Most Keralites, such as this fisherman, live in rural areas.The 3.18 crore (31.8 million) of Kerala’s compound population is predominantly of Malayali Dravidian ethnicity, while the rest is mostly made up of Indo-Aryan, Jewish, and Arab elements in both culture and ancestry (both of which are usually mixed). Kerala is also home to 321,000 indigenous tribal Adivasis (1.10% of the populace), who are mostly concentrated in the eastern districts. Malayalam is Kerala's official language; Tamil and various Adivasi languages are also spoken by ethnic minorities. Kerala is home to 3.44% of India's people, and at 819 persons per km² its land is three times as densely settled as the rest of India. However, Kerala's population growth rate is India's lowest while Kerala's decadal growth (9.42% in 2001) is less than half the all-India average of 21.34%. Additionally, whereas Kerala's population more than doubled between 1951 and 1991—adding 156 lakh (15.6 million) people to reach a total of 291 lakh (29.1 million) residents in 1991—the population stood at less than 320 lakh (32 million) by 2001. Kerala's people are most densely settled in the coastal region, leaving the eastern hills and mountains comparatively sparsely populated.
Women comprise 51.42% of the population. Kerala's principal religions are Hinduism (56.1%), Islam (24.7%), and Christianity (19%). Remnants of a once substantial Cochin Jewish population also practice Judaism. In comparison with the rest of India, Kerala experiences relatively little sectarianism. Nevertheless, there have been signs of increasing influences from religious extremist organisations.
Kerala's society is less patriarchial than the rest of the Majority World. Certain Hindu communities (such as the Nairs), Travancore Ezhavas and the Muslims around Kannur used to follow a traditional matrilineal system known as marumakkathayam which has in the recent years (post Indian independence) ceased to exist. Christians, Muslims, and some Hindu castes such as the Namboothiris and the Ezhavas follow makkathayam, a patrilineal system. Kerala's gender relations are among the most equitable in India and the Majority World. However, this too is coming under threat, from such forces as patriarchy-enforced oppression of women.
Kerala's human development indices — elimination of poverty, primary level education, and health care — are among the best in India. For example, Kerala's literacy rate (91%) and life expectancy (73 years) are now the highest in India. Meanwhile, Kerala's rural poverty rate fell from 69% (1970–1971) to 19% (1993–1994), while the overall (urban and rural) rate fell 36% between the 1970s and 1980s. By 1999–2000, the rural and urban poverty rates dropped to 10.0% and 9.6% respectively. These changes stem largely from efforts begun in the late 19th century by the kingdoms of Cochin and Travancore to boost social welfare. This focus was maintained by Kerala's post independence government. However, Kerala's unemployment and suicide rates are high by Indian standards. Kerala's above-unity female-to-male ratio—1.058—also distinguishes it from the rest of India. The same is true of its sub-replacement fertility level and infant mortality rate (estimated at 12 to 14 deaths per 1,000 live births). However, Kerala's morbidity rate is higher than that of any other Indian state—118 (rural Keralites) and 88 (urban) per 1,000 people. The corresponding all India figures are 55 and 54 per 1,000, respectively. Kerala's 13.3% prevalence of low birth weight is substantially higher than that of First World nations. Further, outbreaks of water-borne diseases including diarrhoea, dysentery, hepatitis, and typhoid, among the more than 50% of Keralites who rely on some 30 lakh (3 million) water wells constitutes another problem, a situation only exacerbated by the widespread lack of sewerage.
Kerala's health care system has garnered international acclaim, with UNICEF and the World Health Organization (WHO) designating Kerala the world's first "baby-friendly state". For example, more than 95% of Keralite births are hospital-delivered. Aside from Ayurveda (both elite and popular forms), siddha, and Unani, many endangered and endemic modes of traditional medicine, including kalari, marmachikitsa, and vishavaidyam, are practiced. These propagate via gurukula discipleship, and comprise a fusion of both medicinal and supernatural treatments, and are partly responsible for drawing increasing numbers of medical tourists. A steadily aging population—11.2% of Keralites are over age 60-and low birthrate (18 per 1,000) make Kerala one of the few regions of the Third World to have undergone the "demographic transition" characteristic of such developed nations as Canada, Japan, and Norway. In 1991, Kerala's TFR (children born per women) was the lowest in India. Hindus had a TFR of 1.66, Christians 1.78, and Muslims 2.97.