Kerala has recorded the lowest infant mortality rate in India with five deaths per 1,000 live births across the urban-rural divide, according to the Sample Registration System report for 2023. This rate is better than even that of developed countries like the United States of America. India, too, has made progress on the IMR — it fell by 37.5% from 40 in 2013 to 25 in 2023. But much remains to be done, especially in terms of regional inequalities. States such as Chhattisgarh, Madhya Pradesh, and Uttar Pradesh reported the highest IMR at 37, while Manipur was at the other end of the spectrum with just 3. There are lessons to be learnt from states like Kerala and Manipur. Since 2010, the health department of Kerala — irrespective of the party in power — has conducted a series of intense infant death audits and come up with clinical guidelines and an improved form of antenatal and neonatal care. It has also regularly trained obstetricians and nurses in the latest medical developments, which proved to be a game-changer for the state’s IMR. A 2025 study published in Cureus highlighted the role that Accredited Social Health Activists play in ensuring that pregnant women and new mothers have the help they so badly need and thus contribute positively to bringing down both IMR and maternal mortality rate. It must be noted that while ASHAs in Kerala are among the best paid in the country, their counterparts in Chhattisgarh and Uttar Pradesh are the worst paid. There is thus a case to heed the demands of ASHAs in
these states on payments apart from further strengthening child health programmes, such as the Janani Suraksha Yojana and the Janani Shishu Suraksha Karyakram.
There are also things that India can learn from its neighbours. Sri Lanka, Bangladesh, Nepal and Bhutan, with economies that are smaller than India’s, have lower IMRs. Sri Lanka’s strong maternal and child healthcare system and Bangladesh’s public-private partnerships have shown that targeted policy can deliver results. IMR reduction, however, cannot be treated in isolation. It is tied to malnutrition, maternal deaths, inadequate diets and poor immunisation. Progress in one area influences outcomes in others. India’s gains in IMR may thus help it address these overlapping challenges. Social and economic barriers must be addressed too. Vaccine hesitancy, distrust of institutional care, gender and caste discrimination in access to treatment, and the crippling cost of healthcare must be tackled.