Monitoring of newborns at birth for clinically and cytogenetically observable malformations as well as a comprehensive Health Audit Survey are being carried out in the high-level natural radiation (HLNR) area of Kerala, a southwest state of India. A total of 92,689 newborns were monitored from August 1995 to June 2004 and overall incidence of stillbirths and malformations was 0.51% and 2.03%. Multiple logistic regression analyses of congenital malformation and stillbirths do not suggest any correlation with the radiation levels. Health Audit Survey was carried out in three Panchayats, and the pattern of both birth defects and late onset diseases was similar. The karyotype analysis of 23,844 cord blood samples was carried out. The overall incidence of constitutional karyotype anomalies was 4.86F 0.45 per 1000.