Published Nov 01, 2026 | 9:30 AM ⚊ Updated Nov 01, 2026 | 9:30 AM
Keralam has prepared a roadmap to achieve its goal of zero preventable deaths among mothers and children. (iStock)
Synopsis: Keralam has unveiled an ambitious twin action plan to eliminate preventable maternal and child deaths. The proposed initiatives include a statewide digital registry to track high-risk pregnancies, a pregnancy risk-scoring system, round-the-clock emergency obstetric services, GPS-enabled maternal and neonatal ambulance networks, and mandatory reviews of every maternal death. For newborns, the plan envisages trained resuscitation personnel at every delivery point, real-time availability of neonatal ICU beds, expanded Kangaroo Mother Care and others. Special outreach is also planned for tribal settlements and migrant families.
From ensuring a trained newborn resuscitation provider at every birth to tracking high-risk pregnancies through a statewide digital registry, Keralam has drawn up an extensive action plan to eliminate preventable maternal and child deaths.
The proposed measures cover the entire continuum of care, from pre-pregnancy health checks and safe delivery to newborn intensive care, post-discharge monitoring and emergency transport.
The Director of Health Services submitted two detailed roadmaps to the government on 3 October: Zero Preventable Maternal Death – State Action Plan Keralam, 2026 and Zero Preventable Child Death – Keralam Action Plan 2026. The approved the plans on 25 October.
Prepared in consultation with public health experts, clinicians, professional organisations and other stakeholders, including Kerala Federation of Obstetrics and Gynaecology (KFOG), Indian Academy of Pediatrics – Keralam Chapter and National Neonatology Forum, Keralam Chapter, the plans set out separate but interconnected strategies to achieve the goal of zero preventable deaths among mothers and children.
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The child-death prevention plan rests on six key areas, beginning with the accurate reporting and investigation of every death.
All infant deaths will have to be notified within seven days under the Keralam Clinical Establishments Act. The plan proposes digitised coding of causes of death using the ICD-PM system, along with verbal and social autopsies to examine community and transit deaths.
Ensuring a safe birth and immediate newborn care is another priority.
Every delivery point must have personnel trained and certified in Newborn Resuscitation Programme (NRP) procedures. Designated delivery centres will also have round-the-clock paediatrician coverage, while standardised perinatal care protocols will be introduced across public and private hospitals.
The third pillar focuses on strengthening treatment facilities for premature, low birth weight and critically ill newborns.
A tiered network of Special Newborn Care Units (SNCUs) and Neonatal Intensive Care Units (NICUs) is proposed, supported by a real-time bed-availability dashboard and an organised neonatal transport system.
The plan also calls for expanding Kangaroo Mother Care (KMC) and Comprehensive Lactation Management Centres (CLMCs) to improve newborn survival.
Early detection and treatment of congenital conditions form another major component. Universal pulse-oximetry screening for critical congenital heart disease (CCHD), wider access to aneuploidy and anomaly scans, and integrated referral arrangements under the Hridyam and Shalabham programmes are among the proposed interventions.
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The strategy does not end with a newborn’s discharge from hospital.
A high-risk newborn discharge registry will be established, with ASHAs and Junior Public Health Nurses (JPHNs) undertaking home visits under the Samagra Shishu Bal Swasthya Karyakram (SSBSK). Training in Integrated Management of Neonatal and Childhood Illness (IMNCI) and its facility-based component will also be refreshed.
The sixth pillar seeks to address disparities in child survival, particularly among vulnerable communities.
Special interventions are planned for Scheduled Tribe settlements in Wayanad, Idukki and Palakkad, as well as families of migrant workers.
These will include targeted outreach, preconception care and health communication in different languages.
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The maternal death prevention plan adopts a similarly comprehensive approach, beginning even before pregnancy.
Preconception screening, risk assessment, adolescent health interventions and measures to improve women’s health before conception are proposed to identify potential complications early.
During pregnancy, a statewide online registry will track high-risk cases. The registry will be linked to the Unique Health Identification (UHID) and Ayushman Bharat Health Account (ABHA) systems.
The Keralam Pregnancy Risk Score (KPRS) will be introduced to identify women requiring closer monitoring and structured follow-up.
Ensuring round-the-clock emergency obstetric care is another key objective.
All designated delivery centres are expected to have 24-hour availability of obstetricians, anaesthesiologists and trained nursing staff. Blood bank services must also remain accessible at all times.
The plan proposes implementing the Keralam Maternal Obstetric Early Warning Score (MOEWS) to identify signs of deterioration in pregnant women and enable timely intervention.
Critical care facilities will also be strengthened, with functional High Dependency Units (HDUs) and ICU referral pathways envisaged in every district. Standardised emergency treatment protocols will cover major maternal complications, including postpartum haemorrhage (PPH), eclampsia, sepsis and maternal collapse.
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Recognising that delays in reaching appropriate medical facilities can prove fatal, the action plan proposes a Keralam Maternal-Neonatal Emergency Transport Network with GPS tracking.
The system will provide for stabilisation before referral, compulsory communication between referring and receiving hospitals, and contingency funds to facilitate emergency transfers, particularly for vulnerable pregnant women.
The final component places emphasis on surveillance, accountability and learning from every maternal death. Hospitals will be required to report maternal deaths within two to four hours. District-level reviews must be completed within one to five days, followed by Confidential Reviews of Maternal Deaths (CRMD) in collaboration with KFOG.
The reviews are intended to identify gaps in care, delays in treatment and systemic failures that could have contributed to the death, allowing corrective measures to be taken.
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The state had earlier disputed the reported increase in its Infant Mortality Rate (IMR) from five to eight deaths per 1,000 live births in the Sample Registration System (SRS) 2024 report, maintaining that the state’s actual rate has remained around five for the past eight years.
According to an official note issued by the Additional Director of Health Services (Family Welfare) on 6 June, the higher SRS estimate does not reflect a deterioration in infant survival rates but is the result of limitations in sample-based calculations in states with very low mortality.
The Health Department has based its position on data compiled through the Health Management Information System (HMIS) and the Department of Health Services’ infant death line-list, which capture registered births and deaths across the state. These records indicate that Kerala’s calculated IMR has remained close to five per 1,000 live births over eight consecutive years.
The department has also pointed to a substantial fall in the actual number of infant deaths. The figure declined from 2,970 in 2014-15 to 1,593 in 2025-26, marking a reduction of 46.36% over 12 years.
The discrepancy between the SRS estimate and the state’s administrative figures has brought into focus the limitations of sample surveys in regions where infant deaths are relatively few.
According to the department’s assessment, the law of small numbers, wide confidence intervals and the division of already limited samples into smaller groups can produce considerable fluctuations in the estimated rates.
In a state with a low baseline IMR, even a small variation in the number of deaths captured by a sample survey can push the estimated rate up or down.
The department maintains that the change from five to eight should therefore not be interpreted as evidence of a reversal in Keralam’s progress in infant health.
The state has also highlighted its performance in maternal healthcare.
Keralam’s Maternal Mortality Ratio (MMR) has declined to 24 deaths per one lakh live births in the latest SRS Special Bulletin for 2022-24, compared with 30 in the previous 2021-23 bulletin.
At 24, Kerala continues to record the lowest MMR in the country, against the national average of 87.
The state attributes its sustained performance in maternal and child health to improvements in public healthcare delivery, early identification of complications, institutional care and clinical interventions under the Aardram Mission.
The Health Department argues that the steady decline in the absolute number of infant deaths, along with the state’s administrative records, offers a more comprehensive picture of child survival than the latest SRS estimate alone.
(Edited by Majnu Babu).
