Post 3: Learning about Meghalaya's Health System

During my first day of the internship, the State Capability Enhancement Project team explained the different topics they wanted us to work on. The two main topics were the health system and early childhood development. Regarding the health system, the state government has focused on reducing maternal and child mortality rates as those are the main threats to public health by developing a Rescue Mission. The Rescue Mission aimed to build a more robust system by introducing frequent review meetings and strengthening local leadership, the use of data, and collaboration across departments through monthly sector meetings. Concerning ECD, the State had an inadequate provision of services, and the ones they had were fragmented and with low coverage. 

After reading and understanding the main issues, we were divided into two groups, and I was assigned to work on maternal mortality rates. First, with my group, we reviewed the available data about the issue to understand the outlook and develop a first preliminary diagnosis of what was happening with the mothers and pregnant women. We found that, according to the Health Management Information System 2019-2020, of 10,000 deliveries, 17 resulted in maternal death, above a national average of 10. Low contraceptive use and high teenage pregnancy are worrisome when zooming in on the potential risk factors for maternal deaths. 73% of currently married 15–49-year-old women do not use any method of contraceptives. Furthermore, 17% of the 226 maternal deaths that were reported in 2021 were teenage mothers. After those statistics, we decided to investigate contraceptive consumption and teenage pregnancy as we thought tackling these high-risk pregnancies would decrease.

Meghalaya has the lowest contraceptive uptake among all States nationwide (27.4% vs. 66.7%) (Figure 1). Low contraceptive use indicates inappropriate birth spacing practices, leading to high-risk pregnancies and maternal death. Furthermore, according to the National Family Health Surveys, during the last two decades, contraceptive use in the State has increased less than 10 percentage points (p.p.), below the national 26 p.p. increase, suggesting that policies to increase usage have either been insufficient or ineffective. 

Additionally, the adolescent fertility rate in the State (49 births per 1,000 women ages 15-19) is above the national average (43), implying an additional risk for pregnancies. Worse off, the prevalence of teenage pregnancy or motherhood has remained unchanged since 2005, at 7-8% of women ages 15-19, while the national average was halved (from 16% to 7%) during the same period. Similar to contraceptive use, we can say that policies to decrease teenage pregnancies have been unsuccessful.

With all this quantitative information in mind, we decided that the next step would be to go to the field to understand the trends we had investigated even more.