Each sister's different

The states of Assam, Arunachal Pradesh, Tripura, Manipur, Mizoram, Meghalaya, Nagaland and Sikkim are mostly subsumed under the category of "North-East" and are often seen as exceptions to mainland India thus limiting an understanding that acknowledges the differences within the region. All the states in this region suffer from inadequate health infrastructure, given the low levels of development, difficult terrain and the problem of insurgency in many parts. But in many ways these states are notably different from each other.

Predictably, Mizoram's high levels of literacy and urbanisation are reflected in the better than average utilisation of reproductive and child health services (RCH) "" 20 per cent of its mothers make use of ante-natal checkup (ANC) services and one-third of the deliveries take place under trained medical professionals. Mizoram has low infant mortality and 35 per cent of its children are immunised.

Conversely Arunachal Pradesh and Assam with low female literacy rates show poor utilisation of antenatal health clinics. These two states are the largest in the North-East region but also amongst the poorest, with large areas that are deficient in basic infrastructure such as road and electricity. These states have high infant mortality rates, especially Arunachal Pradesh with 66 infant deaths per 1,000 live births. Further only about 10 per cent of the mothers in the states received ANC during pregnancy and similarly only about 20 per cent of the children are immunised.

Manipur presents an interesting case despite lower levels of female literacy. Its high level of safe deliveries and very low infant mortality are a result of empowerment of women in a society that shows good gender parity. Though it has the lowest child sex ratio among the North-East states at 957 girls per 1,000 boys, this is much higher than the national average of 927 or states such as Punjab, Haryana and Himachal Pradesh.

Many studies have shown that the economic status of the household is one of the most significant factors determining access to RCH services, but the state of Nagaland stands out as an exception. Although it has considerably higher per capita income and a significant proportion of the population is employed in government jobs, the utilisation of antenatal services and spread of child immunisation is extremely low at 9 per cent and 14 perss cent respectively. But despite these low figures, another contradiction to the general hypothesis emerges as its infant mortality rate is among the lowest in the country at about 17 deaths per 1,000 live births.

Despite their backward status, the Northeastern states have an advantage with relatively high levels of literacy and gender equality. The impact of social characteristics and the intrinsic heterogeneity cannot be ignored while making policy prescriptions for development in the region.

The author can be contacted at aali@indicus.net