Mumbai: Meghalaya, a picturesque hilly state in the sub-eastern Himalayan region, nearly matches India’s richer states on the best health outcomes. However, insurgency and poor infrastructure impede its progress on other development indicators, shows an IndiaSpend analysis of the state’s performance on 20 development indicators in comparison with nine other states and the national average.

This rare matrilineal state--where family descent is traced through the mother rather than the father--is also slipping on gender indices, reflecting a wider change.

Meghalaya will vote in state elections on February 27, 2018. The incumbent Congress party is looking to retain its turf as the Bharatiya Janata Party (BJP) is expected to win a sizeable number of seats for the first time in the tribal-dominated, Christian-majority (74.5%) state’s 38-year history.

After attaining statehood in 1972, since 1976 Meghalaya has mostly been ruled by Congress-led coalition governments, the Economic & Political Weekly reported on February 10, 2018.

BJP president Amit Shah promises to make Meghalaya a model state in five years--he promises to lift the National Green Tribunal’s ban on mining and create jobs if his party, ruling at the Centre, is voted to power in the state.

Our analysis of Meghalaya’s performance on 20 socio-economic and health indicators over 10 years to 2015-16 shows:

  • the state already competes with well-developed counterparts such as Kerala and Goa. On more than half (12) of these indicators, it ranks among the top five of the 10 states that IndiaSpend analysed using various government data including the National Family Health Surveys for 2005-06 (NFHS 3) and 2015-16 (NFHS-4).
  • its per capita health spending (Rs 2,366) is the second highest among the 10 states analysed, lower only than Goa (Rs 2,927), shows the National Health Profile (NHP) 2017.
  • its unemployment rate (4.8%) is below the national average--higher than Tamil Nadu (4.2%) but much lower than other north-eastern states, according to the labour ministry’s annual report of 2015-16.
  • from 2006 to 2016, the rate of crime against women has risen three-fold from 7.1 per 100,000 population to 26.7.

For our analysis--part of our election-year examination of states’ development indicators--we chose states that are development leaders and have high per-capita incomes such as Kerala, Goa, Gujarat and Karnataka, as well as laggards with low income such as Madhya Pradesh (MP), Rajasthan and Uttar Pradesh (UP), as well as Assam and Tripura, Meghalaya’s neighbours in the north-east region.

Four of these states--Madhya Pradesh, Rajasthan, Goa and Gujarat--are under BJP rule. Kerala and Tripura are ruled by the Communist Party of India (Marxist), while Karnataka like Meghalaya is ruled by the Congress. While UP and Assam also have BJP governments today, they were ruled by the Samajwadi Party and the Congress, respectively, in 2016--the cut-off year for our analysis.

Meghalaya and its challenges

Surrounded by Bangladesh on its south and west, and Assam to its east and north, Meghalaya, roughly the size of Israel, holds a population of two million, equivalent to that of Lucknow.

The Khasi, Jaintia and Garo, most of whom are Christian, form the three major ethnic tribes in the state and comprise 86.15% of its population, shows the 2017 Meghalaya statistical handbook. The religious minorities here include Hindus (11.5%) and Muslims (4.4.%).

Once considered a “role model” of peace and democracy, Meghalaya has witnessed rising insurgency and terrorism since the late 1980s and especially since 2009, according to this 2016 policy brief by the Delhi-based Institute for Defense Studies & Analyses. It has also faced unrest due to demands from each of the three major tribes for separate statehood, border disputes with Assam, illegal mining and import of weapons from Assam and Bangladesh, which have impeded the state’s progress.

From 2007 to February 18, 2018, 131 civilians have been killed in terrorist conflict in Meghalaya, according to the South Asia Terror Portal database. In the first two months of 2018, three civilians were killed.

In terms of per capita income, Meghalaya’s Rs 64,638 ranks it 25th among India’s 35 states and union territories, featuring alongside least-developed states such as Orissa and Jharkhand. Primarily an agrarian economy with 80% of the population dependent on the farm for livelihood, the hilly terrains limit agricultural operations to 10% of the area while the potential for agro-based industries remains unutilised, according to this 2016 report by the ministry of micro, small and medium enterprises. The uneven landscape and vast forests also hinder accessibility so that a little over a third of the state (34%) is connected by road, the data show.

Health outcomes

With an infant mortality rate (IMR) of 30 deaths per 1,000 live births, Meghalaya ranks in the top five in our analysis of 10 states, performing better than Gujarat and competing with its richer Congress-ruled counterpart Karnataka (28). In 2005-06, Meghalaya ranked fourth in our 10-state analysis for IMR, but Tripura showing an improvement rate of 24 over this time, now ranks third pushing Karnataka and Meghalaya one place behind.

In terms of the mortality rate of children under five years of age, Meghalaya showed among the best improvements (30 points) over the decade to now rank in the top five in these 10 states. It fares much better than the national average, behind only Karnataka, Goa, Kerala and neighbouring Tripura. In contrast, Gujarat, despite ranking fourth in per capita income, fares worse with an under-five mortality rate of 43 deaths per 1,000 live births.

Source: National Family Health Survey, 2015-16

At a time when wasting among children under five years of age increased across the country, as IndiaSpend reported in March 2017, Meghalaya reported the best improvement among the 10 states analysed from 2005-06 to 2015-16.

In 10 years to 2015-16, the wasting rate here fell from 30.7% to 15.3%--the lowest among the 10 states analysed and much below the national average of 21%.

Its performance on these indicators implies improved antenatal and postnatal care: Nearly 24% of Meghalaya’s mothers received full antenatal care in 2015-16, up from 4.2% in 2005-06, and above the national average of 21%.

How challenges affect outcomes

Low connectivity and poor infrastructure affect the state’s institutional healthcare delivery. Meghalaya reports the lowest proportion of institutional births. In 2015-16, less than 52% of births took place in hospitals here--much below the national average of 79%, and the lowest among the 10 states we analysed.

In 2015-16, only half of Meghalaya’s pregnant women were visited by a healthcare worker at least four times during pregnancy--the minimum requirement according to the World Health Organization’s guidelines--below the national average and way behind Tripura, Gujarat, Karnataka, Goa and Kerala.

Even though the state reported the highest improvement in full immunization of babies among 10 states, by 28.6 percentage points to 61.5% in 2015-16, immunization coverage in the state is still below the national average of 62%.

Source: National Family Health Survey, 2015-16; *Full immunization: BCG, measles, and three doses each of polio and DPT vaccines

Meghalaya also reported the least development among the 10 states of our analysis in boosting household access to improved sources of drinking water.

About a third of households in the state (32.1%) still do not have access to better sources of drinking water--more than 21 percentage points below the national average, and worse than poorer states like Assam (16.2%), Madhya Pradesh (15.3%) and Rajasthan (14.5%).

Improper access to good drinking water affects children’s health--the prevalence of diarrhoea has nearly doubled over the decade. In 2015-16, 10.6% of children were reported to have suffered from diarrhoea two weeks before the NFHS survey, up from 5.7% in 2005-06.

The open defecation rate in Meghalaya is about 7.6%--much below other states analysed; however 40% of the state still does not have access to improved sanitation.

This lack of access to improved sanitation facilities could impede progress on reducing stunting (low height for age) in children, and anaemia, as IndiaSpend reported in April 2017 and September 2016.

Nearly 44% of Meghalaya’s children under five years of age are stunted (low height for age). While this is a 11.3 percentage point improvement from a decade ago when the state reported a stunting rate of 55.1%, its performance on this indicator remains much worse than the national average (38.4%), and better only than Uttar Pradesh (46.3%) in our 10-state analysis.

While most of India has succeeded in reducing the incidence of anaemia among women of reproductive age (15-49 years), in Meghalaya, the figure has grown by 5.4%. A decade ago, Meghalaya had one of the lowest percentages of anaemic women in the country, behind Kerala or Goa among the 10 states we analysed. As of 2016, it is placed between the least developed states of UP, MP and Rajasthan.

Source: National Family Health Survey, 2015-16

Status of women a growing concern in the matrilineal state

Meghalaya’s worsening performance in addressing anaemia among women is indicative of a declining trend in the status of women in the state.

Meghalaya ranks second in the country for a high child sex ratio of 970 females per 1,000 males--better than all states analysed and significantly higher than the national average of 942. However, this has actually declined three points since 2001.

Contrary to the prevailing ideas that women here enjoy a better position than their counterparts in the rest of India, women in this conflict-struck region are actually in a disadvantageous position, the North East Network, a women’s rights organisation, says, adding that although traditionally Meghalaya has had matrilineal societies, violence against women including rape, attempt to rape and domestic violence has been on the rise.

The rate of crime against women has risen three-fold in the past 10 years from 7.1 per 100,000 population in 2006 to 26.7 per 100,000 in 2016, shows an IndiaSpend analysis of data by the National Crime Records Bureau. The state reported the fourth-highest rate (13.8 per 100,000) for rape in the country, behind Delhi (22.6), Sikkim (30.3) and Arunachal Pradesh (14.7).

It is well documented that in conflict zones, the scattering, displacement and breakdown of families and communities cause women to suffer oppression by withdrawal from the public sphere, political exclusion and exposure to male violence, as this study by the South Asia Institute at the University of Heidelberg shows.

In 2005-06, 12.8% of Meghalaya’s women who were ever married reported spousal violence, the lowest proportion among the 10 states in our analysis. Over the course of 10 years, this number more than doubled to 28.7%, bringing Meghalaya on par with the national average of 28.8%. It now ranks third worst among the 10 states.

While female literacy in the state, at 82.8%, is comparable with best performers Kerala and Goa, it is still less than the literacy rate among men within the state. Further, fewer Meghalayan women (33.6%) are educated for more than 10 years compared with Indian women on average (35.7%).

Source: National Family Health Survey, 2015-16

The state holds one of the lowest rates of early marriage before the age of 18 (16.9%) across India (26.8% average), behind Goa (9.8%) and Kerala (7.6%). The percentage of women who have a say in household decisions grew by 1% over 10 years to 91.4%, taking the state to the fourth rank in 2015-16--down from second position in 2005-06 because neighbouring Tripura reported a better growth by 13.8% to rank ahead at third place, the data show.

(Saldanha is an assistant editor and Mohan is an intern with IndiaSpend.)

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