The NITI Aayog’s just-released report, ranking the States as per “Performance in Health Outcomes” Index put Kerala on top as the overall best performing State and at the bottom, at rank 21, when the annual incremental progress was measured.

The annual incremental progress has been measured with 2014-15 as the base year and 2015-16 as the reference year. In fact, between the base year and reference year, Kerala has actually shown a decline in performance by 3.45 points.

However, even while agreeing that the annual incremental progress of a high-performing State like Kerala, which has already achieved significant targets such as very low levels of neonatal mortality, cannot be substantial, there are areas where the State should be concerned.

One of the significant indicator is sex ratio at birth (SRB), which showed a decline in Kerala by seven points from 974 (females per 1,000 males) in the base year (2014-15) to 967 in the reference year of 2015-16.

The ‘son preference’

“It is very difficult to prove from the current data base that sex-selective preference is operational in Kerala. But one should know that the abortion rate in Kerala is extremely high. Smaller surveys have proven that there is indeed son preference in Kerala too and that 49% of couples with one girl child will opt for a second child and will manipulate one way or another so that they do not get a girl again,” says S. Irudayarajan, a senior demographer and researcher

Proportion of Low Birth Weight (LBW, defined as birth weight less than or equal to 2.5 kg)) infants among newborns is an important predictor of newborn health and survival. In 2014-15, if the proportion of LBW newborns in Kerala was 10.8%, it went up to 11.7% in 2015-16, putting Kerala somewhere in the middle, behind Bihar, Jharkhand, and Uttar Pradesh.

Traditional causes of LBW could be risk factors related to the mother, such as child bearing at a young age, multiple pregnancies, poor nutrition, heart disease or hypertension, untreated coeliac disease, and insufficient pre-natal care.

Kerala needs to explore why it has not been able to address the issue of LBW babies and the strategies and interventions it has to adopt to break the inter-generational cycle of malnutrition.

Total immunisation coverage (the proportion of infants between the ages of 9-11 months who have received one dose of BCG, 3 doses of DPT, 3 doses of OPV, and one dose of measles vaccine) is another important indicator where Kerala has fallen behind. Kerala’s proportion of fully immunised children went down from 95.5% in 2014-15 to 94.6% in 2015-16, putting the State at the eighth place.

Surprisingly, the proportion of institutional deliveries in Kerala also went down from 96% in 2014-15 to 92.6% in 2015-16.