Kerala's performance—with male infants at 9 deaths per 1,000 births and female infants at just 2 per 1,000—represents the culmination of decades of focused healthcare investment and social development.
Published Sep 06, 2025 | 7:00 AM ⚊ Updated Sep 06, 2025 | 7:00 AM
Kerala infant mortality. (Representative)
Synopsis: According to the latest Sample Registration System Statistical Report 2023, released on 3 September, the southern states of Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, and Telangana have all recorded IMRs significantly below the national average of 25, demonstrating the region’s emergence as a healthcare powerhouse.
Kerala has achieved a remarkable public health milestone, recording an infant mortality rate (IMR) of just 5 deaths per 1,000 live births in 2023—lower than the United States’ rate of 5.6 per 1,000 births.
This achievement places the southern Indian state among the world’s best performers in child survival, while highlighting the dramatic transformation of India’s healthcare landscape over recent decades.
The achievement comes as part of a broader success story across South India, where states have consistently outperformed national averages and international benchmarks.
According to the latest Sample Registration System Statistical Report 2023, released on 3 September, the southern states of Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, and Telangana have all recorded IMRs significantly below the national average of 25, demonstrating the region’s emergence as a healthcare powerhouse.
Kerala’s performance—with male infants at 9 deaths per 1,000 births and female infants at just 2 per 1,000—represents the culmination of decades of focused healthcare investment and social development.
The state’s achievement is particularly notable given that the U.S. provisional infant mortality rate in 2023 was 5.61 infant deaths per 1,000 live births, meaning Kerala has now surpassed one of the world’s most developed nations.
Tamil Nadu follows closely with an IMR of 12, showing steady improvement from 15 in 2018. The state demonstrates balanced performance across gender lines, with male IMR at 10 and female at 13. Karnataka also has achieved an impressive rate of 14, declining from 23 in 2018, while both Andhra Pradesh and Telangana have reached 18 and 18 respectively, showing consistent downward trends over the past five years.
The regional success becomes even more impressive when examining the rural-urban divide. While India’s rural areas still struggle with an IMR of 28 compared to urban areas at 18, southern states have largely bridged this gap. Kerala maintains identical rates of 5 in both rural and urban areas, while Karnataka shows only a marginal difference between rural (16) and urban (11) areas.
The transformation has been particularly pronounced over the past decade. At the national level, India’s IMR has declined from 40 to 25 —a remarkable 37.5 percent reduction that represents one of the fastest improvements globally. Rural areas have seen a 36 percent decline from 44 to 28, while urban areas improved 33 percent from 27 to 18.
Southern states have led this national transformation. Kerala’s rate has dropped from 7 in 2018 to 5 in 2023, representing a 29 percent improvement in just five years. Karnataka shows the most dramatic improvement, falling from 23 to 14—a 39 percent improvement. Andhra Pradesh has achieved a 38 percent reduction from 29 to 18, while Tamil Nadu improved 20 percent from 15 to 12, and Telangana recorded a 33 percent decrease from 27 to 18.
The year-over-year improvements for 2023 continue this positive trend. Kerala improved from 7 to 5, Karnataka from 15 to 14, Andhra Pradesh from 20 to 19 (based on 2022 data), Tamil Nadu from 11 to 12 (showing slight fluctuation but maintaining low levels), and Telangana from 18 to 18 (maintaining stability at low levels).
While celebrating southern achievements, the data reveals stark regional disparities that underscore India’s healthcare challenges. The national average of 25 masks significant variations, with states like Madhya Pradesh, Chhattisgarh, and Uttar Pradesh all recording IMRs of 37—nearly seven times higher than Kerala’s rate.
This disparity reflects broader developmental challenges. The highest-performing states include Kerala (5), followed by Goa (6), Ladakh (4), Chandigarh (7), and Sikkim (6). In contrast, the worst-performing states struggle with rates that would have been considered high even a decade ago, highlighting the need for targeted interventions in specific regions.
The historical perspective makes current achievements even more remarkable. India’s IMR has fallen from 129 deaths per 1,000 births in 1971 to 25 in 2023—a reduction to less than one-fifth of the former level. This represents one of the most significant public health achievements in human history, with southern states leading this transformation.
The rural-urban analysis reveals sophisticated healthcare delivery across southern states. While the national rural IMR stands at 28 compared to urban at 18, southern states demonstrate more equitable access. Kerala shows no rural-urban difference, both at 5, while Karnataka’s rural rate of 16 compares favourably to the national rural average.
Tamil Nadu maintains a slight rural-urban gap with rural at 13 and urban at 11, but both figures remain well below national averages. Andhra Pradesh shows rural at 21 and urban at 14, while Telangana records rural at 20 and urban at 15. Even these higher figures among southern states remain competitive with many developed nations.
The success factors across southern states include robust primary healthcare systems, high female literacy rates, effective nutrition programs, and strong political commitment to health outcomes. These states have also benefited from better infrastructure, higher per capita incomes, and more effective governance structures.
(Edited by Sumavarsha)
