Dr Tiken Das
The sixth National Family Health Survey reveals a state that has made genuine strides in child survival and maternal care — but where chronic undernutrition and gaps in institutional delivery demand urgent, honest reckoning
Based on NFHS-6 (2023–24), published 29 May 2026, Ministry of Health and Family Welfare, Government of India | Compared with NFHS-5 (2019–21)
When India’s sixth National Family Health Survey was published last Friday, the national headlines focused on rising caesarean section rates and a slowing fertility decline. For Meghalaya, the more urgent task is to read what the data say about our own state — plainly and without deflection. The verdict is mixed: real progress in some areas that matter, and a stubborn, worsening crisis in others that no government scheme has yet managed to fix.
What Meghalaya Has Achieved
The good news is genuine. Institutional births — deliveries in a hospital or health facility — rose from 58.1% in NFHS-5 to 65.6% in NFHS-6, a gain of 7.5 percentage points in four years. This remains well short of the national average of 90.6%, and far behind Kerala or Andhra Pradesh, which have achieved near-universal institutional delivery. But the direction is right, and the pace of change is encouraging.
Full vaccination coverage among children aged 12–23 months improved from 64.0% to 75.3% — an 11-point gain driven largely by Mission Indradhanush. The second dose of the measles vaccine, historically weak in Meghalaya, leapt from 25.9% to 60.0%. Rotavirus vaccination, at just 4.1% in NFHS-5, now stands at 77.2%. These are public health victories. The prevalence of diarrhoea in under-five children fell sharply from 10.4% to 3.6%, and acute respiratory infection symptoms dropped from 4.8% to 1.0%. Child marriage among women aged 20–24 years has declined from 16.9% to 13.8%, and adolescent pregnancy fell from 7.2% to 4.6%.
Perhaps the most striking improvement is in gender-based violence. The proportion of ever-married women who reported experiencing spousal violence fell from 15.0% in NFHS-5 to 5.9% in NFHS-6 — a significant shift, even if the absolute figure remains unacceptable. These gains represent years of programme delivery reaching communities that were previously unreached, and they deserve acknowledgement. Where Meghalaya Is Failing Its Children.“One in three children under five in Meghalaya is chronically stunted — a figure worse than the national average of 29.3%, and worse than Bihar at 35.6%.”
Meghalaya’s child stunting rate stands at 36.8% in NFHS-6 — down from 46.5% in NFHS-5, a 10-point fall that is real. But 36.8% means more than one in three children under five is too short for their age due to chronic undernutrition. That figure is worse than the national average of 29.3%. It is worse than Bihar — a state this newspaper would not ordinarily wish to be compared unfavourably with. Kerala, which has largely solved its child nutrition crisis, records stunting at 20.1%. Meghalaya is not converging toward Kerala; it is still closer to the bottom.
The dietary data explains why the stunting numbers refuse to move fast enough. Only 18.9% of children aged 6–23 months in Meghalaya receive an adequate diet — diverse, frequent, and nutritionally sufficient. Strikingly, this is a fall from 28.5% in NFHS-5. Thousands of anganwadi centres distribute supplementary rations across the state. But rations are not nourishment. The survey tells us that food is not reaching children in the right form or at the right frequency. That is a failure of implementation, not of intent, and it must be named as such.Wasting — acute undernutrition, children dangerously thin for their height — has edged up from 12.1% to 13.2%, and severe wasting has risen from 4.7% to 6.2%. These figures point to an acute nutritional emergency unfolding quietly in rural households. Meanwhile, skilled birth attendance stands at just 70.9% against a national average of 91.3%. In rural Meghalaya, nearly four in ten mothers still deliver without skilled assistance — the background condition against which preventable maternal and newborn deaths continue to occur.
What the Numbers Demand
One figure appears reassuring until it is read carefully. Meghalaya’s caesarean section rate of 6.4% is the lowest in northeast India and far below the national average of 27.2%. Compared to Telangana at 62.2% or Sikkim at 51.1%, this seems virtuous. But a low C-section rate is not automatically good. Given that institutional births cover only 65.6% of deliveries and skilled attendance only 70.9%, the low figure may partly reflect limited access to emergency obstetric surgery rather than clinical appropriateness. The WHO’s recommended range of 10–15% is a floor as much as a ceiling.
The NFHS-6 data are a mirror, not a programme. What Meghalaya sees in that mirror is a state making real gains on vaccination, child marriage, domestic violence, and facility delivery — gains that must be protected. It also sees a state where one in three children is stunted, where infant dietary quality is falling, and where rural mothers remain far from safe obstetric care. The solutions are known: behaviour-focused nutrition counselling, not just ration distribution; accelerated staffing of rural delivery facilities; and honest accountability for frontline health workers against measurable outcomes. What is needed is the political will to treat child undernutrition as the central public health emergency it is — not a residual welfare problem to be managed, but a crisis to be ended.
(The author is Health Economist and Assistant Professor of Economics, Nagaon University, Assam).
