Kerala has recorded an infant mortality rate (IMR) of 5 deaths per 1,000 live births, placing it below the United States, where the rate stands at approximately 5.6, and far below India’s national average of around 25 per 1,000.6 The data, reported in the early 2020s, position Kerala among regions with child survival outcomes comparable to high-income countries. This development highlights sustained public health progress in a low- and middle-income setting and underscores persistent regional disparities within India.
The infant mortality rate (IMR) measures the number of deaths among children under one year of age per 1,000 live births in a given year. Global agencies such as UNICEF use IMR as a core indicator of population health, because it reflects maternal health, access to healthcare services, nutrition, sanitation, and broader socioeconomic conditions.1
Globally, infant and neonatal deaths account for a large share of under-five mortality despite decades of decline, making IMR a critical benchmark for monitoring health system performance and equity.1,2
Kerala’s current IMR reflects decades of gradual decline rather than rapid, short-term change. Historical demographic analyses show that the state reported very high infant mortality levels before the 1960s, followed by consistent reductions over subsequent decades.4,5
Peer-reviewed studies attribute this long-term decline to early and sustained improvements in:
Female literacy and general education
Access to antenatal and postnatal care
Public investment in primary healthcare
Research based on national survey data consistently shows that maternal education, birth spacing, and institutional delivery strongly correlate with infant survival factors that became widespread in Kerala earlier than in most Indian states.3,5
Kerala maintains high coverage of institutional deliveries and skilled birth attendance, both of which significantly reduce deaths from preventable causes in the neonatal period. Analyses of mortality registration systems in the state confirm improved reporting accuracy and widespread utilization of public health services.4
National-level studies show that Indian states with stronger primary healthcare networks and better maternal care coverage experience faster and more sustained declines in IMR, reinforcing the importance of system-level investment rather than isolated interventions. 2,3
India’s national IMR remains approximately 25 per 1,000 live births, with substantial variation across states. Multiple population-based studies identify Kerala as a statistical outlier within the country due to its significantly lower infant mortality.5
In international comparison, Kerala’s IMR now matches or slightly outperforms that of the United States, despite large differences in income and health expenditure.6 Global analyses emphasize that such outcomes depend not only on economic growth but also on equitable access to education and healthcare.1,2
Kerala’s trajectory demonstrates that long-term investment in social development and primary healthcare can produce child survival outcomes comparable to those in high-income countries. However, public health researchers caution that replicating this success elsewhere requires attention to governance continuity, social equity, and community engagement, rather than the replication of individual programmes alone.4
Despite low overall infant mortality, neonatal deaths account for the majority of infant losses, a pattern observed globally.1
Further reductions will depend on:
Strengthening care for preterm and low-birth-weight infants
Sustaining public investment in health systems
Monitoring inequities across regions and population groups remains critical to ensuring that gains in child survival are maintained.2
Infant mortality indicators show stark differences between Kerala, India as a whole, and the United States. Kerala reports an infant mortality rate of 5 per 1,000 live births, which is substantially lower than the Indian national average of around 25 and slightly better than the United States rate of approximately 5.6.
Neonatal mortality in Kerala remains below 4 per 1,000 live births, compared with an estimated 18 per 1,000 nationally in India. Comparable consolidated neonatal mortality data are not available for the United States in this context.1,6
Kerala’s infant mortality rate of 5 per 1,000 live births reflects decades of sustained social and health investment rather than short-term policy change. While the state’s experience cannot be directly transplanted to all settings, it provides strong evidence that equitable access to education, maternal care, and primary health services remains central to reducing preventable infant deaths in India and globally.
UNICEF. 2023. Child Survival: Under-Five Mortality. https://data.unicef.org/topic/child-survival/under-five-mortality
Pal, Anita, Jeetendra Yadav, Dolly Kumari, and Kh. Jitenkumar Singh. 2020.
“Gender Differentials and Risk of Infant and under Five Mortality in India: A Comparative Survival Analysis.” Children and Youth Services Review 118: 105477. https://doi.org/10.1016/j.childyouth.2020.105477
Bhatia, Mrigesh, Laxmi Kant Dwivedi, Mukesh Ranjan, Priyanka Dixit, and Venkata Putcha. 2019.
“Trends, Patterns and Predictive Factors of Infant and Child Mortality in Well-Performing and Underperforming States of India: A Secondary Analysis Using National Family Health Surveys.” BMJ Open 9 (3): e023875. https://doi.org/10.1136/bmjopen-2018-023875
Gupta, Aashish, and Sneha Sarah Mani. 2022.
“Assessing Mortality Registration in Kerala: The MARANAM Study.” Genus 78 (1): 1. https://doi.org/10.1186/s41118-021-00149-z (doi.org in Bing)
Sahu, Damodar, Saritha Nair, Lucky Singh, B.K. Gulati, and Arvind Pandey. 2015.
“Levels, Trends & Predictors of Infant & Child Mortality among Scheduled Tribes in Rural India.” Indian Journal of Medical Research 141 (5): 709–19. https://doi.org/10.4103/0971-5916.159593
Counterview. 2026. With Infant Mortality Rate of 5, Better Than US, Guarantee to Live Is ‘Alive’ in Kerala. January 25, 2026. https://counterview.net/2026/01/25/with-infant-mortality-rate-of-5-better-than-us-guarantee-to-live-is-alive-in-kerala