Northeast’s health paradox: What NFHS-6 tells us

Let’s start with women, because that’s where the lead is widest.

In Assam, the share of married women who say a husband has hit or coerced them fell from 32% to 16% in four years. Halved. The national figure is 22%, and it grinds down only slowly nationally, whatever gets spent on it.

So, when Nagaland reports 4%, Sikkim 4.6%, and Meghalaya 5.9% in the sixth National Family Health Survey (2023-24), stop and read it twice. On the one measure that resists almost everything, the Northeast leads the country.

It runs past safety into money, and the wins here are not all the same size. Financial inclusion is the broad one: in most surveyed states, women own and use their own bank accounts at rates matching or beating the national 89%, with Mizoram at 94%. Earnings are a narrower, more local story.

In Meghalaya, where land and family name pass through women, 44% earned cash for their work last year against 31% nationally, though that owes as much to matriliny as to policy and serves as an important lesson.

Among young women, hygienic menstrual care is near universal in Mizoram (99%) and Arunachal (97%).

Child marriage tells the same story at its better end. Mizoram has all but ended it: 6% of women aged 20-24 were married before 18, against 20% nationally. Sikkim sits at 9%, Nagaland at 10%, among the lowest figures anywhere in India.

Here’s the part worth studying, because these wins are not all the same kind. Safety and child marriage track what a community believes more than what it budgets. You can build a clinic faster than you can change what a household thinks a daughter is owed, and the Northeast reached this point through decades of lived norms. 

Other wins travel cleanly, because they are policy choices rather than inherited norms.

Several states pushed health-insurance coverage up sharply in four years, past the national 60%, with Meghalaya near 75%, and bank-account access rode the same kind of deliberate push. That sort of jump is a choice any state can make.

The work that isn’t done yet

Then you turn the page, and the region refuses to sit still for a single verdict. Some of these states are close to the finish line on the old battles of survival. Others are still partway up the hill. Both are true at once, which is why a regional average tells you almost nothing useful. 

A few states are still looking into finishing the first chapter, the one about getting every baby born safely and every child fed enough. In Meghalaya and Nagaland, roughly two in three births happen in a hospital, against more than nine in ten nationally, and Meghalaya carries one of the highest child-stunting rates among states, at 37%.

The same access gap shows up in surgery: caesarean rates in Meghalaya (6%) and Nagaland (10%) sit at or below the WHO floor, which points to mothers who needed an operating theatre and could not reach one.

These are numbers geography helped write. Steep valleys and scattered hamlets turn a hospital birth into a longer, harder journey than it is on the plains, and that distance shows up in the figures.

The encouraging part is that the route is known, and it runs through the Northeast itself. Sikkim already gets 98% of its babies born in a facility and Mizoram 91%, on the same hard terrain.

Geography didn’t stop them. What got them there is services built for the hills: more health workers close to scattered villages, and transport that arrives when a delivery starts. Kerala sits at the top of that climb at 99.7%. None of it is mysterious. It’s work, and it’s viable. 

The next wave is already breaking

The faster-moving states have a newer problem, and it’s arriving before the region is well equipped to tackle it.

Start with the biggest and most widespread of these: Tobacco. Use among men runs to 74% in Mizoram and sits between 45% and 58% across most of the region, well above the national 36%. It is the quietest big killer in the room, and unlike the rest it is heavy almost everywhere, not in one or two states.

The diseases of affluence are further off, and for now they cluster in the front-runners. Sikkim reports 48% of women as overweight or obese against 31% nationally, with men close behind, but most of the region still sits below the national line.

Behind it, the early signs are already showing: Arunachal Pradesh sits just under the national mark for women (29%) and above it for men (32%), while in Mizoram more than a third of men (36%) are overweight or obese, in the same state where tobacco use runs highest. This is a wave forming at the leading edge, not yet breaking across the whole Northeast.

Caesarean sections show the mirror image of the access gap further north: they run past the WHO range of 10-15% and reach 51% in Sikkim, higher still in private facilities.

Contraception, meanwhile, has drifted toward older, less reliable methods in states like Sikkim (34%) and Tripura (31%), which usually leaves a woman carrying the risk when one fails.

What the next few years should do

Picture the to-do list, in priority order.

First, close the safe-birth and child-nutrition gap in the states still climbing, because that is where avoidable deaths sit. Build services for hill country: more health workers near scattered villages, and transport that arrives when labour starts.

Second, put real muscle behind tobacco control, the largest avoidable disease burden in the region and the cheapest to move.

Third, get ahead of diabetes, blood pressure, and weight while the curves are still gentle and cost effective to bend, through screening at the local clinic and food environments that make the healthy choice the easy one.

Fourth, rebuild family-planning counselling so women have the full menu of choices again.

And whatever the plan, it has to teach as much as it treats. Skilling young people for frontline health work in hard-to-reach areas, plain-spoken public awareness, and steady behaviour-change communication will shift these numbers as much as any new building.

The wild card is the weather: more floods and landslides, longer dry spells, and shifting growing seasons can quietly erase a decade of nutrition and health gains, so the region’s plans have to be built to absorb that blow if the growth it’s reaching for is going to hold.

One absence hangs over all of it. NFHS-6 didn’t survey Manipur. A Northeastern state, is missing from the national picture, and every “India” and “Northeast” figure here is quietly incomplete because of it.

So read the Northeast closely, and read it state by state. It has more to teach the country than almost anywhere about keeping women safe and putting assets in their hands. It has places still working to carry the basics to every village.

And it has an emerging cluster walking into the diseases of plenty with the weather still turning against it. 

Views expressed are that of the author and do not reflect EastMojo’s stance on this or any other issue. Dr Poulami Sanyal is a fellow and Dr Bitupan Bora is the regional director of the Northeast at Pahlé India Foundation (PIF).

All figures are drawn from the NFHS-6 (2023-24) India and State/UT Fact Sheets, released by IIPS in May 2026.

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