Case Study: Urban health policy in an indigenous context

Meghalaya state is a rapidly urbanising state in North-East India, and the home of indigenous matrilocal and matrilinear people mostly belonging to the Khasi-Jaintia and Garo tribes. Maternal mortality rates (MMR), anaemia and malnutrition are high among women and girls. Urban health indicators are overall better than those in rural areas, but have worsened recently. Political representation of women is limited.

Urban health is not on the health policy agenda in general, and primary health appears to be focused on rural rather than urban settings. There is a sizable urban population including a growing slum population, consisting of rural indigenous migrants, migrants from states in mainland India such as Bihar, Bengal and migrants from neighbouring Bangladesh and nearby Nepal. 

In 2013, Meghalaya introduced a policy of universal access to health, but it is unclear whether and how poor urban women and girls can benefit. This case study explores the following three policy questions:

  • How are health system data used for urban health policy formulation processes, on SRHR for women and girls in two poor urban areas?
  • How can women and girls in urban areas participate in city and state policy development and public decision making on SRHR?
  • How are urban and state health priorities developed at the state level?

Case Study Reports

When the Hen Crows: Obstacles that Prevent Indigenous Women from Influencing Health-care Policies – A Case Study of Shillong, Meghalaya, India

P. Oosterhoff, L. Saprii, D. Kharlyngdoh, S. Albert 2015

Despite living in a matrilineal society, when it comes to health and education, women in Meghalaya, India lag behind their peers in other northeastern states. The state has some of the worst maternal health indices and the highest unmet contraceptive need in India. One of the reasons for the women’s low status is the position of Khasi women in their communities – they do not participate in traditional political decision-making, which historically is a male domain. Khasi women are barred from even attending decision-making processes. This paper examines how the Indian state prioritises health needs, and how and whether poor and indigenous women are able to participate in decisions about their sexual and reproductive health. The focus is on the indigenous Khasi population in Meghalaya, with its traditional systems of governance that exist in tandem with India’s modern institutions. Literature and document reviews, documented participation through interviews and focus group discussions at these different levels in Shillong help explain what opportunities and barriers women have for political participation.


Digital Storytelling from Shillong

This case study employed a number of innovative methodologies, including Digital Storytelling. Four indigenous and non-indigenous women from Shillong in Meghalaya, India share their personal stories via the medium of digital storytelling, Click on the image below to view all of their stories.

Poster presentation at City Health International 2014

The City Health International 2014 conference took place in Amsterdam on November 3rd-4th. At this conference, we presented a poster highlighting the research on evidence-based policy planning for women and girls in poor urban areas in an indigenous context - Shillong - Meghalaya, India.


Blog: The plight on non-indigenous women in Shillong's urban slums

Researcher Chongneithem Lhouvum writes a blog post on the disadvantages and challenges of being a non-indigenous woman in the urban slums of Shillong, India. Read the full blog post.