Despite Fragile Peace, Nagaland Outranks Rich States In Health, Gender Parity

Mumbai: After a decade of precarious peace, Nagaland, India’s once troubled north-eastern state, now rivals and even outperforms India’s richest states on a number of development outcomes, according to an IndiaSpend analysis of 10 states on 20 socio-economic and health indicators.

However, poor infrastructure and a fragile peace continue to be problem areas as the state--formed on December 1, 1963--heads to the polls on February 27, 2018.

Perched on India’s eastern edge bordering Myanmar, Nagaland is roughly the size of Kuwait and has 2 million people, the same as the central Indian city of Indore. There are 16 major tribes and 20 sub-tribes, each marked by distinct clothing and jewellery; 87.93% of its population is Christian. English may be the official language, but over 30 languages and dialects are spoken.

With a per capita income of Rs 78,367, Nagaland ranks 22nd in India, below the national average of Rs 86,454, though ahead of low-income states such as Chhattisgarh (Rs 78,001) and Rajasthan (Rs 75,201). It is also ahead of other north-eastern states such ase Meghalaya (Rs 64,638) and Assam (Rs 52,895), according to the India Economic Survey 2016-17.

For the first time since Nagaland attained statehood in 1963, the Bharatiya Janata Party (BJP), which heads the ruling alliance at the Centre, is seeking to expand its presence in the state and in the rest of the north-east. Along with the Naga People’s Front (NPF), the BJP has been a part of the ruling coalition here, the Democratic Alliance of Nagaland.

However, earlier this month, the BJP broke away from the incumbent NPF government over seat-sharing issues. It has now instead joined forces with the Nationalist Democratic Progressive Party, which includes many former leaders of the NPF, agreeing to a 20:40 seat-sharing arrangement.

In his poll campaign, apart from offering senior citizens state-sponsored pilgrimage to Jerusalem, Prime Minister Narendra Modi has promised that the BJP would “transform Nagaland” and bring in a “stable, inclusive and corruption-free government” if voted to power.

Violent clashes between Naga rebel factions and state armed forces kept development at bay for nearly half a century until 2007 when the largest insurgent group entered into an indefinite-ceasefire with the Indian government. Since then, the state has made significant strides on several socio-economic indicators, showed an IndiaSpend analysis of various government data including the National Family Health Surveys for 2005-06 (NFHS-3) and 2015-16 (NFHS-4):

Key findings

For our analysis of Nagaland, a part of our election-year examination of the development indicators of the states in the fray, we chose states that are development leaders and have high per-capita incomes such as Kerala, Goa, Gujarat and Karnataka; laggards with low incomes such as Madhya Pradesh (MP), Rajasthan and Uttar Pradesh (UP), and also Nagaland’s other neighbours in the north-east, Meghalaya and Tripura.

Four of these states--Madhya Pradesh, Rajasthan, Goa and Gujarat--are under BJP rule. Kerala and Tripura are ruled by the Communist Party of India (Marxist), while Karnataka and Meghalaya are ruled by the Congress. Though UP also has a BJP government today, it was under the Samajwadi Party in 2016--the cut-off year for our analysis.

Maternal, child health indices that equal or rival rich states

At 29 deaths per 1,000 live births, Nagaland’s infant mortality rate (IMR) in 2015-16 was better than the national average (42), and just a point behind the richer Karnataka (28), ranking among the top five in our 10-state analysis. Down from 38 in 2005-06, NFHS data show the IMR is higher for children whose mothers have less than 10 years’ schooling (30 deaths per 1,000 live births) compared to those whose mothers had a higher education (25 deaths per 1,000 live births).

Similarly, the state’s mortality rate for children under five years of age has also come down to 37 deaths per 1,000 in 2015-16 from 65 in 2005-06. This is 13 points better than the national average (50), and ranks in the top five in our 10-state analysis, behind states such as Karnataka (36), Kerala (7) and Goa (13) which hold much higher per capita incomes.

Stunting among children (low height for age) in Nagaland decreased by 10 percentage points from 39% in 2005-06 to 29% in 2015-16, leaving the state in fourth best position behind Kerala (19.7%), Goa (20.1%) and Tripura (24.3%).

Nagaland reported the best performance among 10 states in reducing wasting rates (low weight for height) among children with a decrease of two-percentage points from 13% in 2005-06 to 11% in 2015-16. This is 10 percentage points ahead of the national average (21%), and even better than richer Kerala (15%) or neighbouring Meghalaya (15%).

Similarly, in terms of the health status of women of reproductive age (15-49 years), the state reported the lowest percentage of women with anaemia (23.9%), outranking Kerala (34.2%) and Goa (31.3%). The meat-eating state’s iron-rich diet may be attributed to this success, as this 2012 study pointed out.

Healthcare Outcomes (2015-16)
State	Stunting (In %)	Wasting (In %)	Prevalence Of Anaemia Among Women Aged 15-49 (In %)	Infant Mortality Rate	Under-5 Mortality Rate
Kerala	19.7	15.7	34.2	6	7
Goa	20.1	21.9	31.3	13	13
Gujarat	38.5	26.4	54.9	34	43
Karnataka	36.2	26.1	44.8	28	32
Tripura	24.3	16.8	54.5	27
India Avg	38.4	21	53	41	50
Meghalaya	43.8	15.3	51.6	30	40
Rajasthan	39.1	23	46.8	41	51
Madhya Pradesh	42	25.8	52.5	51	65
Uttar Pradesh	46.3	17.9	52.4	64	78
Nagaland	28.6	11.2	23.9	29	33

Source: National Family Health Survey, 2015-16

More gender equity, lower rates of spousal violence and early marriage

The indefinite ceasefire in Nagaland has had a particularly positive impact on its gender indicators. While the sex ratio at 931 females per 1,000 males is lower than the national average--and much below that of other north-eastern states such as Tripura, Meghalaya or Assam--it is still a significant 31-point improvement from 2001, Census data show.

Most women in Nagaland (97.4%) have a say in household decisions. The state performs best in this regard, ahead of best-performers Kerala (92.1%) and Goa (93.8%). The state also reported the lowest percentage of ever-married women who experienced spousal violence (12.7%), less than half the national average.

They are also among the least likely to be married before 18. As of 2015-16, less than a sixth or 13.3% of women in the state had early marriages--only Kerala (7.6%) and Goa (9.8%) fared better, our analysis shows.

Women who marry later and are educated more, are healthier mothers with healthier children as they better prepare for childbirth and motherhood, and are more open to accessing healthcare facilities and understanding the implications of their health on their children, IndiaSpend reported on July 21, 2017.

Source: National Family Health Survey, 2015-16

Despite poor access to water, good sanitation

About 20% households in Nagaland still do not have access to better sources of drinking water--only 80.6% do--the second lowest after Meghalaya (67.9%) and more than nine percentage points below the national average of 89.8%. Yet, the state manages to do well on sanitation, an IndiaSpend analysis of the data show. Only 1.7% people in Nagaland defecate openly or do not use any sanitation facility, thereby allowing the state to report lowest defecation rate after Kerala (0.8%).

However, issues with infrastructure advancement impinge on the state’s progress on this development indicator as about 25% of the population are still unable to access improved sanitation facilities, NFHS data show.

Poor road connectivity impacts access to public facilities

The state also faces problems of low quality infrastructure. For instance, despite a road density of 95%, access remains a problem as many roads are dilapidated and prone to landslides, affecting transportation of people and goods and services, especially during monsoons, according to Nagaland’s Economic Survey 2016.

With only one airport and one rail track connecting the city of Dimapur to the rest of India, this poorly maintained road network is the state’s main mode of communication.

Almost all or 97% of households in Nagaland have access to electricity, above the national average of 88.2%. Still, the state’s improvement rate (14.1%) is actually 6 percentage points below the national average (20.3%), leaving it to rank fourth highest among 10 states analysed in 2015-16. But the availability of constant power supply in the electrified areas is “altogether a different matter”, said the Nagaland 2030 vision document, highlighting problems of transmission and distribution in rural areas.

In terms of telephone connectivity, the tele-density of Nagaland is 69%--21 percentage points below the all-India average of 90, shows this Telecom Regulatory Authority of India press note from February 2017.

Slow progress on infrastructure is affecting citizens’ access to healthcare institutions in the state--most of which are government-run in these predominantly rural parts--an analysis of NFHS data showed.

For instance, barely 15% of mothers--the lowest among 10 states analysed--were visited four or more times during their pregnancy by healthcare workers, the minimum requirement according to the World Health Organization’s guidelines. Women in urban areas (29%), known for better connectivity, were three times more likely to receive four or more antenatal care visits than their rural counterparts (9%) in the state.

In terms of institutional births, about a third of births or 32.8% take place in a health facility while a majority 67% continue to take place in informal settings. Though the proportion of institutional births has nearly tripled in a decade--from 11.6% in 2005-06 to 32.8% in 2015-16, the state ranks lowest among the 10 states analysed here.

The state also reported the worst coverage of immunisation: Only 36% of children age 12-23 months received full immunisation in 2015-16--that includes polio, BCG, DPT, and measles vaccines in 2015-16--much below the national average of 62%, making this the lowest-ranking state of the 10 analysed.

Even in terms of literacy--while female literacy rate (81%) in Nagaland grew at more than double the pace of male literacy rate (85.6%) and places above the national average of 68.5%--the growth rate is still much lower than other states, indicating a persistent problem of access and infrastructure. This is also seen in the slow progress on increasing women’s access to higher education. As of 2015-16, about a third of Nagaland’s women (33.3%) had more than 10 years of schooling, 11% more than in 2005-06. This is the lowest decadal growth rate among the states analysed. This again may be attributed to the poor infrastructure of schools in the state.

“Almost all government school buildings in the high school and higher secondary sector are in dilapidated conditions. Such deprecating environment adds to their lacklustre performance,” said the Nagaland 2030 Vision document.

With a high youth population, state is in urgent need of job opportunities

Lapses in infrastructure development hold significant implications for Nagaland’s future.

In 2016, youth comprised 30% of the population in the state, higher than the national average of 27%, with 682,000 youth aged 15-29 years, state data showed. This puts significant pressure on employment demands in the largely agrarian state. The agricultural sector, despite employing over 60% of the state’s workforce, contributes to less than 30% of the state’s gross domestic product (GSDP), according to the state’s economic survey 2016.

The state has an unemployment rate of 8.9%, nearly twice the national average (4.8%), according to the ministry of labour’s annual Employment-Unemployment Survey, 2015-16 report. With elasticity of employment in agriculture pegged at -0.43% in the Nagaland 2030 vision document, the state needs to focus on developing employment opportunities in the secondary and tertiary sectors which comprise 15% and 54.5% of the GSDP, respectively.

Currently, in the absence of private investment, a significant chunk (15%) of the tertiary sector, which adds the most to the GSDP, is employed in public administration. Job security, as the cut-off age for the Nagaland Public Service Commission in Nagaland is 35 years, has emerged as a key issue in the state elections, the Financial Express reported on February 12, 2018.

To this end, raising private investment into Nagaland will require a concerted effort to improve the state’s infrastructure, which may only be possible if peaceful relations in the state grow. This is also necessary to maintain the Nagaland’s steady rise of visiting tourists which has nearly tripled from 2007 (936) to 2017 (2,759), as the 2016 economic survey shows.

Per Capita Income, Unemployment in 10 states (2015-16)
States	Per Capita Income* (In Rs)	Unemployment** (In %)
Kerala	135537	12.5
Goa	289185	9.6
Gujarat	127017	0.9
Karnataka	129823	1.5
Tripura	71666	19.7
India Avg	86454	4.9
Meghalaya	64638	4.8
Rajasthan	75201	7.1
Madhya Pradesh	56182	4.3
Uttar Pradesh	42267	7.4
Nagaland	78367	8.5

Source: India Economic Survey 2016-17; *2014-15,

**Ministry of labour’s Annual Employment-Unemployment Survey, 2015-16 report

Peace is still precarious in the state

Three years after brokering the Framework Agreement for peace with Nagaland’s largest rebel group in August 2015, earlier this month, the BJP broke its 15-year alliance with the state’s ruling party, as we said.

Traditionally, votes were cast on the basis of village or clan affiliations. However, with the Hindutva-centric BJP now entering the fray, the campaign has turned communal, as the Indian Express reported on February 22, 2018.

This political jousting will overshadow the peace process for several months, said this Mint column from February 22, 2018.

Despite the indefinite ceasefire, Nagaland continues to live under the controversial Armed Forces Special Power Act, in its 60th year in the state now (1958 to 2018). Declared a “disturbed area”, the deadline for repealing the Act in the state has been extended for another six months, to June 2018.

At least 126 civilians in Nagaland were killed in insurgency attacks from 2007 to February 2018, showed the South Asia Terror Portal database. In the first two months of 2018 alone, the state reported four deaths, indicating peace in Nagaland is still precarious.

"Correction: An earlier version of this story erroneously used a photograph of women in Shillong. We regret the error."

(Saldanha is an assistant editor and Mohan is an intern with IndiaSpend.)

We welcome feedback. Please write to respond@www.health-check.in. We reserve the right to edit responses for language and grammar.