The state recorded the lowest population growth rate, 9.42, in the country during the decade 1991-2001 as per 2001 census.  The decadal growth rate has recorded substantial decline over the previous census, from 14.32 (1981-91) to 9.42 (1991-2001). As per the result of sample registration survey 2007, state of Kerala has recorded the lowest birth rate (14.7) and Infant Mortality Rate (13) far below the National average of 23.1and 55 respectively.  Death rate in the State is 6.8 against National rate of 7.4 during the year. As per the results of NFHS-3 Kerala has achieved the target of hundred percent institutional deliveries there by reducing Maternal Mortality to considerable levels. Sex ratio as per census 2001 is 1058 female per thousand men. Child Sex ratio (age 0-6) is 960 females per thousand male children. Female literacy rate is (86.87%) is also the highest in the country. National Family Health Survey 2005-06 has recorded the total fertility rate as 1.9, which is below the replacement level of fertility. SRS 2007 has recorded a further reduction in TFR to 1.7 which is the lowest in the country

However the results of NFHS 3 show that the state has gone down in vaccination coverage due to many reasons.  Various action plans have been mooted to sustain the achievements already recorded and improve performance wherever required. As a result the latest Coverage Evaluation Survey shows that 87.9 % of children are fully immunized though the percentage of full immunization by age 12 months is 82.9. Further the recently concluded DLHS III shows 79.5% coverage for full immunization.
Many initiatives have been taken to improve the immunization status in the state.  Outreach immunisation camps have been identified as a means to extend immunization to floating and migrant population. Service of ASHA is utilised in a big way to achieve maximum coverage of these groups. Immunization sessions are organised in the remote areas giving special attention to tribal, coastal and urban slums. In the low coverage areas, immunization activities are strengthened with the help of NGOs and private institutions.

Alternate vaccine delivery programme enables the field functionaries to carry out immunization sessions on a continuous basis due to flexibility in making vaccine available at sites without depending on routine governmental system.

Mobility support is ensured for staff engaged in immunization activities. Hassle free arrangements for transportation of vaccine, maintenance of Cold Chain etc. are ensured. Vehicle is being hired wherever government vehicles are not available.

In order to make available enough number of service providers, JPHNs were hired at places like urban slums.