The Enigma of Kerala

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Kerala's remarkable access to affordable health care has provided a similar double blessing. There's a dispensary every few kilometers where IUDs and other forms of birth control are freely available, and that helps. But the same clinic provides cheap health care for children, and that helps even more. With virtually all mothers taught to breast-feed, and a state-supported nutrition program for pregnant and new mothers, infant mortality in 1991 was 17 per thousand, compared with 91 for low-income countries generally. Someplace between those two figures--17 and 91--lies the point where people become confident that their children will survive. The typical fertility for traditional societies, says Harrison, is about seven children per woman, which 'represents not just indiscriminate breeding, but the result of careful strategy.' Women needed one or two sons to take care of them if they were widowed, and where child mortality was high this meant having three sons and, on average, six children. In a society where girls seem as useful as boys, and where children die infrequently, reason suddenly dictates one or two children. 'I have one child, and I am depending on her to survive,' said Mr. Sivaram. 'If I ever became insecure about that, perhaps my views would change.'

Kerala's attitude toward female children is an anomaly as well. Of 8,000 abortions performed at one Bombay clinic in the early 1990s, 7,999 were female fetuses. Girl children who are allowed to live are often given less food, less education, and less health care, a bias not confined to India. In China, with its fierce birth control, there were 113 boys for every 100 girls under the age of 1 in 1990. There are, in short, millions and millions of women missing around the world--women who would be there were it not for the dictates of custom and economy. So it is a remarkable achievement in Kerala to say simply this: There are more women than men. In India as a whole, the 1991 census found that there were about 929 women per 1,000 men; in Kerala, the number was 1,040 women, about where it should be. And the female life expectancy in Kerala exceeds that of the male, just as it does in the developed world.

Whatever the historical reasons, this quartet of emancipations--from caste distinction, religious hatred, the powerlessness of illiteracy, and the worst forms of gender discrimination--has left the state with a distinctive feel, a flavor of place that influences every aspect of its life. It is, for one thing, an intensely political region: Early in the morning in tea shops across Kerala, people eat a dosha and read one of the two or three Malayalam-language papers that arrive on the first bus. (Kerala has the highest newspaper-consumption per capita of any spot in India.) In each town square political parties maintain their icons--a statue of Indira Gandhi (the white streak in her hair carefully painted in) or a portrait of Marx, Engels, and Lenin in careful profile. Strikes, agitations, and 'stirs,' a sort of wildcat job action, are so common as to be almost unnoticeable. One morning while I was there, the Indian Express ran stories on a bus strike, a planned strike of medical students over 'un

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