with 89.4 percent of deliveries taking place in public institutions. It is followed by Madhya Pradesh (83.9 percent), Assam (81.8 percent), Rajasthan (80.8 percent), and Odisha (77.3 percent) – all states that rely heavily on public healthcare, especially in underserved areas.
At the other end of the scale is Kerala, where just 34.2 percent of births happen in government hospitals – the lowest in the country. Other states with relatively low use of public hospitals for childbirth include Punjab (45.2 percent), Uttarakhand (53.4 percent), Haryana (53.8 percent), and Gujarat (56.1 percent).
(Edited by Dese Gowda)
