Paper short abstract:

Matrilocal indigenous Khasi women in India have poor maternal health indicators, but are excluded from the indigenous political arena. State health policies are influenced by the central state and health data are lacking. Gender and healh equity require reforms of indigenous and state institutions.

Paper long abstract:

Meghalaya is a rapidly urbanizing state in India's 'tribal belt', with a predominantly indigenous population (86%), of which the matrilineal Khasi constitute slightly more than half. The state has some of the worst maternal health indices in the country and the highest unmet contraceptive need in India.

This qualitative research combines political and medical anthropology with public health policy analysis. We examined 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 in a context where indigenous and state governance systems co-exist.

The study found that Meghalaya's health policies are strongly influenced by national policies and limited documentation of community felt needs. Health expenditure has steadily declined in the last decade. Public health facilities are available in Shillong, but fear for out-of pocket expenses contributes to urban women's avoidance of seeking health care.

Indigenous governance institutions exist alongside India's state government machinery recognizing indigenous authority, but Khasi women are excluded from holding office in indigenous governance systems. Within the state governance system, the opportunities for Khasi women are relatively better, as women can vote and hold office at every level yet only a handful of women were elected. As a result, women's views and perspectives -including those on sexual and reproductive health- remain submerged.