Kerala is a state on the southwestern Malabar Coast of India. Spread over 38,863 km, Kerala is the twenty-third largest Indian state by area. It is bordered by Karnataka to the north and northeast, Tamil Nadu to the east and south, and the Lakshadweep Sea to the west. With 33,387,677 inhabitants as per the 2011 Census, Kerala is the thirteenth-largest Indian state by population. Malayalam is the most widely spoken language and is also the official language of the state.
Kerala has the lowest positive population growth rate in India, highest Human Development Index, highest literacy rate, highest life expectancy, and highest sex ratio. The state's coastline extends for 595 kilometres and around 1.1 million people in the state are dependent on the fishery industry which contributes 3% to the state's income.
Kerala is a pioneer in implementing the universal health care programme. Kerala's 13.3% prevalence of low birth weight is higher than that of many first world nations. Outbreaks of water-borne diseases such as diarrhoea, dysentery, hepatitis, and typhoid among the more than 50% of people who rely on 3 million water wells is an issue worsened by the lack of sewers.
Kerala is one of the pioneer states in India for initiating pro-poor policies and social protection programmes for children and women in the most marginalized communities. The state introduced progressive legislations and schemes such as social security measures, expansion of health, nutrition, WASH and education systems and public distribution system.
The United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) designated Kerala the world's first "baby-friendly state" because of its effective promotion of breast-feeding over formulas. Over 95% of Keralite births are hospital delivered and the state also has the lowest Infant mortality rate in the country. The third National Family Health Survey ranks Kerala first in "Institutional Delivery" with 100% births in medical facilities.
Over the decades, these social policies were implemented effectively with high public investment in social sector and strong administrative structures and systems that facilitated effective planning and monitoring. This significantly demonstrated impact on well-being of children in health, nutrition and education. Infant and neo-natal mortalities and prevalence of stunting among under 5 children are lowest and primary enrolment rates in schools are highest in the country.