Assessment of geographic and contextual vulnerabilities to reproductive, maternal, child and adolescent health in Northeast India

Communities in Northeast India are vulnerable to various social and geographic vulnerabilities that lead to poor health outcomes. This paper examines various geographic vulnerabilities and their association, particularly with impacts on reproductive, maternal, newborn and child health. Multivariate logistic regression and univariate and bivariate methods of local indicators of spatial association were used to examine the impact of various vulnerabilities faced by women, using data from the National Family Health Survey-5 (2019–21). The findings can be used to develop regionally tailored and targeted interventions to meet local needs and improve overall health status.

This document was prepared as part of the Population Council's Research and Analyses for Scientific Transformation and Advancement initiative and funded by ICF Macro, Inc.'s DHS-8 contract with the U.S. Agency for International Development under the terms of Cooperative Agreement No. 7200AA18C00083. The contents of this document are the sole responsibility of the authors and do not necessarily reflect the views of USAID, the U.S. Government, or the Population Council.

Geographical location is one of the determinants of healthInequalities, especially in disadvantaged areas with limitedhealth resources (Dwivedi et al. 2019). The northeastern states of India, for example, face various obstacles to development due to the difficult hilly terrain that hampers transportation and communication. This region is frequently affected by climate-related disasters such as floods, cyclones or droughts.hts, and has porous international borders, and areas with large tea plantations. In addition, the northeastern states have a high index of linguistic diversity (Lhungdim et al. 2021). and geographies with densely populated tribal areas with diverse and unique cultures. Also, the elevation pattern varies in the northeast of the region. The plains include the Brahmaputra and Barak river valleys. While large populations depend on agriculture in these areas for their livelihood, both valleys are equally prone to annual flash floods (Das et al. 2009). According to the 2011 Indian census, there were about 135 Scheduled Tribes (STs) living in the northeastern states and most of these tribal communities lived in poverty (Lhungdim et al. 2021). In this region, Assam plays a major role in the tea industry, which employs about 17% of Assamese workers. Among these, 50% of the workers in the tea industry are women, who are marginalized both in the workplace and within society and live in poor conditions (Dhanaraju and Das 2019).