Families in south India are paying some of the highest childbirth-related medical expenses in the country according to the latest National Sample Survey (NSS 80th Round 2025) report on Household Social Consumption: Health.
The report shows that while states such as Kerala, Tamil Nadu, Telangana, Karnataka, and Andhra Pradesh have nearly eliminated home births and maintain high ante-natal and post-natal care coverage, the strong reliance on private hospitals has sharply increased out-of-pocket expenditure (OOPME) for childbirth.
Across India, institutional deliveries now account for 96.2% of all childbirths, leaving only 3.8% of births taking place at home. Government hospitals continue to handle the majority of deliveries nationally, accounting for 61.7% of childbirths. In rural India, nearly two-thirds of births take place in public facilities, while private hospitals dominate urban deliveries, accounting for 50.8% of childbirths.
The average out-of-pocket medical expenditure per childbirth case across India stands at Rs 14,775. Deliveries in government hospitals cost an average of Rs 2,299, making them the most affordable option, while childbirth in private hospitals costs Rs 37,630 on average.
Among the southern states, Kerala records the highest average expenditure per institutional childbirth with delivery costs at Rs 4,463 in public institutions and Rs 53,125 in private institutions, and an average of Rs 39,893, making it the costliest. The state is also heavily dependent on private hospitals for maternity care, with 65.7% of rural deliveries and 80.3% of urban deliveries taking place in private institutions.
Tamil Nadu follows with an average childbirth expenditure of Rs 29,682. Although the state reports 100% institutional deliveries across both rural and urban areas, the cost gap between public and private healthcare remains striking. A childbirth in a government hospital costs an average of just Rs 1,412, while the same delivery in a private hospital costs Rs 69,914.
Telangana records an average childbirth expenditure of Rs 24,269 and reports some of the strongest maternal health indicators in the country. Institutional deliveries stand at 100% in rural areas and 99.7% in urban areas, while the state reports 100% ante-natal care and 99% post-natal care coverage. However, childbirth in private hospitals costs Rs 53,355 on average compared to Rs 1,714 in public hospitals.
Karnataka reports an average expenditure of Rs 21,924 per institutional childbirth, while Andhra Pradesh stands close behind at Rs 21,770. Both states record near-universal institutional deliveries and high maternal care coverage, but private hospitals remain the preferred option for urban childbirth, pushing up household spending.
Across the five southern states, childbirths at home are virtually non-existent. Kerala and Tamil Nadu report complete institutional delivery coverage across both rural and urban areas. Telangana records 100% institutional deliveries in rural areas and 99.7% in urban centres, while Andhra Pradesh and Karnataka report rates ranging between 98% and 99.8%.
Maternal care indicators are also significantly stronger than the national average of 98% ante-natal care and 93% post-natal care. Telangana leads with 100% ante-natal care and 99% post-natal care coverage. Karnataka reports 100% ante-natal care and 97% post-natal care, while Tamil Nadu records 99% and 98% respectively. Kerala reports 99% ante-natal care and 94% post-natal care, while Andhra Pradesh records 98% and 91%.
The report also highlights sharp regional contrasts across India. States such as Odisha, Madhya Pradesh, Chhattisgarh, and Tripura rely heavily on public hospitals for childbirth, often with more than 75% to 80% of rural deliveries taking place in government facilities, helping keep costs lower.
In contrast, several northeastern states continue to report significantly higher home deliveries. Arunachal Pradesh records 25% of rural deliveries and 19.4% of urban deliveries taking place outside institutions. Nagaland reports 17.7% of rural and 16.9% of urban deliveries as non-institutional, while Meghalaya and Assam also report higher-than-average rural home births.
Tripura also shows weaker post-natal care despite high institutional delivery rates. Only 70% of rural mothers and 54% of urban mothers reported receiving post-natal care, indicating major gaps in follow-up healthcare after childbirth.