NFHS-6 shows Northeast India’s gender gains are real, but so are the gaps

The latest National Family Health Survey (NFHS-6) offers encouraging evidence that women across Northeast India are making significant gains in education, digital inclusion, health awareness and social empowerment.

Compared to the previous survey round, the region has witnessed notable improvements in women’s schooling, internet usage, menstrual hygiene practices, and a decline in child marriage and gender-based violence in several states.

Yet beneath these encouraging trends lies a quieter challenge: reproductive health and bodily autonomy remain unfinished agendas.

A comparative analysis based on NFHS-5 and NFHS-6 data reveals a region that is rapidly modernising, and while many indicators show upward movement, progress in reproductive health, nutrition and informed family planning choices has been slower and more uneven.

Northeast Women’s Progress at a Glance

Indicator//State	Women with 10+ Years Schooling (%)	Women with 10+ Years Schooling (%)	Internet Use (%)	Internet Use (%)	Child Marriage (%)	Child Marriage (%)	Menstrual Hygiene (%)	Menstrual Hygiene (%)	Spousal Violence (%)	Spousal Violence (%)
	NFHS-5	NFHS-6	NFHS-5	NFHS-6	NFHS-5	NFHS-6	NFHS-5	NFHS-6	NFHS-5	NFHS-6
Arunachal Pradesh	46.4	50.4	64.3	73.4	22.0	17.3	77.6	96.7	29.2	17.8
Assam	26.1	42.5	23.4	70.0	34.9	13.7	66.9	99.7	37.0	10.2
Meghalaya	35.1	37.5	27.3	59.0	17.7	13.8	64.9	94.9	18.0	4.3
Mizoram	49.9	54.7	30.8	82.5	12.0	6.0	83.7	99.1	11.0	4.6
Nagaland	44.4	46.3	45.3	76.6	12.5	10.2	80.4	80.0	11.0	16.2
Sikkim	49.0	63.6	54.9	63.6	23.0	5.1	86.3	98.8	15.0	11.4
Tripura	23.2	58.4	28.6	63.5	40.5	19.2	69.1	90.4	29.0	19.2
All India	41.0	48.0	33.3	57.7	23.3	20.1	77.3	89.4	29.3	18.9

Source: NFHS Round 5 and NFHS Round 6; Manipur is not covered under NFHS Round 6 

The most dramatic change is visible in digital inclusion. Internet use among women has surged across the region. Assam recorded perhaps the most remarkable leap—from just 23.4 per cent in NFHS-5 to 70 per cent in NFHS-6.

Mizoram now reports internet usage among women at 82.5 per cent, far above the national average of 57.7 per cent, while Nagaland and Arunachal Pradesh have also emerged as leaders in women’s digital access. Mobile phone ownership has crossed 90 per cent in states such as Arunachal Pradesh, Mizoram and Sikkim.

Educational attainment has also improved. Sikkim leads the region, with nearly two-thirds of women completing ten or more years of schooling, well above the national average of 48.8 per cent. Arunachal Pradesh, Mizoram and Tripura have also registered substantial gains. These improvements matter because education continues to be one of the strongest predictors of women’s autonomy, employment opportunities, reproductive choices and health outcomes.

The decline in child marriage is equally noteworthy. Assam’s reduction from 34.9 per cent to 13.7 per cent is particularly striking. Sikkim and Mizoram have brought child marriage down to around five to six per cent, among the lowest rates in the country and far below the national average of 20.1 per cent.

The data reinforce a familiar but important lesson: when girls stay in school longer, early marriage declines.

Similarly, menstrual hygiene practices have improved. Nearly every state now reports usage of hygienic menstrual products above 90 per cent, compared to the national average of 89.4 per cent, with Assam reaching an impressive 99.7 per cent. What was once considered a taboo public health issue has become a visible success story across much of the Northeast.

Another encouraging trend is the reduction in spousal violence. Assam, Meghalaya, Mizoram, Arunachal Pradesh and Tripura all show significant declines compared to NFHS-5 levels. Meghalaya and Mizoram now report some of the lowest rates of spousal violence in the country at 4.3 per cent and 4.6 per cent, respectively, compared to the national average of 18.9 per cent.

NFHS-6 points to significant improvements in maternal healthcare across much of Northeast India. More women are receiving antenatal care in the first trimester, completing four or more antenatal visits, and accessing institutional delivery services.

In Sikkim, for instance, nearly all births (97.7%) now take place in health institutions, while over 73 per cent of mothers receive four or more antenatal check-ups. Similar gains are visible across several Northeastern states, reflecting improved access to maternal health services and stronger public health outreach.

Yet the data raise important questions about the quality of care women receive. Caesarean section deliveries continue to rise nationally, reaching 27.2 per cent of all births in NFHS-6.

In the Northeast, rates are substantially higher in some states, including Tripura (35.8%), Assam (34.8%)and Sikkim (33.7%), all well above the level considered medically necessary for population health.

While increased institutional deliveries have undoubtedly contributed to safer childbirth, the growing reliance on surgical deliveries raises questions about whether maternal health systems are adequately prioritising informed choice and medically appropriate care.

The challenge is no longer simply getting women into health facilities, but ensuring that the care they receive is safe, evidence-based and centred on women’s needs.

Perhaps one of the most serious concerns emerging from NFHS-6 is the persistence of anaemia among women. Despite gains in education, digital access and reproductive health services, anaemia remains alarmingly high across much of the Northeast. 

Assam reports anaemia among 65.2 per cent of women aged 15–49 years, while Tripura records 61.2 per cent, both higher than the national average of 57.0 per cent. Even states that perform relatively well on several gender indicators continue to face substantial nutritional challenges.

The Missing Conversation: Reproductive Health

The NFHS-6 findings suggest that reproductive health challenges remain stubbornly persistent, even in states where social indicators are improving. Nationally, 8.5 per cent of currently married women still report an unmet need for family planning, meaning they wish to delay or avoid pregnancy but are not using contraception. While this represents an improvement from NFHS-5, it indicates that millions of women continue to face barriers to exercising reproductive choice.

The challenge is not merely access to contraception. It is about informed choice, counselling, availability of methods, and women’s ability to negotiate reproductive decisions within households and communities.

The Northeast also presents a mixed picture on the unmet need for family planning. NFHS-6 estimates that 8.5 per cent of currently married women in India have an unmet need for family planning—meaning they wish to delay or avoid pregnancy but are not using any contraceptive method.

Several Northeastern states continue to perform worse than this national average. The total unmet need stands at 10.4 per cent in Meghalaya, 10.0 per cent in Tripura, 9.0 per cent in Assam and 8.3 per cent in Arunachal Pradesh, indicating persistent gaps in reproductive health services and reproductive choice.

In contrast, Sikkim (4.8%), Mizoram (5.2%) and Nagaland (5.8%) report substantially lower levels of unmet need than the national average. These differences are important because unmet need is widely regarded as one of the strongest indicators of reproductive autonomy.

Even where fertility is declining, and educational attainment is improving, a significant proportion of women may still lack access to appropriate reproductive health services, counselling, contraceptive options, or the agency to translate reproductive preferences into reproductive choices.

The contrast between states such as Meghalaya and Sikkim also highlights that demographic progress does not automatically guarantee reproductive empowerment.

Household decision-making presents a more encouraging picture. NFHS-6 shows that women across much of the Northeast report high levels of participation in decisions regarding their own healthcare, major household purchases and visits to relatives.

The proportion reaches 97.8 per cent in Meghalaya, 95.8 per cent in Mizoram, 95.3 per cent in Sikkim and 93.4 per cent in Nagaland, all above the national average of 89 per cent. Yet the coexistence of relatively high decision-making power and persistent unmet need for family planning in states such as Meghalaya, Tripura and Assam suggests that participation in household decisions does not automatically translate into reproductive autonomy.

Access to services, social norms, quality counselling and the ability to negotiate contraceptive choices continue to shape women’s reproductive outcomes. This highlights an important distinction between having a voice within the household and having full control over reproductive decisions.

This distinction becomes particularly important because fertility patterns across the Northeast are already undergoing rapid change. NFHS-6 shows that several states have reached fertility levels well below the replacement level of 2.1 children per woman. Sikkim records a Total Fertility Rate (TFR) of 1.0, Mizoram 1.4, Nagaland 1.5 and Arunachal Pradesh 1.7, while Assam stands at 1.9, below replacement level for the first time. Meghalaya, with a TFR of 2.9, remains the only Northeastern state significantly above replacement level. However, here too, fertility has declined compared to earlier survey rounds. These figures indicate that the region’s demographic transition is largely complete.

The policy challenge is therefore no longer one of reducing fertility, but of ensuring that women and couples can make informed reproductive choices, access quality maternal healthcare, and exercise their reproductive rights throughout the life cycle.

Beyond Access to Agency

Taken together, the NFHS-6 findings tell a story that is both encouraging and cautionary. Across much of the Northeast, women are more educated, more digitally connected, marrying later, adopting better menstrual hygiene practices and experiencing lower levels of spousal violence than in the previous survey round. On several indicators, the region now performs significantly better than the national average.

Yet the data also reveal a more complex reality. Women in many Northeastern states report remarkably high levels of participation in household decision-making—reaching nearly 98 per cent in Meghalaya and exceeding 95 per cent in Mizoram and Sikkim.

At first glance, this would appear to signal a major shift in women’s agency. However, the coexistence of high decision-making power with persistent unmet need for family planning, rising caesarean-section rates, and widespread anaemia suggests that empowerment cannot be measured solely by participation in household decisions.

The Northeast’s demographic transition is largely complete; its reproductive rights transition is not. Women may increasingly have a voice within the household, but many still face barriers in translating that voice into informed reproductive choices, better nutritional outcomes and control over their own health.

The challenge before policymakers is therefore no longer simply to expand services, but to ensure that women can exercise meaningful autonomy over their bodies and lives.

As the region moves into the next phase of development, success will depend less on counting how many women are reached and more on understanding whether their choices, well-being and health outcomes are genuinely improving. That is perhaps the most important message emerging from NFHS-6: the next frontier of gender equality in Northeast India lies not in access alone, but in the ability to transform participation into power, and voice into choice.

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