Kerala beats US in infant mortality, but home births pose ‘last mile’ challenge

Kerala basked in international attention this week after Health Minister Veena George announced that the state’s infant mortality rate had fallen to an all-time low of 5 per 1,000 live births — a figure lower than the United States.

Yet, even as the announcement was celebrated, report emerged of an infant dying in the state under avoidable circumstances — after the mother opted to deliver at home for religious reasons.

The irony could not be sharper: a state that tops global charts for infant survival continues to witness rare but devastating losses when families turn away from institutional care.

Also read: Infant mortality rate in India drops to 25

Kerala in elite company

That Kerala now outperforms the US has drawn global interest. In global terms, Kerala’s numbers now place it in the company of countries such as Finland, Japan, and Cuba, widely admired for their robust child survival rates.

Veena George, in a statement posted on her official Facebook handle, cited the latest Sample Registration System report of the Registrar General of India. She declared that Kerala had achieved a milestone unmatched anywhere in the country: its infant mortality rate had dropped to 5, against a national average of 26.

“Kerala’s IMR is now lower than that of the United States, which stands at 5.6. This achievement reflects our state’s strength in maternal and child healthcare,” she wrote. The Centers for Disease Control and Prevention reported an American IMR of 5.6 in 2022.

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Years of systematic effort

Kerala’s IMR figures mark a steady decline over recent years. In 2021, it stood at 6. The fall to 5 represents both continuity and consolidation of the state’s model of public health, a model shaped by decades of investment in primary care, near-universal institutional deliveries, and social determinants such as literacy and women’s empowerment.

Kerala’s achievement is not accidental. The state has worked systematically to reduce infant deaths. Nearly all deliveries are now institutional — 96 per cent in rural areas and 99 per cent in urban centres — ensuring access to trained staff, equipment, and emergency intervention.

Neonatal intensive care units have been expanded even to remote tribal and coastal belts. Programmes like Hrudyam, which provides free treatment for congenital heart defects, and Mathruyanam, which ensures postnatal mothers have free transportation, have further reduced risks.

Also read: Kerala tops the chart as India makes significant gains in maternal and child health

Avoidable tragedies

But the celebration of statistics collided with grim headlines from within the state. A newborn died following a home delivery at Perumkala near Cheruthoni in Idukki. Police said the child’s parents, Johnson (45) and Viji (45), avoided medical assistance due to their religious beliefs, with the father himself conducting the delivery.

The story of Kerala’s infant mortality is, therefore, two-fold. On the one hand, it is a triumph of policy, social investment, and public health innovation. On the other, it is a cautionary tale of how even the strongest systems can be undermined by personal conviction.

A separate case in another part of the state added to the unease. A woman who attempted home birthing succumbed to complications, and though her newborn was kept alive on life support for days, the survival outcome remained uncertain. Health officials confirmed that institutional delivery could almost certainly have prevented both the tragedies.

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Kerala’s paradox

Both incidents drew public attention precisely because they stood out as anomalies in Kerala’s otherwise stellar record. Yet the timing of the Idukki infant death, coinciding with the announcement of the state’s global milestone, brought into fore the paradox that progress at the macro level does not immunise against tragedy at the micro level.

The common thread in these tragedies is not lack of access but refusal of it. In both cases, families turned away from institutional care due to religious or cultural beliefs. While such decisions are rare in Kerala, health workers say they expose the limits of policy. The state can build hospitals, train doctors, and provide ambulances, but it cannot compel families to use them when belief dictates otherwise.

“During a recent incident in Ernakulam, an ASHA worker intervened in a dangerous home delivery despite the doctor’s warning that both mother and child could die without timely medical care. Yet, the couple remained opposed to hospital childbirth. It is a highly complicated situation,” Health Minister Veena George told The Federal a few days ago.

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The ‘last mile’ challenge

Public health specialists describe these cases as the “last mile” challenge of healthcare, not geographic inaccessibility but social and ideological resistance. “Even with clear evidence of the benefits of hospital births, we see groups worldwide pushing so-called ‘natural’ home deliveries,” said Dr KP Aravindan, senior pathologist from Kozhikode and former president of the Kerala Sastra Sahitya Parishad.

“These are often the same circles that oppose routine childhood immunisation and even COVID vaccination, recklessly endangering women and children in the name of ‘natural living’. In Kerala, too, such collectives are emerging, backed by naturopaths, acupuncture practitioners, and certain religious fundamentalists. There has to be strong action against them. In fact, even culpable homicide charges should be considered,” he added.

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More dialogue needed

In recent years, public health campaigns have emphasised not just services but trust-building. Health workers visit homes, engage with community leaders, and attempt to frame institutional delivery as both safe and culturally acceptable. But the persistence of outliers suggests that more dialogue is needed.

The tragedy of the infants who died is a reminder that Kerala’s journey is unfinished. The averages may rival Finland or Japan, but progress will not be complete until every mother and child, regardless of belief or circumstance, is protected.

As Veena George’s announcement ricocheted across national headlines, the simultaneous reports of preventable deaths offered a sobering reality check. For policymakers, the challenge is now not only to maintain the low IMR but to ensure that its benefits are universal, unbroken by exceptions rooted in belief.